New Insights into Autonomic Nerve Preservation in High Ligation of the Inferior Mesenteric Artery in Laparoscopic Surgery for Colorectal Cancer

Aim: To take a deeper insight into the relationship between the root of the inferior mesenteric artery (IMA)and the autonomic nerve plexuses around it by cadaveric anatomy and explore anatomical evidence of autonomicnerve preservation in high ligation of the IMA in laparoscopic surgery for colorectal cancer. Methods: Anatomicaldissection was performed on 11 formalin-fixed cadavers and 12 fresh cadavers. Anatomical evidence-basedautonomic nerve preservation in high ligation of the IMA was performed in 22 laparoscopic curative resectionsof colorectal cancer. Results: As the upward continuation of the presacral nerves, the bilateral trunks of SHPhad close but different relationships with the root of the IMA. The right trunk of SHP ran relatively far awayfrom the root of IMA. When the apical lymph nodes were dissected close to the root of the IMA along the fasciaspace in front of the anterior renal fascia, the right trunk of SHP could be kept in suit under the anterior renalfascia. The left descending branches to SHP constituted a natural and constant anatomical landmark of therelationship between the root of IMA and the left autonomic nerves. Proximal to this, the left autonomic nervessurrounded the root of the IMA. Distally, the left trunk of the SHP departed from the root of IMA under theanterior renal fascia. When high ligation of the IMA was performed distal to it, the left trunk of SHP could bepreserved. The distance between the left descending branches to SHP and the origin of IMA varied widely from1.3 cm to 2.3 cm. Conclusions: The divergences of the bilateral autonomic nerve preservation around the rootof the IMA may contribute to provide anatomical evidence for more precise evaluation of the optimal positionof high ligation of the IMA in the future.     

Systolic Fluttering of the Noncoronary Cusp of the Aortic Valve and the Posterior Wall of the Aortic Root – A Sign of Mitral Regurgitation due to Dysfunction of the Posterior Leaflet of the Mitral Valve

Ten consecutive patients with severe isolated mitral regurgitation were studied. All the patients were evaluated by physical examination, EKG, chest X-ray, M-mode echocardiogram, and left ventricular angiogram. In eight patients a systolic murmur of mitral regurgitation radiated to the left parasternal and aortic areas. All of these patients demonstrated fluttering of the noncoronary cusp of the aortic valve and the posterior wall of the aortic root. Two patients in whom the systolic murmur of mitral regurgitation did not radiate to left parasternal and aortic areas, did not show fluttering of the noncoronary cusp and the posterior aortic wall. These patients had a classical murmur of mitral regurgitation that radiated to the left axilla. A review of 120 normal echocardiograms revealed fluttering of the right coronary cusp in three cases. None of these echocardiograms demonstrated fluttering of the noncoronary cusp or the posterior wall of aorta. The findings lead us to conclude that the presence of systolic fluttering of the noncoronary cusp and the posterior wall of the aorta is suggestive of mitral regurgitation due to dysfunction of the posterior leaflet of the mitral valve. Isolated fluttering of the right coronary cusp is a nonspecific finding.     

Controversies over the diagnosis of oligodendroglioma: a report from the satellite workshop at the 4th international symposium of brain tumor pathology, Nagoya Congress Center, May 23, 2012

With the goal of discussing how the neuropathology community should resolve the controversy over the diagnosis of oligodendroglioma, this Satellite Workshop reflects the collaboration between two invited keynote speakers: Dr. Johan M. Kros of the Erasmus Medical Center and Dr. Kenneth D. Aldape of the University of Texas MD Anderson Cancer Center and the Organizing Committee of the Japanese Society of Brain Tumor Pathology. In the first half of the workshop, the keynote speakers reviewed the current status of the pathology and genetics of oligodendroglioma. In the second half, six debatable cases that exemplify the current controversies over the diagnosis of oligodendroglioma were presented. The consensus diagnoses in these six cases, which have been reviewed by members of the Society, were opened to discussion and comments by the speakers. These cases highlight unresolved issues in the WHO 2007 classification of oligodendrogliomas, particularly the discordance between morphology and genetics. To achieve synchronization between phenotypes and genotypes, the neuropathology diagnosis should focus on the classic features of oligodendrogliomas that are highly correlated with the genetic background.     

