Impact of Tumor Grade Distribution on Genetic Alterations in Clear Cell Renal Cell Carcinoma and Prostate Cancer

BACKGROUND/AIM

A genomic analysis based on next-generation sequencing is important for deciding cancer treatment strategies. Cancer tissue sometimes displays intratumor heterogeneity and a pathologic specimen may contain more than two tumor grades. Although tumor grades are very important for the cancer prognosis, the impact of higher tumor grade distribution in a specimen used for a genomic analysis is unknown.

PATIENTS AND METHODS

We retrospectively analyzed the data of 61 clear cell carcinoma and 46 prostate cancer patients that were diagnosed between December 2018 and August 2022 using the GeneRead Human Comprehensive Cancer Panel or SureSelect PrePool custom Tier2. Genome annotation and curation were performed using the GenomeJack software.

RESULTS

Tumor mutation burden (TMB) was increased in proportion to the higher tumor grade distribution in grade 2 clear cell renal cell carcinoma (ccRCC). In PC, Grade Group 3/4 specimens that included an increased distribution of Gleason pattern 4 had more frequent gene mutations.

CONCLUSION

Our results suggest the importance of selecting the maximum distribution of higher tumor grade areas to obtain results on the precise gene alterations for genomics-focused treatments.

Molecular Evaluation of Endometrial Dedifferentiated Carcinoma, Endometrioid Carcinoma, Carcinosarcoma, and Serous Carcinoma Using a Custom-Made Small Cancer Panel

It is often difficult to histologically differentiate among endometrial dedifferentiated carcinoma (DC), endometrioid carcinoma (EC), serous carcinoma (SC), and carcinosarcoma (CS) due to the presence of solid components. In this study, we aimed to categorize these carcinomas according to The Cancer Genome Atlas (TCGA) classification using a small custom-made cancer genome panel (56 genes and 17 microsatellite regions) for integrated molecular diagnosis. A total of 36 endometrial cancer cases with solid components were assessed using IHC, next-generation sequencing (NGS), and the custom-made panel. Among 19 EC cases, six were categorized as MMR-deficient (MMR-d) and eight were classified as having a nonspecific molecular profile. Three EC cases were classified as POLE mutation (POLEmut)-type, which had a very high tumor mutation burden (TMB) and low microsatellite instability (MSI). Increased TMB and MSI were observed in all three DC cases, classified as MMR-d with mutations in MLH1 and POLD1. Except for one case classified as MMR-d, all SC cases exhibited TP53 mutations and were classified as p53 mutation-type. SC cases also exhibited amplification of CCND1, CCNE1, and MYC. CS cases were classified as three TCGA types other than the POLEmut-type. The IHC results for p53 and ARID1A were almost consistent with their mutation status. NGS analysis using a small panel enables categorization of endometrial cancers with solid proliferation according to TCGA classification. As TCGA molecular classification does not consider histological findings, an integrated analytical procedure including IHC and NGS may be a practical diagnostic tool for endometrial cancers.

A Green Light-Regulated T7 RNA Polymerase Gene Expression System for Cyanobacteria

In this study, we developed a green light-regulated T7 RNA polymerase expression system (T7 RNAP system), to provide a novel and versatile high-expression system for cyanobacteria without using any chemical inducer, realizing high expression levels comparable with previously reported for recombinant gene expression in cyanobacteria. The T7 RNAP system was constructed and introduced into Synechocystis sp. PCC6803. T7 RNAP was inserted downstream of the cpcG2 promoter, which is recognized and activated by the CcaS/CcaR two-component green-light-sensing system, to compose a vector plasmid, pKT-CS01, to achieve the induction of T7 RNAP expression only under green light illumination, with repression under red light illumination. The reporter gene, superfolder green fluorescent protein (sfGFP), was inserted downstream of the T7 promoter. Transcriptional analyses revealed that T7 RNAP was induced under green light but repressed under red light. Expression of the sfGFP protein derived from pKT-CS01 was observed under green light illumination and was approximately 10-fold higher than that in the control transformant, which expressed sfGFP directly under the cpcG2 promoter, which is directly regulated by CcaS/CcaR, under green light illumination. Comparison with the strong promoter expression systems P_cpc560 and P_trcΔlacO revealed that the expression of sfGFP by the T7 RNAP system was comparable with the levels obtained with strong promoters. These results demonstrated that the green light-regulated T7 RNAP gene expression system will be a versatile tool for future technological platform to regulate gene expression in cyanobacterial bioprocesses.

