Reduction of telomeric repeats as a possible predictor for development of hepatocellular carcinoma: convenient evaluation by slot-blot analysis

Hepatocellular carcinoma (HCC) mainly arises from the liver with chronic inflammation. Because telomere reduction reflects replicative history in somatic cells, we analyzed the possibility that liver tissues surrounding HCC consist of the cells carrying substantial reduction of telomere. We studied 20 HCC and surrounding noncancerous liver tissues (SL) obtained by surgical resection, and 10 laparoscopically obtained needle biopsy specimens of the liver with chronic inflammation including no overt HCC (CI). Five liver tissues without chronic liver diseases (ND) were also examined. Extracted genomic DNAs were blotted on a nylon membrane, and probed at first with radio-labeled d(TTAGGG)(3) and reprobed with radio-labeled d(CCT)(7). The intensity caused by d(TTAGGG)(3) was divided by that of d(CCT)(7). The ratio was defined as telomeric repeats content (TC). Dilution experiments reproducibly revealed almost the same TC. The reduction rate of telomere length through aging estimated by regression analysis of TC was 0.62% per year. Concomitant analyses of TC and average telomere length revealed that both values were significantly correlated (r =.45; P =.009). To compare TC in the liver with respect to chronic inflammation, the value was divided by TC in peripheral blood leukocytes (PBL) from the same donor. The ratio was defined as relative TC (RTC). There was a statistically significant decrease of RTC in CI compared with that in ND (P =.03). Furthermore, RTC in SL was significantly lower than that in CI (P =.0001). These observations suggest that RTC value in liver tissues may digitally indicate a replicative history of hepatocytes under chronic inflammation, and a risk of HCC development.

A Case of Adenoid Squamous Cell Carcinoma of the Breast Skin

We report a case of a 45-year-old Japanese women with adenoid squamous cell carcinoma (ASCC) of the left breast skin. The patient had showed a large mass in the left breast region with axillary swelling about 1 year before admission. Grossly, the tumor was an extensively ulcerated and elevated lesion measuring 15 x 16 x 5cm. Based on the tumor biopsy and cytologic examination of the axillary lymph nodes, squamous cell carcinoma (SCC) was diagnosed. No evidence of distant metastasis was identified. A modified radical mastectomy with left axillary node dissection was performed. Microscopically, the resected tumor showed on invasive proliferation of atypical squamous cells with marked keratinization. At the periphery of the tumor, an adenoid growth pattern was frequently seen with a transitional area showing squamous cell carcinoma and adenoid growth components. ASCC was diagnosed. A transition between the overlying squamous cell epithelium and squamous cell carcinoma component was also seen, thus the tumor was thought to haveoriginated from the breast skin. The patient died of respiratory failure due tomultiple lung metastasis about 1 month after the mastectomy. Tumor rarely originates at the breast region to include both the mammary glands and breast skin. The pathogenesis and management of ASCC are discussed following the presentation of this case.

Caudal left hepatic duct in relation to the umbilical portion of the portal vein

BACKGROUND/AIMS

Intrahepatic ducts from the left lateral segment of the liver are generally considered to run from the cranial to the umbilical portion of the left portal vein. This understanding often limits surgical exploration of the left hepatic ducts during both curative and palliative surgical procedures. The prevalence of ducts from the lateral segment running caudally to the umbilical portion was studied retrospectively on computed tomography (CT) films, and its clinical implications were evaluated.

METHODOLOGY

One hundred and sixty-six DIC (drip infusion cholangiography) CT and 30 post-PTCD (percutaneous transhepatic cholangio-drainage) CT films taken during 4 consecutive years were reviewed giving special consideration to whether the ducts from the left lateral segment of the liver run caudal to the umbilical portion of the left portal vein.

RESULTS

Corresponding variation was found in 3.6% of the DIC-CT examinations and in 3.3% of the CT examination after PTCD, respectively.