Cytotoxic index in melanoma patients

The cytotoxic index was studied in 38 patients with melanoma. The cytotoxic effect would not be observed in tumor progression or in the persistent absence (1.5 years) of the signs of metastasization and recurrences in case of the previously removed tumor. The positive effect of the cytotoxic test in some cases was gained in the presence only of the primary focus or after the latter and metastases being removed, and in the long-term absence of metastases and recurrences in the period to come. In other cases the positive effect was gained during a short period of time before the appearance of metastases or in progressing of the disease. To fully estimate the results of the study the cytotoxic test should be methodically associated with studying of the blocking effect of patient's serum. The blood groups A. B. O compatibility or incompatibility of patient's and donor tumor cells did not influence the results of the cytotoxic test.     

Natural history of human cancer and prognostic factors. The example of breast cancer

The most important event during the growth of a human cancer is the occurrence of distant spread. A model of the natural history of breast cancer was developed which was used for several aims. It has been possible to study the relationship between the size of the breast tumor and the probability of dissemination either in regional lymph nodes or in distant sites. It was found that the distribution of tumor volume at metastatic dissemination is log normal with a median (termed V50) of 23.6 ml (diameter 3.5 cm). The number of involved axillary lymph nodes and the histological grade have both an impact on the dissemination probability and the size of the V50. It is also possible to estimate the median volume of the primary at the involvement of the first axillary node, of the second, of the third... On average, the V50 for distant metastatic dissemination is greater than the volume of the tumor at the initiation of the second axillary node but smaller than the volume at the initiation of the third. Another study was the assessment of the time at which the metastases were initiated. The results concerning age of metastases at the time of initial treatment allow to estimate the reduction in the incidence of distant metastases which can be obtained by an earlier diagnosis; these estimations are consistent with data of screening programs. The size of the occult metastases at the time of treatment of primary tumor was calculated. It was found that this size is much larger in the subset of patients with pejorative prognostic factors which probably explains the relatively low effectiveness of adjuvant chemotherapy in these patients. The maximum size of the metastases which are controlled by adjuvant chemotherapy was found equal to 1.5.10(6) cells. Finally the model was used to investigate the possible dissemination arising from loco-regional recurrence. The discrepancy between the great reduction in the incidence of loco-regional recurrences obtained with post-operative radiotherapy and its relatively small impact on survival is probably due to the fact that a recurrence has an impact on survival only in patients without distant metastases at the time of initial treatment and in whom the recurrence was not detected and treated before it reached the size at which it can initiate a metastasis. This situation is likely to occur only in patients with tumors of the inner quadrants in whom the internal mammary chain has a great likelihood of being involved.     

Excel建立回归方程法在恶性肿瘤相关物质检测中的应用

目的为克服传统手工绘制TSGF标准曲线以找出患者样品TSGF值方法不精确和烦琐性,我们采用Ex-cel软件,以自动生成此标准曲线及获取回归方程。方法我们使用了2种excel方法。第一种统计函数法为直接使用excel中的几个统计函数,包括SLOPE、INTERCEPT、CORREL、RSQ函数。第二种绘制曲线法是利用excel的图形功能,先绘制曲线,然后在此曲线上添加趋势线,以获得回归方程。结果2种方法都可获得相同的回归方程,并以此回归方程求得患者样品的TSGF值。结论Excel极方便的电子表格、强大的数据与公式自动填充功能、方便的数据编辑与透视分析功能、灵活的单元格绝对引用与相对引用功能、完美的图形绘制系统与丰富的内置函数功能,使工作变得直观、方便、快捷。     