Improving the induction fold of riboregulators for cyanobacteria

Cyanobacteria are ideal cellular factories for biochemical production because of their ability to fix CO₂ by photosynthesis and convert this molecule into biochemicals. Previously, we engineered a riboregulator that enables post-transcriptional gene regulation in the cyanobacterium Synechocystis sp. PCC 6803. Here, we improved the riboregulator by designing two RNA species, taRNA and crRNA, to enhance its induction fold. We inserted nucleotides into the crRNA loop to enhance intermolecular hybridization and successfully improved its induction fold. The engineered riboregulator exhibited a higher induction fold than the previously engineered riboregulator in both Escherichia coli and Synechocystis sp. PCC 6803. This improved riboregulator can be used to control gene expression over a wide dynamic range in cyanobacteria.

Applying a riboregulator as a new chromosomal gene regulation tool for higher glycogen production in Synechocystis sp. PCC 6803

Cyanobacteria are one of the most attractive hosts for biofuel production; however, genetic approaches to regulate specific chromosomal genes in cyanobacteria remain limited. With the aim of developing a novel method to regulate chromosomal gene expression in cyanobacteria, we focused on riboregulatory technology. Riboregulators are composed of two RNA fragments whose interaction leads to target gene regulation with high specificity. In this study, we inserted a riboregulator sequence upstream of the chromosomal gene encoding AbrB-like transcriptional regulator, cyAbrB2, to investigate the utility of this tool. The inserted riboregulator was able to regulate cyabrB2 gene expression, with a high ON-OFF ratio up to approximately 50-fold. The transcription levels of several genes for which cyAbrB2 acts as a transcriptional upregulator were also decreased. Further, the cyAbrB2 expression-repressed mutant showed high glycogen accumulation, equivalent to that in the cyabrB2 deletion mutant (ΔcyabrB2). Phenotypic similarities between the cyabrB2 expression-repressed mutant and the ΔcyabrB2 mutant suggest that the riboregulator can potentially be used as a new chromosomal gene regulation tool in cyanobacteria.

Fate of aorta and clinical outcomes in patients with chronic type B aortic dissection: over 20-year experience

AIM

In type B double-barrel aortic dissection (AD), the fate of the affected aorta, causes of death, and very long-term clinical outcomes have not been completely elucidated. The purpose of this study was to clarify the fate of the affected aorta and long-term clinical outcomes in patients with type B AD during the chronic phase.

MEHODS

One hundred and four patients were entered into this study, and regular follow-up CT studies (mean; 87.6 months) were performed. Also, clinical data including AD-related events (including aneurysm formation, rupture, ischemia, and re-dissection), AD-related deaths, and long-term survival were retrospectively reviewed.

RESULTS

Forty-six of 104 patients (44.2%) had one more AD-related event during the follow-up period. The actuarial event-free rates for any AD-related events of all patients were 95±2%, 75±5%, 53±6%, and 13±7% at 1, 5, 10, and 20 years, respectively. Initial aortic diameter ≥40 mm and blood flow in the false lumen were significant risk factors for AD-related events in univariate and multivariate analysis.

CONCLUSION

In type B chronic aortic dissection, the affected aortas have a high incidence of AD-related events during the follow-up period. Prophylactic surgery or endovascular treatment for patients at high risk may reduce the AD-related events.

Double-balloon endoscopy versus magnet-imaging enhanced colonoscopy for difficult colonoscopies, a randomized study

BACKGROUND AND STUDY AIMS

Studies have estimated that failure of cecal intubation occurs with conventional colonoscopy in up to 10 % of cases. Double-balloon endoscopy (DBE) systems, magnetic endoscope imaging (MEI), and transparent cap have been shown to improve success rates for colonoscopy. This study evaluated the utility of DBE for complete examination of the colon compared with MEI plus cap (MEI-Cap) after incomplete or technically difficult colonoscopy in a randomized comparative manner.

PATIENTS AND METHODS

A total of 94 patients with incomplete or technically difficult colonoscopy were randomly assigned to receive either DBE (n = 47) or colonoscopy with MEI-Cap (n = 47). The primary end point was cecal intubation rate within 30 minutes. Secondary end points included intubation time, pain score using a visual analog scale, abdominal pressure attempts, doses of sedative medication, and changes in patient position during colonoscopy.

RESULTS

Patient characteristics were comparable in both groups. Cecal intubation rate within 30 minutes was significantly higher for DBE (45 /47, 95.7 %) than for MEI-Cap (34 /47, 72.3 %) (P = 0.0049). Mean time to reach the cecum was significantly lower in the DBE group (13.0 ± 5.3 minutes) than in the MEI-Cap group (16.4 ± 4.8 minutes; P = 0.0003). No complications were encountered in either group.  