CONCLUSIONS

The incidence of caudal left hepatic ducts with respect to the umbilical portion of the left portal vein was higher than expected from clinical experience. These results emphasize that more careful planning is necessary prior to hepatobiliary surgery.

Prenatal diagnosis of long QT syndrome using fetal magnetocardiography

We describe the detection of congenital long QT syndrome in a fetus at 37 weeks' gestation using magnetocardiography (MCG). The prenatal diagnosis was confirmed by standard electrocardiography (ECG) performed after birth. This is the first case report of fetal long QT syndrome detected by MCG. Fetal MCG may be useful in the prenatal diagnosis of congenital cardiac disease with abnormal ECG findings.

Adhesion preventive effect of hyaluronic acid after intraperitoneal surgery in mice

Prevention of intraperitoneal adhesion after gynaecological surgery is essential for maintaining postoperative fertility. In this study, the adhesion prevention effect was examined of a hyaluronic acid (HA) solution obtained from the fermentation method and having a molecular weight of 1.9x10(6) with high viscosity. Laparotomy was conducted on female mice 7 weeks old, whose menstrual periods were synchronized by pregnant mare serum gonadotrophin (PMSG) to injure the uterine horn surface. Intraperitoneal adhesions were favourably formed in 91.7% of cases induced with iodine abrasion, compared with 50% induced by electrosurgery. Intraperitoneal administration of HA was evaluated for its effect on the prevention of adhesions made by iodine abrasion. Adhesion prevention effects of HA were observed at concentrations of 0.3, 0.5, 0.75 and 1.0%, among which the most pronounced effect was with the use of a 0.3% solution (92.3% of cases). Compared with the control group adhesion score of 2.0 +/- 0. 8, significant decreases in adhesion scores were observed at all concentrations. HA with a molecular weight of 1.9x10(6) was recognized to have a definitive prevention effect on postoperative adhesions in mice after laparotomy and is considered to be a prospective material for future clinical use.

A study of therapy for pediatric hepatoblastoma: prevention and treatment of pulmonary metastasis

Our results of treatment for pediatric hepatoblastoma are presented with special emphasis on pulmonary metastasis. The pulmonary metastasis rate of hepatoblastoma was 44% (11/25). In 19 patients with resected hepatoblastomas, the 5-year survival rate without pulmonary metastasis was 90% (9/10); while with pulmonary metastasis it was 22% (2/9). Six patients with unresected hepatoblastomas all died within 4 months regardless of chemotherapy and/or metastasis. To improve survival in patients with hepatoblastoma, preoperative or postoperative chemotherapy was thought to be essential for tumors extending over 2 hepatic segments and having predictable factors for pulmonary metastasis (large size or histological evidence of capsular invasion). A long-term multidisciplinary approach including hepatic lobectomy, current multiagent chemotherapy (including CDDP, THP-ADR), and partial pulmonary resection for localized lung areas with metastases would ultimately be needed.

Novel lipase-catalyzed ring-opening copolymerization of lactide and trimethylene carbonate forming poly(ester carbonate)s

Poly(lactide-co-trimethylene carbonate)s were prepared by the lipase-catalyzed ring-opening copolymerization of lactide and trimethylene carbonate having carbonate content from 0 to 100%. Their thermal properties and enzymatic degradability were measured. The L,L-, D,D- and D,L-lactides were copolymerized with trimethylene carbonate by porcine pancreatic lipase to produce random copolymers having molecular weights of up to 21000. The glass transition temperature (Tg of the copolymer was dependent on the carbonate content and the Tg values linearly decreased from 35 degrees C (polylactide) to -8 degrees C [poly(trimethylene carbonate)]. Among the lipases tested, the porcine pancreatic lipase and proteinase K showed biodegradability towards poly(ester-carbonate)s.