人膝关节半月板不同测量方法的准确性和匹配性研究

目的：明确X线测量方法、MRI测量方法、解剖学测量方法三者的相互关系以及准确性和匹配性。方法选取意外死亡男性膝关节6只,年龄20～45岁,排除膝关节创伤和疾患,随机编号,分别行X线标准正侧位摄像、常规膝关节MRI扫描,将所得影像数据资料导入Unisight图象分析系统对相关指标进行测量并记录,然后将膝关节离断,直视下按照我院组织库的半月板测量方法进行测量并记录相关数据。X线测量指标包括：内侧胫骨平台矢状径、外侧胫骨平台矢状径、胫骨平台冠状径、内侧胫骨平台冠状径、外侧胫骨平台冠状径。MRI测量指标包括：胫骨平台冠状径、内侧胫骨平台冠状径、外侧胫骨平台冠状径、内侧胫骨平台矢状径、外侧胫骨平台矢状径、内外侧半月板的厚度（前角、体部、后角）、内外侧半月板的宽度（前角、体部、后角）。解剖学测量的指标包括：胫骨平台冠状径、内侧胫骨平台冠状径、外侧胫骨平台冠状径、内侧胫骨平台矢状径、外侧胫骨平台矢状径、内外侧半月板的厚度（前角、体部、后角）、内外侧半月板的宽度（前角、体部、后角）。结果在半月板测量的直接指标中,除内侧半月板体部宽度、内侧半月板前角厚度、外侧半月板体部厚度的MRI测量变异系数＜10%之外,所有指标变异系数均＞10%。外侧半月板后角宽度及外侧半月板前角宽度的MRI测量,变异系数分别为65.97%、70.26%。半月板测量的间接指标,变异系数均＜10%。半月板厚度的MRI测量总大于解剖学测量结果。3种测量方法的一致性方面存在关联,但仍有差异。结论半月板相关测量指标中,X线测量值均偏大,经MRI测量的指标与解剖学测量结果接近,MRI所测的半月板指标较X线测量指标更具准确性及稳定性,值得推荐其作为临床匹配性测量的方法,其中胫骨平台冠状径、内侧胫骨平台矢状径、外侧胫骨平台矢状径是稳定性最好的3个指标,变异系数均＜7%,且胫骨平台冠状径值得作为匹配性测量的首要指标。     

Periosteo-Temporofascial flap for cavity obliteration - first Indian study

Healing of the mastoid cavtiycompletely is the desired result after a mastoid surgery. Even after the Sade’s principles’ of the complete disease clearance, adequate lowering of the facial ridge, good meatoplasty and closure of the perforation of the tympanic membrane are fallowed, the complete healing of tike mastoid cavity is sometimes net the end result. According to various surgeons, the incidence of discharging mastoid cavity after a open cavity mastoid surgery is between /0-60%-H The usual techniques of obliteration of the mastoid cavity to decrease the size of the mastoid cavity, unusually has good healing results due to good vascularity. The failure ta the early detectmn 0/disease recurrence and risk of sudden appearance of intra-cranial complications are the most important disadvantages of the technique. We undertook a study in SO randomly chosen patients of Unsafe CSOM. Twenty five underwent obliteration of the mastoid cavity with Periosteo-Temporofascial flap, which is based on branches of posterior auricular artery and rest twenty five underwent non-obliteration of the mastoid cavity. Tfie results between the two groups were compared in terms of healing of the mastoid cavity and hearing gain after operation. Very good results in terms of healing of the cavity were seen after obliteration surgery. The rate of healing of the cavity was much faster after obliteration. The additional advantage with the flap is the see-through character of the cavity lining, which would lead to early detection of the disease recurrence. No significant increase in the hearing was seen in the obliterated patients as compared to non-obliterated cases.     

Non-Hodgkin's lymphoma of the uterus: apropos of 4 cases and review of the literature]

The primary non hodgkin's lymphoma of the uterus is rare. This rarity explains of one part certain difficulties of the histological diagnosis and on the other hand the absence of a therapeutic strategy clearly established. We report 4 cases of primary non-hodgkin lymphoma of the uterus. Two patients had a cervical location, the two other had corpus location. The average age of our patients is of 59 years (extremes: 54-68). Histological diagnosis was confirmed by biopsy for the cervical location. For the corpus location, it is study of the uterus after hysterectomy which retained the diagnosis of lymphoma. The type of the lymphoma was low grade in two cases and high grade in the two other cases. The disease was limited to the pelvis for all our patients (stage IE according to Ann-Arbor's classification). The treatment consisted of an association of chemotherapy and radiotherapy in both cases of lymphoma of the cervix and in a radical hysterectomy followed by chemotherapy for the two cases of lymphoma of the corpus. Our patients are regularly followed, with an average follow-up of 56 months. Two patients are in disease free, the third patient presented a dissemination of the disease and the fourth patient presented a squamous cell carcinoma of the lung.     