CONCLUSION

DBE is more useful for complete examination of the colon than MEI-Cap in patients with incomplete or technically difficult colonoscopy.

Long-term results of surgical therapy for masticatory muscle tendon-aponeurosis hyperplasia accompanied by limited mouth opening

Masticatory muscle tendon-aponeurosis hyperplasia is a new disease entity characterized by limited mouth opening due to contracture of the masticatory muscles, resulting from hyperplasia of tendons and aponeuroses. In the case of masseter muscle type, the face displays a square mandible configuration. Pharmacotherapy, occlusal splints and physical therapy are ineffective. This study evaluated the long-term results of aponeurectomy of the masseter muscle with coronoidectomy to release the temporal muscle tendon. The subjects were 10 patients who underwent surgery between 2000 and 2005. Mean maximum mouth opening before surgery was 21.8mm (range 17-29 mm). All patients received bilateral aponeurectomy of the masseter muscle and coronoidectomy. Three patients additionally underwent bilateral anglectomy for esthetic reasons. After discharge, one patient did not return to the hospital. Data from the other nine patients were analyzed. The mean duration of follow-up was 4 years. At final follow-up, the maximum mouth opening was >44 mm in four patients, 40-44 mm in three patients, and 35-39 mm in two patients. Overall satisfaction was excellent or good in all patients.

Myocardial delayed contrast-enhanced MRI: relationships between various enhancing patterns and myocardial diseases

The concentration of MR contrast agents is relatively high in abnormal myocardial tissue, with increased extravascular space and/or abnormal contrast wash-in and wash-out characteristics. Based on this mechanism, myocardial delayed contrast-enhanced MRI has been increasingly used to detect myocardial damage. Delayed enhancement (DE) can be seen in various components, such as fibrosis, protein infiltration or possibly myocardial disarray with disorganized myocardial fibre packing. Therefore, DE can be seen in various myocardial diseases, each of which has a characteristic DE pattern. Knowledge of the relationships among various DE patterns and myocardial diseases is useful for differential diagnosis and management.

Clinical evaluation of magnetic resonance imaging flowmetry of portal and hepatic veins in patients following hepatectomy

BACKGROUND

Hepatic blood flow was associated with degree of hepatic damage. Measurements of blood flow using ultrasonography (US) may vary due to any observer's and patient's conditions. The utility of magnetic resonance imaging (MRI) flowmetry in portal and hepatic veins was assessed.

PATIENTS AND METHODS

Using the phase-contrast method, the mean flow velocity of portal (PVF) and hepatic vein (HVF) were determined by MRI and US in 75 consecutive patients with liver diseases, including 58 patients undergoing hepatectomy. The correlations between these parameters and clinicopathological findings were examined.

RESULTS

PVF and HVF measured by MRI flowmetry were 12.8+/-4.5 and 14.7+/-5.3 cm/s, respectively. There was no significant correlation of both flows between MRI and US. PVF correlated significantly with portal pressure (r = -0.722; P < 0.05). There was a negative correlation between HVF and histological activity index score (r = -0.366; P < 0.05). PVF and HVF were lower in patients with cirrhosis and higher staging score (2-4) and PVF was lower in patients with higher grading score (2-3; P < 0.05). PVF and HVF were not significantly associated with postoperative complications.

CONCLUSIONS

Our results suggest that MRI flowmetry is a potentially useful tool for measurement of hepatic blood flow and recommend its use for estimation of liver cirrhosis-associated impairment.

The comparison between pains, difficulties in function, and associating factors of patients in subtypes of temporomandibular disorders

The aim of this study was to compare the multidimensional properties among subtypes of painful temporomandibular disorders (TMD): myofascial pain (group I), disc displacement (group II), arthralgia (group IIIa) and osteoarthritis (group IIIb). A total of 511 patients answered a battery of questionnaires, which included questions relating to intensity and duration of pain, the Japanese version of the McGill Pain Questionnaire, limitation of daily functions, the Hospital Anxiety and Depression Scale, the Eysenck Personality Questionnaire short-form and 34 items of behavioural contributing factors. Group IIIb showed significantly the highest age in all subtypes. Those in group I had higher depression scores than those in group II (P = 0.005). Group IIIa had a lower women's ratio than in group II (P = 0.001) and the patients showed a shorter pain duration than those in groups I (P = 0.000) and II (P = 0.001). Group IIIa patients also showed lower visual analogue scale (VAS) ratings for pain descriptors 'heavy' (P = 0.002) and 'tiring' (P = 0.004) than those of group I, and 'dull' (P = 0.005), 'heavy' (P = 0.001) and 'tiring' (P = 0.005) than those of group II. Group IIIa showed lower ratios of contributing factors of 'an awareness of grinding/clenching during sleep' (P = 0.000) and 'an awareness of clenching sensation when waking up at night' (P = 0.002) than those of group I, and also showed a higher ratio of 'a liking for a hard food' (P = 0.000) and lower ratio of 'talking for a long time on the telephone' (P = 0.001) than those of group II. In conclusion, although several properties were different between subtypes, the majority of them were similar in the four subtypes of TMD.