Loss of heterozygosity of 14q32 in colorectal carcinoma

Previous allelotyping studies on colorectal carcinoma suggest that loss of heterozygosity (LOH) on chromosome 14q may be a common genetic alteration in this tumor type. The purpose of this study was to determine precise frequency of LOH at 14q32 region in colorectal carcinomas and to define a minimal region of LOH. LOH at 14q32 in 66 primary colorectal carcinomas were analyzed by polymerase chain reaction-based deletion mapping using six highly polymorphic microsatellites. The average rate of informative data was 68.2% in all cases of colorectal carcinoma analyzed. The average rate of LOH at 14q32 was 44.1%, with the highest frequency of 50.0% at D14S267 locus in the informative cases. The minimal region of LOH was defined by markers D14S65 and D14S250 at 14q32. The present data provide useful information for the isolation of tumor suppressor genes from this region.

Localization of prostate-specific antigen-like immunoreactivity in human salivary gland and salivary gland tumors

Immunoreactivity of prostate-specific antigen (PSA), a kallikrein-like enzyme present in the seminal plasma, was demonstrated by indirect immunoperoxidase staining using a PSA antiserum in the apical cytoplasm along the luminal border of small-sized duct epithelial cells of the major salivary (parotid and submandibular) gland of both sexes (56/56, 100%). No PSA-like immunoreactivity was seen in large-sized duct epithelial cells and acinar cells. Minor salivary gland ducts were negative. When inflammatory and atrophic changes were observed, ductal expression of PSA-like immunoreactivity was decreased (12/37, 32%) and the site of intracellular localization often became diffusely cytoplasmic. The immunoreactivity was absorbed by human seminal plasma. Immunoreactivities of prostatic acid phosphatase and sex hormone receptors were undetectable in the salivary gland. Twenty-nine (34%) of 86 salivary gland tumors with ductal differentiation were immunoreactive for PSA mainly in the cytoplasm. A PSA monoclonal antibody ER-PR8 detected immunoreactivity in the prostate but not in the salivary glands or their tumors. Prostate-specific antigen-like immunoreactivity in small-sized (intercalated) duct epithelial cells of the major salivary gland and their tumors may be due to cross-reactivity of the antiserum with kallikrein-like substances.

Neutrophil accumulation and damage to the gastric mucosa in resuscitated hemorrhagic shock is independent of inducible nitric oxide synthase

Polymorphonuclear leukocytes (PMN) and inducible nitric oxide synthase (iNOS) appear to play important roles in the liver and in lung injury induced by hemorrhagic shock. Their precise roles in hemorrhagic shock-induced acute gastric mucosal lesions (AGML), however, are still poorly understood. In this study, we investigated the effect of neutropenia on hemorrhagic shock-induced AGML. We also examined the roles of iNOS in PMN infiltration into the mucosa and AGML during hemorrhagic shock by using L-N6-(1-iminoethyl)-lysine, a potent inhibitor of iNOS, and by reverse transcriptase polymerase chain reaction. Remarkable gastric mucosal damage occurs after hemorrhagic shock. PMN depletion caused by Vinblastine pretreatment significantly attenuates this AGML. Although low-dose L-N6-(1-iminoethyl)-lysine (50 microg/kg, iNOS inhibition) has no effect on AGML, high-dose L-N6-(1-iminoethyl)-lysine (250 microg/kg, iNOS + endothelial NOS inhibition) significantly exacerbates AGML without increasing PMN infiltration into the mucosa. The mRNA expression of iNOS in the stomach during hemorrhagic shock cannot be detected by reverse transcriptase polymerase chain reaction. We conclude that PMN play a pivotal role in hemorrhagic shock-induced AGML, iNOS does not regulate PMN infiltration into the mucosa, and endothelial NOS provides important protection against AGML during hemorrhagic shock.