直肠癌的外科治疗进展

本文介绍直肠癌外科治疗的进展，探讨直肠癌外科治疗方面的一些重要问题，如保肛、膀胱和性功能的损伤和术后复发三个主要的难点。对于直肠癌手术的切缘问题、全系膜切除的概念、局部切除的手术指征、侧方淋巴结清扫的必要性以及直肠癌切除后结肠袋的重建等保肛手术，应把肿瘤的根治始终放在第一位，在不降低根治原则的前提下最大限度的提高保肛机率，应保证足够的下切缘和环形切缘；保护盆腔自主神经的手术的开展有利于减少膀胱和性功能的损伤；直肠癌的局部复发有很多因素值得考虑；直肠全系膜切除大大减少了直肠手术后的局部复发率；直肠肿瘤的局部切除应注意避免指征的过度扩大和缩小；侧方淋巴结清扫宜选择性开展；直肠癌切除后结肠袋的重建具有一定价值。     

Effect of N-phosphonacetyl-L-aspartate and D-glucosamine on the incorporation of 5-fluorouridine into normal tissues and an adenocarcinoma in the rat

Cytostatic treatment of liver metastases from colorectal cancer has been of limited value. Higher drug levels in the target substances of the tumor may improve the results. It was the aim of this investigation to examine the effect of PALA (N-phosphonacetyl-L-aspartate) and D-glucosamine on the level of uracil nucleotides in the liver and in an N-methyl-N-nitrosoguanidine-induced adenocarcinoma of the colon transplanted to the liver of rats, and on the incorporation of 3H-FUrd into the acid-soluble fraction, the RNA and the DNA of the tumor and of several normal tissues. Combined treatment with PALA and D-glucosamine reduced the UTP pool in the liver and the tumor. D-glucosamine alone increased UDP-N-acetyl-hexosamine in liver tissue. Pretreatment with PALA and D-glucosamine increased incorporation of 3H-FUrd into RNA of the liver and kidney, and into the DNA fraction of the liver, but had no effect on 3H-FUrd incorporation in the tumor.     

Application of video imaging for improvement of patient set-up.

BACKGROUND AND PURPOSE: For radiotherapy of prostate cancer, the patient is usually positioned in the left-right (LR) direction by aligning a single marker on the skin with the projection of a room laser. The aim of this study is to investigate the feasibility of a room-mounted video camera in combination with previously acquired CT data to improve patient set-up along the LR axis. MATERIAL AND METHODS: The camera was mounted in the treatment room at the caudal side of the patient. For 22 patients with prostate cancer 127 video and portal images were acquired. The set-up error determined by video imaging was found by matching video images with rendered CT images using various techniques. This set-up error was retrospectively compared with the set-up error derived from portal images. It was investigated whether the number of corrections based on portal imaging would decrease if the information obtained from the video images had been used prior to irradiation. Movement of the skin with respect to bone was quantified using an analysis of variance method. RESULTS: The measurement of the set-up error was most accurate for a technique where outlines and groins on the left and right side of the patient were delineated and aligned individually to the corresponding features extracted from the rendered CT image. The standard deviations (SD) of the systematic and random components of the set-up errors derived from the portal images in the LR direction were 1.5 and 2.1 mm, respectively. When the set-up of the patients was retrospectively adjusted based on the video images, the SD of the systematic and random errors decreased to 1.1 and 1.3 mm, respectively. From retrospective analysis, a reduction of the number of set-up corrections (from nine to six corrections) is expected when the set-up would have been adjusted using the video images. The SD of the magnitude of motion of the skin of the patient with respect to the bony anatomy was estimated to be 1.1 mm. CONCLUSION: Video imaging is an accurate technique for measuring the set-up of prostate cancer patients in the LR direction. The outline of the patient is a more accurate estimate of the set-up of the bony anatomy than the marker on the patient's abdomen.     

Variations of focal regions versus numbers and positions of sources in two-dimensional media

This paper explores the behaviour of the primary and secondary hot spots in homogeneous and two-dimensional inhomogeneous medium. Circular arrays are considered with a radius of up to five wavelengths. The number of sources and their positions in the array are varied, and the influence of these variations on the primary and secondary hot spots is observed. It is found that the primary hot spot reaches its final shape with the addition of a very small number of sources to the array. An increase in the number of sources results in a reduction of the normalized magnitude of the secondary hot spots, but the size of the normalized primary hot spot remains the same. An upper limit of sources in the array exists after which no further reduction of the secondary hot spots is observed. The finite-difference time-domain method (FDTD) is used to obtain the electric-field distribution in the inhomogeneous medium. A genetic algorithm is then applied to find the optimal positions of the antennae in the array.     