Intramucosal adenocarcinoma of the appendix: how to find and how to treat

A colonoscopic examination of a 58-year-old man revealed a small elevated lesion inside the orifice of the appendix. Using a polypectomy snare, a nodular polypoid lesion with a diameter of ca. 20 mm was removed from the lumen of the appendix. Histopathology showed that it was a well-differentiated adenocarcinoma. This is the first report of an intramucosal adenocarcinoma of the appendix diagnosed preoperatively; laparoscopy-assisted colectomy with a D2 lymph-node dissection was carried out. Endoscopists should consider an appendiceal tumor when an erosion, elevation, or deformity is seen in the head of the cecum.

Mutations in the ST7/RAY1/HELG locus rarely occur in primary colorectal, gastric, and hepatocellular carcinomas

Human cancers frequently show a loss of heterozygosity on chromosome 7q31, which indicates the existence of broad-range tumour-suppressor gene(s) at this locus. Truncating mutations in the ST7 gene at this locus are seen frequently in primary colon cancer and breast cancer cell lines. Therefore, the ST7 gene represents a novel candidate gene for the tumour suppressor at this locus. However, more recent studies have reported that ST7 mutations are infrequent or absent in primary cancer and cell lines. To ascertain the frequency of mutations of the ST7 gene in cancer cells, we examined mutations in the ST7 coding sequence in 48 colorectal, 48 gastric, and 48 hepatocellular carcinomas using polymerase chain reaction-single-strand conformational polymorphism and direct sequencing. We detected somatic mutations, which were located near the exon-intron junction in intron 8, in only three out of 144 cases. We conclude that mutations in the ST7 gene are rare in primary colorectal, gastric, and hepatocellular carcinomas.

Immunohistochemical and electron microscopic study of extrinsic hepatic reinnervation following orthotopic liver transplantation in rats

BACKGROUND/AIMS

Because little has been known about the morphological and functional consequences of liver transplantation on hepatic autonomic nerves, we examined the time-course of extrinsic hepatic innervation at the level of the porta hepatis of liver allografts.

METHODS

Orthotopic liver transplantation was performed using male Lewis rats. Crosscut tissue specimens were obtained postoperatively for up to 6 months from the porta hepatis of transplanted livers, and processed for immunohistochemical staining for protein gene product 9.5 (PGP 9.5) and growth-associated protein 43 (GAP-43), and for transmission electron microscopy (TEM).

RESULTS

Extrinsic nerve fibers at the porta hepatis stained positively for PGP 9.5 throughout the entire study period. In contrast, the immunoreactivity of GAP-43 was negative at postoperative day (POD) 1 and 2. GAP-43-positive nerves were first observed to appear in the porta hepatis at POD 3. The immunoreactivity of GAP-43 remained positive thereafter until 3 months post-OLT, and became negative in all the specimens at 4 months post-OLT. Transmission electron microscopy demonstrated a small number of regenerating axons existing among many degenerating axons at POD 3. At 3 months post-OLT, most regenerating axons had been fully ensheathed by the cytoplasm of Schwann cells, although their density remained at a lower level compared with normal.

CONCLUSION

The results of this study suggest that liver allografts become extrinsically reinnervated, with the regenerating axons reaching the hepatic hilus 3 days after transplantation. The process of extrinsic hepatic reinnervation is considered to almost terminate 4 months after transplantation in rats.

Anomalous systemic arterial supply to normal basal segments of left lower lobe: characteristic imaging findings

PURPOSE

The purpose of this study was to describe the characteristic findings in each imaging modality of anomalous systemic arterial supply to normal basal segments of the left lower lobe of the lung.

METHOD

Five patients with anomalous systemic arterial supply to normal basal segments of the left lower lobe were retrospectively reviewed. Chest radiography, contrast-enhanced CT scan, angiography, and other imaging modalities were analyzed.