Gestational hyperlipidemic pancreatitis without non-gestational hyperlipidemia

A 27 year-old pregnant woman was referred to our department with nausea, abdominal pain, and hypertriglyceridemia (5500 mg/dl). A diagnosis of acute gestational hyperlipidemic pancreatitis was made. She had no history of nongestational hyperlipidemia. Subsequently, she underwent pancreatic drainage and Caesarean section. Our experience suggests that gestational hyperlipidemic pancreatitis may occur in pregnant women without nongestational hyperlipidemia. Intensive monitoring of serum lipid levels is mandatory when managing pregnant women who develop or show gestational worsening of hypertriglyceridemia.

Major hepatectomy combined with pylorus-preserving pancreatoduodenectomy for middle bile duct cancer with multiple lymph node metastases: a case report of 5-year survival

Hepatopancreatoduodenectomy has been well established as an aggressive surgical approach for advanced biliary tract malignancy. However, long-term survival of more than 5 years after this operation is rarely reported, especially with bile duct carcinoma. We report herein a 64 year-old man with middle bile duct cancer who underwent extended right hepatectomy combined with pylorus-preserving pancreatoduodenectomy because of widespread intramural extension of the tumor. Resection margin, which is considered the most significant prognostic parameter, was made clear only by additional hepatectomy in this case. In addition, although microscopic examination revealed multiple lymph node involvement up to the superior mesenteric node, the patient has survived 5 years and 6 months without tumor recurrence. It remains unclear whether aggressive lymph node dissection may improve surgical outcome; however, it is thought that surgical clearance of potentially involved nodes and tissue may be the only chance for long-term survival.

Hemorrhagic shock results in intestinal muscularis intercellular adhesion molecule (ICAM-1) expression, neutrophil infiltration, and smooth muscle dysfunction

Intestinal stasis followed by mucosal barrier breakdown and the generation of locally produced cytokines has been proposed as the cause of systemic infection and multiple organ failure following hemorrhagic shock. The aim of this study was to investigate the underlying mechanisms of impaired intestinal muscle function leading to ileus following hemorrhagic shock. Rats were subjected to severe hemorrhagic shock (mean arterial pressure 40 mm Hg) followed by resuscitation and were killed early at 4 h or late at 24 h. Other groups consisted of control and sham animals. Intercellular adhesion molecule (ICAM-1) mRNA levels were significantly elevated in the muscularis but not in the mucosa using the semiquantitative reverse transcriptase polymerase chain reaction (RT-PCR). There was a marked infiltration of neutrophils into the muscularis early and late after shock. Furthermore, smooth muscle contractility in response to bethanechol was significantly decreased, being more pronounced in the early group. Immunohistochemistry revealed signal for ICAM-1 in the muscularis microvasculature and on infiltrating cells. These results suggest that the expression of ICAM-1 within the muscularis vasculature after hemorrhagic shock promotes the local recruitment of leukocytes and that this inflammatory response is accompanied by a subsequent impairment of intestinal contractility.

The role of lymphatic drainage of the liver in gallbladder cancer: a case report

We report a case of a patient with a unique lymph node relapse after right hepatectomy and aggressive lymph node dissection for gallbladder cancer. There was extensive involvement of the hepatic parenchyma from the primary tumor, but no extension to the lymph nodes or other adjacent organs. Seventeen months later, the patient underwent re-dissection of the retroperitoneal lymph nodes with right nephrectomy and partial resection of the vena cava because of lymph node recurrence at the hilum of the right kidney. This pattern of lymph node metastasis to the right side of the vena cava from gallbladder cancer invading the liver is probably due to the distinct lymphatic drainage of the liver.

Splenic artery aneurysm associated with systemic lupus erythematosus: report of a case

We herein report on a 64-year-old Japanese female patient who presented with a splenic artery aneurysm (SAA) associated with systemic lupus erythematosus (SLE). The saccular aneurysm, which measured 3 cm in diameter, was located in the proximal third of the splenic artery from the pancreas with a portosystemic shunt. A double ligation of the splenic artery (the distal and proximal sides of the aneurysm) was performed without a splenectomy. The postoperative course showed acute pancreatitis without either splenic infarction or portal thrombus. To our knowledge, the closed association of SLE with an aneurysmal dilatation of the splenic artery has not been previously reported. Both the pathogenesis and the management of SAA associated with SLE are discussed following the presentation of this case. This is the first reported case of SAA associated with SLE.