Vaccination against Human Papilloma Virus (HPV): Epidemiological Evidence of HPV in Non-genital Cancers

Recently, the vaccine against human papillomavirus (HPV) was introduced in the national vaccination programmes of several countries worldwide. The established association between HPV and the progression of cervical neoplasia provides evidence of the expected protection of the vaccine against cervical cancer. During the last two decades several studies have also examined the possible involvement of HPV in non-genital cancers and have proposed the presence of HPV in oesophageal, laryngeal, oropharyngeal, lung, urothelial, breast and colon cancers. The possible involvement of HPV in these types of cancer would necessitate the introduction of the vaccine in both boys and girls. However, the role of HPV in the pathogenesis of these types of cancer has yet to be proven. Moreover, the controversial evidence of the possible impact of the vaccination against HPV in the prevention of non-genital cancers needs to be further evaluated. In this review, we present an overview of the existing epidemiological evidence regarding the detection of HPV in non-genital cancers.     

Délais et retards à la radiothérapie : réflexion à propos de trois types de tumeurs

In the following review of the literature, the reasons and consequences of a tendency to the increase of the delay between the diagnosis and the first irradiation session will be studied. The duration of the delay varies according to the protocol of treatment, which itself depends on the tumour. Moreover, all types of radiotherapy are concerned by the increase in delay. A retrospective study enables to determine for a given series of similar tumours and treatments the mean duration of delay and find the excessive duration. The increase of delay phenomenon exists in different countries. We know that before irradiation the tumour grows according to its biological characteristics and the TNM initial determination will no longer be true. On the other hand, effective treatments such as chemotherapy and hormone therapy are increasingly used alone, before or in combination with radiotherapy. Consequently, the classical timing of radiation therapy could be modified often delayed. It is difficult to consider that successive treatments are a real increase of delay and compare its results with previous data from radiotherapy alone. We will study its impact in three types of tumours, including tumours of head and neck, of the breast and prostate, which are the most widely reported. The consequences of prolonged delay are not easily evaluated: one of the more important parameters is the possible modification of the stage of tumour. This phenomenon is not restricted to the studied types of tumours. We will try to find possible ways of reducing abnormal delays before irradiation.     

Ultrastructural changes in atrial myxoma

Ultrastructural changes of 20 cases of atrial myxoma were studied. Under the electron microscope, in a large amount of amorphous matrix, the myxomal cells were either scattered or aggregated. There were numerous microvilli-like cytoplasmic processes on the surface of the tumor cells. In many aspects, the ultrastructural features of the tumor cells were similar to those of the smooth muscle cells. The abundant cytoplasmic filaments were one of the most prominent ultrastructural features. Sometimes, some of them could form dense bodies. There were cytoplasmic filaments in the cytoplasmic processes of a certain tumor cells and lots of micropinocytic vesicles beneath the inner surface of the plasmic membrane. Nuclear membrane of the tumor cells often had marked indentation which was probably related to contraction of the cytoplasmic filaments. 2 of 20 lesions showed malignant characteristics. One lesion infiltrated into the atrial myocardium, and the other involved the left and right atria. It is suggested that the atrial myxoma be a true neoplasm of the atrium with potential malignant tendency. It originates from the multipotential mesenchymal tissue and differentiates mainly towards smooth muscle cells.     

Retrospective Studies on Clinical Features of Melanosis of the Colon and Its Correlation with the Polypus and Carcinoma of Large Intestine

OBJECTIVE To investigate the clinical characteristics of melanosis of the colon (MC) and its correlation with polypus and carcinoma of the large intestine.METHODS Clinical feature and colonoscopic findings of 156MC patients were retrospectively analyzed. Final diagnosis of MC case was made after colonoscopic and pathological examination,and data of the case history was recorded.RESULTS The overall detection rate of MC was 1.12%, with 0.46% in males, 0.66% in females. An 82.69% of the patients suffered various constipations and had a history of taking cathartics. The clinical manifestation of total-colon melanosis occurred in 83.97% of the patients. There was no significant difference between the rate of concomitant polypus (27.56%) in the MC patients and the detection rate of polypus in the patients who underwent a synchronous colonoscopy (x2= 1.205, P = 0.298).Also there was no significant difference between the detection rate of carcinoma of the large intestine (8.97%) in MC patients and the detection rate of the same disease in the patients who underwent synchronous colonoscopy (x2= 0.268, P = 0.604). A logistic regression analysis has shown that the older the age of MC patients is, the more opportunities of MC and the concomitant polypus would occur.CONCLUSION MC may be related to constipations and a long-term administration of cathartics, among which total-colon melanosis ranks first in the cases. There is an earlier age of onset in the females, with a higher detection rate. The older the age of the patients is, the higher the detection rate of MC is, and the more possibility the onset of the concomitant polypus.