RESULTS

The imaging findings of this anomaly were characterized by three issues as follows: an anomalous systemic artery arising from the thoracic aorta, absence of pulmonary arterial supply, and normal bronchial system as well as normal pulmonary parenchyma in the affected segments. The anomalous systemic artery was demonstrated on chest radiography, contrast-enhanced CT scan, MRI, and thoracic aortography. Absence of pulmonary arterial supply was revealed by pulmonary angiography, radiolabeled perfusion scan, and CT scan. Normal bronchial system was confirmed by radiolabeled ventilation scan, bronchography, and CT scan.

CONCLUSION

CT is useful in making the correct diagnosis of this anomaly because it is the only diagnostic method that can demonstrate the anomalous systemic artery, absence of pulmonary arterial supply, and normal bronchial system in the affected segments.

Fibrous adhesions in the joint compartment of the temporomandibular joint associated with experimental opposite drawing mandibular ramus in rabbit

The purpose of this study was to develop a rabbit model of fibrous adhesions in the joint compartment of the temporomandibular joint (TMJ) without surgical invasion into the joint compartment. A unilaterally elastic force of about 120 grams was applied from the anterior edge of masseteric tuberosity to the posterior part of the zygomatic arch between the masseteric fascia layer and the subcutaneous layer in 14 rabbits. The blocks of nondrawing side TMJ were removed after four weeks. Fibrous adhesions were observed in 13 rabbits except for one rabbit that lost over 30% of its body weight. In eight of the rabbits, the adhesions were detected in both joint compartments. This animal model for fibrous adhesion of the TMJ will be useful in understanding the pathogenesis of adhesion in human TMJs.

A model for internal derangement and osteoarthritis of the temporomandibular joint with experimental traction of the mandibular ramus in rabbit

OBJECTIVES

The purpose of this study is to make a model of internal derangement (ID) and osteoarthritis (OA) by postero-superior displacement of the mandible in the rabbit temporomandibular joint (TMJ).

MATERIALS AND METHODS

Sixteen Japanese white rabbits (8 months old) were subjected to traction of the mandibular ramus in the postero-superior direction unilaterally using elastic force and five rabbits were used as the control. The operations were performed without surgical invasion of the TMJ capsule. Temporomandibular joint tissue was removed after 4 weeks and Technovit and paraffin sections with or without decalcification were observed histologically.

RESULTS

In contrast to the control group, it showed anterior disc displacement, disc deformity, resorption of subchondral bone and osteophyte formation in the drawing side of the experimental group. Intra-articular fibrous adhesions were observed in both sides.

CONCLUSION

It is concluded that posterosuperior displacement of the mandible caused ID and OA in the rabbit TMJ. This model may contribute to the understanding of the etiology of human temporomadibular disorders (TMD).

Suppressive effect of Lactobacillus gasseri OLL 2716 (LG21) on Helicobacter pylori infection in humans

To examine the efficacy of Lactobacillus gasseri OLL2716 (LG21) as a probiotic for Helicobacter pylori in humans, 31 subjects infected with the bacterium ingested yogurt containing LG21 daily for an 8 week period. The [(13)C]urea breath test and assays of serum pepsinogens revealed a significant improvement following LG21 treatment. LG21 was thus determined to be effective in both suppressing H. pylori and reducing gastric mucosal inflammation.

[CT-guided needle biopsy of the lung: factors affecting risk of complications]

PURPOSE

To analyze factors influencing the risk of complications associated with CT-guided percutaneous needle biopsy for lung lesions.

MATERIALS AND METHODS

Sixty patients, aged 24-85 years (37 men and 23 women), underwent CT-guided needle biopsy. A definite diagnosis was made in 49 of 60 cases (81.7%), including 38 of 43 malignant lesions (88.4%) and 11 of 17 benign lesions (64.7%). Complications associated with biopsy were observed in 35 patients (58.3%). Major complications included pneumothorax (n = 26) and pulmonary hemorrhage (n = 20). Chest tube placement was needed in 5 (19.2%) of 26 pneumothorax cases (8.3% of all biopsies).

RESULTS

The high frequency of pneumothorax (43.3%) in this series had several contributing factors, including the presence of pulmonary emphysema, lesion size, and traversal of aerated lung. Chest tube replacement was necessary more frequently in patients with pulmonary emphysema. The number of pleural passes, location of lesions, and size of needles were not correlated with the incidence of pneumothorax.

CONCLUSION

The presence of pulmonary emphysema, lesion size, and traversal of aerated lung are the predominant risk factors for pneumothorax in patients with CT-guided lung biopsy.

Evaluation of pancreatic secretion after administration of secretin: application of magnetic resonance imaging

BACKGROUND

To evaluate pancreatic exocrine function, we measured the changes in T2 enhanced hydrograhic intensity on magnetic resonance (MR) images of the pancreas following an injection of secretin, which is representative of the changes in duodenal fluid volume.