Role of shear stress and immune responses in liver regeneration after a partial hepatectomy

This report reviews studies addressing the new concepts in liver regeneration after a partial hepatectomy (PHx). The review begins with an overview of the immunologic mechanisms of liver regeneration after PHx, especially regarding Kupffer cells and extrathymic T cells of the regenerative liver in the cell-mediated immunity, based on major histocompatibility complex I and II antigens. Attention is then devoted to "on and off" studies in liver regeneration after PHx, by hypothesizing the shear stress based on the fact that the portal flow against hepatocytes or sinusoidal endothelial cells triggers their regeneration after a partial hepatectomy and controls the volume of the regenerating liver by the stimulating the cell surface modulator (CSM) of hepatocytes and sinusoidal endothelial cells (SEC). We propose that the acute elevation of shear stress after PHx influences the adhesion between SEC and intrahepatic leukocytes. These concepts are expected to positively contribute to the future research on liver regeneration after PHx.

Left-sided gallbladder on the basis of a right-sided round ligament

Left-sided gallbladder, a rare congenital anomaly, is defined as a gallbladder located to the left of the round ligament. A 42 year-old female underwent a cholecystectomy for gallstone disease. At laparotomy, we found that the round ligament was located to the right of its normal position and was continuous with the right anterior branch of the portal vein. Though normally situated, the gallbladder was therefore, on the left side of the anomalously right-sided round ligament, fulfilling the definition of a left-sided gallbladder. This case indicates that a third type of left-sided gallbladder may occur in addition to the other forms: one resulting from a right-sided round ligament, in addition to the "true" left-sided gallbladder and the variety seen in situs inversus.

Interleukin-6 production in hemorrhagic shock is accompanied by neutrophil recruitment and lung injury

Hemorrhagic shock (HS) initiates an inflammatory cascade that includes the production of cytokines and recruitment of neutrophils (PMN) and may progress to organ failure, inducing acute respiratory distress syndrome (ARDS). To examine the hypothesis that interleukin-6 (IL-6) contributes to PMN infiltration and lung damage in HS, we examined the lungs of rats subjected to unresuscitated and resuscitated HS for the production of IL-6 and activation of Stat3. Using semiquantitative RT-PCR, we found a striking increase in IL-6 mRNA levels only in resuscitated HS, with peak levels observed 1 h after initiation of resuscitation. Increased IL-6 protein expression was localized to bronchial and alveolar cells. Electrophoretic mobility shift assay of protein extracts from shock lungs exhibited an increase in Stat3 activation with kinetics similar to IL-6 mRNA. In situ DNA binding assay determined Stat3 activation predominantly within alveoli. Intratracheal instillation of IL-6 alone into normal rats resulted in PMN infiltration into lung interstitium and alveoli, marked elevation of bronchoalveolar lavage cellularity, and increased wet-to-dry ratio. These findings indicate that IL-6 production and Stat3 activation occur early in HS and may contribute to PMN-mediated lung injury, including ARDS after HS.

Orally administered ginseng extract reduces serum total cholesterol and triglycerides that induce fatty liver in 66% hepatectomized rats

The effects of ginseng extract (from the root of Panax ginseng) on factors inducing fatty liver were examined in 66% hepatectomized rats. Oral administration of ginseng extract at 125 or 250 mg/kg/day produced statistically significant reductions in total cholesterol and triglyceride concentrations in the blood 3 days after hepatectomy (P<0.05); the total cholesterol response appeared to be dose-related. Administration of ginseng extract at both doses also reduced total cholesterol and triglyceride concentrations in the liver 3 days after hepatectomy. Food intake and serum chemistry parameters indicating liver and kidney function were unchanged after ginseng administration except for the lipid metabolic parameters. These observations suggest that orally administered ginseng extract can suppress the formation of fatty liver after hepatic resection.