METHODS

The subjects were 10 patients with normal pancreatic function (N > 70% detected by using a pancreatic function diagnostant test) and 12 patients with hypo-function, including those with mild hypo-function (MH, 50-70%, six patients) and severe hypo-function (SH < 50%, six patients).

RESULTS

In the N group, T2 enhanced intensity of the pancreas increased to a maximum value (more than 10% compared with baseline) within 5 min of stimulation, then gradually decreased. No significant difference in the response was observed between the head and body of the pancreas. Changes in the MH group were similar to those of the N group. In contrast, significantly lower changes in T2 enhanced intensity were observed in SH group, relative to both the N and MH group (P < 0.05). The amount of secretin-induced increase in duodenal fluid after 16 min was not significantly different among the three groups. Furthermore, an evaluation of the residual pancreatic tissue after a pancreatoduodenectomy was also feasible.

CONCLUSIONS

Our results indicate that the MR-secretin test is useful for the evaluation of severe pancreatic exocrine dysfunction. The diagnostic test is simple, direct and non-invasive.

Inhibition of the Wnt signaling pathway by Idax, a novel Dvl-binding protein

In attempting to clarify the roles of Dvl in the Wnt signaling pathway, we identified a novel protein which binds to the PDZ domain of Dvl and named it Idax (for inhibition of the Dvl and Axin complex). Idax and Axin competed with each other for the binding to Dvl. Immunocytochemical analyses showed that Idax was localized to the same place as Dvl in cells and that expression of Axin inhibited the colocalization of Dvl and Idax. Further, Wnt-induced accumulation of beta-catenin and activation of T-cell factor in mammalian cells were suppressed by expression of Idax. Expression of Idax in Xenopus embryos induced ventralization with a reduction in the expression of siamois, a Wnt-inducible gene. Idax inhibited Wnt- and Dvl- but not beta-catenin-induced axis duplication. It is known that Dvl is a positive regulator in the Wnt signaling pathway and that the PDZ domain is important for this activity. Therefore, these results suggest that Idax functions as a negative regulator of the Wnt signaling pathway by directly binding to the PDZ domain of Dvl.

Aortic aneurysms in patients with Takayasu's arteritis: CT evaluation

OBJECTIVE

The objective of this study was to evaluate the incidence, development, and outcome of aortic aneurysm on CT in a group of patients with Takayasu's arteritis.

MATERIALS AND METHODS

We reviewed the files of 31 patients with Takayasu's arteritis between January 1990 and March 1999. All patients were followed up for more than 6 months with CT, and the mean follow-up period was 52.9 months (median, 36.0 months). In all patients, initial CT was performed within 6 months of diagnosis of Takayasu's arteritis. The study group comprised 24 female patients and seven male patients; their ages at the first CT examination ranged from 8 to 72 years (mean, 42. 6 +/- 16.5 years).

RESULTS

Seventeen aortic aneurysms were found in 14 (45.2%) of the 31 patients. Patients with severe calcification of the aorta showed significantly lower incidence of aneurysm formation than those without severe calcification of the aorta (p < 0.05). Of the 17 aneurysms, three were not present at the time of initial CT and appeared during the follow-up period. Nine of 17 aneurysms increased in size during the follow-up period. Three of the nine aneurysms rapidly increased in size and ruptured during the follow-up period. In all three of these aneurysms, aortic wall thickening was identified on CT. The remaining six aneurysms slowly increased in size but did not rupture.

CONCLUSION

Aortic aneurysm associated with Takayasu's arteritis is not rare. The aorta with little calcification has a greater possibility of aneurysm formation in patients with Takayasu's arteritis. Aortic aneurysms with wall thickening can have fatal consequences.

[Radiation-induced squamous cell carcinoma of the chest wall seven years after adjuvant radiotherapy following the surgery of breast cancer: a case report]

A 54-year-old woman, who had underwent an adjuvant radiotherapy following the modified radical mastectomy in the left primary breast cancer in June 1988. She underwent second surgery and adjuvant radiotherapy (electronic radiotherapy) for recurrent breast cancer in the major pectoral muscle and received chemoimmunotherapy in May 1989. In May 1996 she complained of two ulcers of the chest wall. The ulcer biopsy findings was squamous cell carcinoma, and we diagnosed she fell the radiation-induced skin cancer. She underwent chest wall resection and reconstruction with vertical rectal abdominal musculocutaneous flap (VRAM). However two months later her chest wall resection, she again got the recurrent squamous cell carcinoma in the right axillary lymph nodes and left pleura. The third radiotherapy and the chemotherapy with pepleomycin were uneffective on her recurrent cancer. And she died in March 1997.

A randomized prospective study of oral versus intravenous antibiotic prophylaxis against postoperative infection after sagittal split ramus osteotomy of the mandible

BACKGROUND

We investigated whether oral levofloxacin was as effective as intravenous cefazolin sodium for preventing postoperative infections in patients undergoing sagittal split ramus osteotomy of the mandible.

METHODS

Forty-four patients were randomized to treatment with levofloxacin or cefazolin sodium. Levofloxacin (100 mg t.d.s.) was administered orally, and cefazolin sodium (1 g b.i.d.) by intravenous infusion. Both drugs were given until 5 days postoperatively. The concentrations of levofloxacin in the mandibular bone marrow and serum were measured.

RESULTS

The mean levofloxacin concentration 4 h and 53.7 min after administration was 1.086 microg/ml in serum and 1.328 microg/ml in the mandibular bone marrow. The efficacy rate of levofloxacin was 95% and that of cefazolin sodium was 85.7%, with no significant difference between the two drugs (p = 0.322).

CONCLUSION

Oral administration of levofloxacin is a simple, cost-effective and safe alternative to intravenous antibiotic prophylaxis after mandibular surgery.

A novel beta-catenin-binding protein inhibits beta-catenin-dependent Tcf activation and axis formation

beta-Catenin is efficiently phosphorylated by glycogen synthase kinase-3beta in the Axin complex in the cytoplasm, resulting in the down-regulation. In response to Wnt, beta-catenin is stabilized and translocated into the nucleus where it stimulates gene expression through Tcf/Lef. Here we report a novel protein, designated Duplin (for axis duplication inhibitor), which negatively regulates the function of beta-catenin in the nucleus. Duplin was located in the nucleus. Duplin bound directly to the Armadillo repeats of beta-catenin, thereby inhibiting the binding of Tcf to beta-catenin. It did not affect the stability of beta-catenin but inhibited Wnt- or beta-catenin-dependent Tcf activation. Furthermore, expression of Duplin in Xenopus embryos inhibited the axis formation and beta-catenin-dependent axis duplication, and prevented the beta-catenin's ability to rescue ventralizing phenotypes induced by ultraviolet light irradiation. Thus, Duplin is a nuclear protein that inhibits beta-catenin signaling.

An evaluation of Bosniak's radiological classification of cystic renal masses

OBJECTIVE

To determine the clinical usefulness of Bosniak's classification of cystic renal masses, the differentiation of which remains difficult despite significant advances in diagnostic imaging.

PATIENTS AND METHODS

The computed tomography (CT) findings of all histopathologically examined cystic renal masses diagnosed at our institution were analysed retrospectively; 35 patients with cystic renal masses were treated between 1986 and 1998. Tissues surgically removed were examined pathologically and the final diagnosis compared with the preoperative CT category of Bosniak's classification.

RESULTS

The histopathological examined showed cystic renal cell carcinoma in 21 patients, a benign renal cyst in 12, haemangiosarcoma in one and transitional cell carcinoma in one. Most of the 35 masses (26, 74%) were found incidentally during evaluation for an unrelated disease or a routine health check. All 11 masses of Bosniak category I were benign and one category II mass was malignant. All 10 masses of category III and 12 of category IV were malignant.

CONCLUSIONS

Bosniak's classification is useful for differentiating category I, III and IV cystic renal masses. There were too few samples to allow meaningful conclusions to be drawn for category II renal masses. It is critical to differentiate between complicated cysts of category II and III because of the major implications for prognosis and clinical management.

Comparison of the effectiveness of arthrocentesis in acute and chronic closed lock: analysis of clinical and arthroscopic findings

The objective of this study was to investigate the effectiveness of temporomandibular joint arthrocentesis in acute and chronic closed lock patients. Eighteen patients with closed lock of the temporomandibular joint (TMJ) were treated with fine needle fiber arthroscopic observation following arthrocentesis. Maximal mouth opening (MMO) and intensity of pain (VAS) were evaluated at pretreatment and each posttreatment appointment (one week, one month, three months following treatment). The clinical and arthroscopic findings were analyzed categorizing two groups into: good (A) and poor (B) groups. At pretreatment there was no significance relative to age or the mean MMO and VAS between the groups, but the mean of duration of the symptoms in group B was significantly longer than in group A (P < 0.03). Group B showed more severe synovitis, adhesions, and chondromalacia than group A (P < 0.01). Results suggest that arthrocentesis is more effective in closed lock of short duration where there is less severe synovitis, adhesions, and chondromalacia.