Gallbladder cancer with intratumoral anechoic foci: a mimic of adenomyomatosis

We report a case of advanced gallbladder cancer in a 58-year-old man. On ultrasonography, there were anechoic foci within the tumor. Although anechoic foci within a thickened gallbladder wall usually represent intramural diverticula (dilated Rokitansky-Aschoff sinuses) of adenomyomatosis, cystically dilated cancerous glands were the etiology of these foci in this case. Thus, gallbladder cancer may also have anechoic foci within the tumor.

Prognostic determinants in extrahepatic bile duct cancer

BACKGROUND/AIMS

The understanding of histopathological prognostic factors is critical to improving surgical outcome. This study investigated the microscopic features of cancer of the extrahepatic bile duct in order to clarify the prognostic determinants affecting surgical outcome.

METHODOLOGY

In 90 cancers of the extrahepatic bile duct, the correlation between several microscopic parameters and survival was investigated. Lymphatic, venous, and perineural invasion, and the surgical margin (tumor-free or tumor-positive) were examined with serial step-wise sectioned specimens.

RESULTS

Seven pT1-tumors showed no venous or perineural invasion and no lymph node involvement and were associated with prolonged survival (5 year survival, 86%) compared with pT2,3 tumors (23%). In pT2,3 tumors, lymphatic, venous, and perineural invasion was found in 80%, 47%, and 88%, respectively, with no significant differences in occurrence of these parameters according to the origin of the primary tumor. As for survival with pT2,3 tumors, lymph node involvement (58%) and status of the surgical margin were significant parameters (p=.0330 and p=.0309, respectively). In addition, these latter parameters differed significantly according to the origin of the primary tumor.

CONCLUSION

In cancer of the extrahepatic bile duct, lymph node involvement and status of the surgical margin were the most important microscopic parameters affecting prognosis.

Expression of the anti-metastatic effect induced by Juzen-taiho-to is based on the content of Shimotsu-to constituents

We investigated the inhibitory effect of oral administration of Juzen-taiho-to, a Kampo Japanese herbal medicine, and its related formulations on the experimental liver and lung metastasis of tumor cells in vivo. Oral administration of Juzen-taiho-to for 7 d before tumor inoculation significantly reduced the number of liver metastatic colonies of colon 26-L5 carcinoma cells and attenuated the increase of liver weight in a dose-dependent manner ranging from 4 to 40 mg/d. Its oral administration for this same period before tumor inoculation also significantly inhibited lung metastasis of B16-BL6 melanoma cells. Juzen-taiho-to originally consisted of 8 crude drugs derived from Shimotsu-to and Shikunshi-to prescriptions together with two crude drugs (Cinnamomi Cortex and Astragali Radix). Oral administration of Shimotsu-to as well as Juzen-taiho-to for 7 d before tumor inoculation resulted in a significant reduction in the number of metastatic colonies and the liver weight as compared with the control, whereas Shikunshi-to did not exhibit such an inhibitory effect. Unsei-in containing four Shimotsu-to constituents was also active in inhibiting liver metastasis. Toki-shakuyaku-san and Ninjin-yoei-to, which include all Shimotsu-to constituents except Rehmanniae Radix and Cnidii Rhizoma, respectively, did not show a significant anti-metastatic effect. Rikkunshi-to and Ninjin-yoei-to, which contain Shikunshi-to constituents, did not affect the inhibition of liver metastasis. Hochu-ekki-to treatment before tumor inoculation also led to a significant inhibition of liver metastasis, probably through an inhibitory mechanism different from Juzen-taiho-to. These results suggest that the anti-metastatic effect of Juzen-taiho-to is partly associated with its Shimotsu-to-derived constituents.