Practical synthesis of the disaccharide epitope, D-galactopyranosyl-alpha-1,3-D-galactopyranose, by using 1,2;5,6-di-O-cyclohexylidene-alpha-D-galactofuranose as the glycosyl acceptor

D-Galactosyl-alpha-1,3-D-galactopyranose (1) was chemically prepared in a good yield by coupling phenyl 2,3,4,6-tetra-O-benzyl-1-thio-beta-D-galactopyranoside (5) or 2,3,4,6-tetra-O-benzyl-alpha-D-galactopyranosyl bromide (8) with 1,2:5,6-di-O-cyclohexylidene-alpha-D-galactofuranose (3) with subsequent de-O-benzylation and de-O-cyclohexylidenation of the resulting protected alpha1,3-disaccharide.

Synthesis of 2-C-methyl-D-erythritol and 2-C-methyl-L-threitol; determination of the absolute configuration of 2-C-methyl-1,2,3,4-butanetetrol isolated

2-C-Methyl-D-erythritol (A) and 2-C-methyl-L-threitol (B) were respectively synthesized from D-glucose and D-galactose. The 2-C-methyl-1,2,3,4-butanetetrol compound (C) recently isolated from Phlox sublata L was confirmed to be A by comparing the CD and 1H-NMR spectra of its tri-O-benzoate with those of A and B.

Penetrating atherosclerotic ulcer of the aorta: imaging features and disease concept

Penetrating atherosclerotic ulcer is an ulcerating atherosclerotic lesion that penetrates the elastic lamina and is associated with hematoma formation within the media of the aortic wall. This pathologic condition is distinct from classic aortic dissection and aortic rupture; however, care should be taken in making the diagnosis, particularly if the disease is discovered incidentally. At computed tomography (CT), penetrating atherosclerotic ulcer manifests as focal involvement with adjacent subintimal hematoma and is often associated with aortic wall thickening or enhancement. Magnetic resonance imaging is superior to conventional CT in differentiating acute intramural hematoma from atherosclerotic plaque and chronic intraluminal thrombus and allows unenhanced multiplanar imaging. Spiral CT involves shorter examination times and allows high-quality two- and three-dimensional image reconstruction. CT angiography can demonstrate complex spatial relationships, mural abnormalities, and extraluminal pathologic conditions. Transesophageal echocardiography has been reported to be highly sensitive and specific in the differentiation of aortic disease, and intravascular ultrasonography may also be useful in this setting. Although rupture or other life-threatening complications are rare, patients with penetrating atherosclerotic ulcer must be followed up, particularly during the 1st month after onset. Surgical treatment may become necessary in cases involving evidence of intramural hematoma expansion, signs of impending rupture, inability to control pain, or blood pressure changes.

Symptomatic peripheral vascular tree stenosis. Comparison of subtracted and nonsubtracted 3D contrast-enhanced MR angiography with fat suppression

OBJECTIVE

To determine the clinical feasibility of contrast-enhanced three-dimensional (3D) MR angiography (MRA) with fat suppression spectral inversion at lipids and to compare subtracted and nonsubtracted images.

MATERIAL AND METHODS

In 13 patients suspected of having lower extremity ischemia, 3D dynamic contrast-enhanced MRA of the iliac and femoral arteries was performed using the fat suppression technique. The validity of the MRA interpretations of the degree of stenoses was evaluated by comparing with conventional angiography as the gold standard. The contrast-to-noise (C/N) ratios of both subtracted and nonsubtracted maximum-intensity-projection (MIP) images were calculated.

RESULTS

In the arteries with stenosis of 50% or greater, the sensitivity and specificity of the subtracted MR angiograms were 100% and 96.5%, respectively, not significantly different from the corresponding values in nonsubtracted MRAs (100% and 94.1%, respectively). The C/N ratios of the subtracted images were significantly higher than those of the nonsubtracted images (p<0.001).

CONCLUSION

With this technique, fat suppression can be performed with only a slight increase in the examination time. A lower dose of contrast material can be used in MRA with fat suppression than without it. Subtracted MRA improves the ease of interpretation compared to nonsubtracted MRA.

Pancreatic pseudoaneurysm converted from pseudocyst: transcatheter embolization and serial CT assessment

We present a case of pancreatic pseudoaneurysm converted from a pseudocyst. Contrast-enhanced CT disclosed a round enhancing lesion at the previously identified pseudocyst, and angiography confirmed the diagnosis of a pseudoaneurysm. The pseudoaneurysm was successfully treated by arterial embolization. We believe arterial embolization to be the treatment of choice for pseudoaneurysm as a complication of pancreatitis.