Correlation between Dose and Tumor Response in the Radiotherapy of Lung Cancer of Various Histological Types

Correlation between dose and tumor response by cell types wasdetermined in 50 patients with lung cancer in order to predictthe possibility of further tumor regression. The TDF (time-dose-fractionation)concept was used as dose factor. The radiation source was a cobalt-60 -ray or linear accelerator10 MV X-ray. As a routine regime a fraction dose of 2 Gy fivetimes per week was given to 39 of the 50 patients, but a doseof 2 Gy three times per week or of 1.5 Gy five times per weekwas given to seven and four patients, respectively. Radiation response was the best in small cell carcinoma andbetter in adenocarcinoma than in squamous cell carcinoma, showinga tumor regression rate of 50% or more in 90%, 80% and 58% ofthe patients, respectively. The correlation between tumor regression rate and TDF valueswas good in squamous cell carcinoma (r=0.73) and small cellcarcinoma (r=- 0.72), but poor in adenocarcinoma (r=- 0.10).These results suggest that in squamous cell carcinoma improvementof tumor regression can be expected by increasing TDF values,and in adenocarcinoma and small cell carcinoma the optimal TDFvalues are about J00 and 60 to 80, respectively.     

Para-Hisian Pacing for a Pediatric Patient with a Congenitally Corrected Transposition of the Great Arteries (SLL)

We report a pediatric patient with a congenitally corrected transposition of the great arteries (ccTGA)(SLL) in which permanent para-Hisian pacing (PPHP) could improve dyssynchrony-associated systemic ventricular (SV) dysfunction resulting from permanent morphologic left ventricular pacing for complete atrioventricular block. Since, in patients with ccTGA(SLL), an elongated His-bundle runs medially toward the upper septum to the site of the fibrous continuity between the right-sided mitral valve and pulmonary artery, the His-bundle may easily be captured by a pacing lead, unlike in normal hearts. Thus, PPHP may be an effective therapeutic strategy for the treatment of dyssynchrony-associated SV dysfunction associated with ccTGA (SLL). (PACE 2010; e4–e7)     

An Enhanced Device for Transluminal Retrieval of Vascular Stents Without Surgical Procedures: Experimental Studies

Background: Although efforts have been focused on developing endovascular procedures by which intravascular devices such as stents could be effectively deployed, few data exist regarding devices for the nonsurgical retrieval of deployed stents. Therefore, we designed to enable retrieval of deployed stents without a surgical procedure. Methods: The device consisted of four components: ultra‐low profile forceps with 2.0 mm in diameter, conducting shaft with 1.8 mm in diameter, control handle by which the forceps is opened or closed, and a covering sheath. This device was designed to advance into the vessel lumen along a 0.014‐inch guidewire by over the wire fashion. Results: The forceps could firmly catch nonexpanded as well as expanded tubular‐type stents with open cells in an in vitro model that was 4.0 mm in diameter. Then, we used this device in porcine renal arteries with 2.5–5.0 mm in diameter. At first, a fragmented 0.014‐inch guidewire could be safely removed without vessel damage that was confirmed by intravascular ultrasound. This device could successfully remove four of five inappropriately and 11 of 14 appropriately deployed stents. Under these conditions, intravascular ultrasound demonstrated minor vessel wall dissection in two‐third of cases. Conclusions: These results demonstrate that the present device can be used for transluminal removal of foreign bodies such as nonexpanded as well as expanded stents in acute phase. Further miniaturization may enable using this type of device in the renal as well as coronary arteries. (J Interven Cardiol 2010;23:264–270)     

Urinary control after the definitive reconstruction of cloacal anomaly

PURPOSE: Urinary control after definitive repair of a cloacal anomaly is difficult to achieve. The present report aims to describe the clinical course of urinary control, and the need for the management of bladder dysfunction after reconstruction. METHODS: The present consecutive series consisted of 11 girls who underwent definitive repair of cloacal anomalies over a period of 11 years. Eight patients were associated with hydrocolpos. Radiological examination included a plain X-ray radiograph of the lumbosacral spine and a voiding cystourethrography with or without a urodynamic study. RESULTS: Reconstruction of the cloaca was performed on patients aged between 1 and 3 years using a posterior sagittal approach. Vaginal reconstruction was carried out 13 times in 11 patients using tubularized vaginal flap, distal rectal segment, perineal skin flap, or total urogenital sinus mobilization. Cystostomy or vesicostomy was carried out in four newborns/infants. Another seven patients could void spontaneously but incompletely with residual urine. Occult spinal dysraphism was found in five patients and hemisacrum in two patients. After definitive reconstruction, most patients acquired an adequate to normal bladder volume for 1-year-olds. Normal detrusor-sphincter function was seen in three patients. Detrusor areflexia was seen in two patients who underwent in utero vesico-amniotic shunt. Detrusor underactivity was observed in six patients. Bladder compliance was good in all patients except for one. No patients in the present series showed persistent urinary incontinence from the bladder neck or urethral dysfunction. CONCLUSION: It is postulated that wetting after definitive repair may be the result of overflow incontinence and poor bladder contractility rather than sphincter injury. The main clinical characteristic of bladder dysfunction was a failure to empty. We could not define the exact etiology, but iatrogenic injury from extensive dissection can lead to the higher risks of peripheral nerve damage. Accomplishment of definitive repair involves not only anatomical reconstruction, but also postoperative urinary control, including the initiation of clean intermittent catheterizations under repeated urodynamic evaluations.     

Micropapillary bladder cancer

A characteristic clinical course of a patient with micropapillary bladder cancer, a rare histological variant with high metastatic potential, is presented. An 80-year-old woman had locally advanced high-grade bladder cancer with a focal micropapillary variant identified which was treated with intra-arterial chemotherapy with radiation therapy. Standard follow-ups involving cystoscopy with cold-cup biopsies and computed tomography could not detail the bladder carcinoma; however, the patient died of carcinomatosis 20 months after treatment. At autopsy, carcinomas proliferated under benign mucosa and infiltrated diffusely in the retro peritoneum. This behavior differs from the normal pattern of invasive transitional cell carcinoma, which usually proliferates forming a mass lesion. Thus, it may be difficult to detect micropapillary bladder cancer by computed tomography which demonstrates only increased tissue density in retroperitoneal fascia; therefore, care should be taken in the follow-up of micropapillary bladder cancer.     

Influence of heart surgery on magnesium concentrations in pediatric patients

BACKGROUND: There have been only a few investigations into the effects of cardiopulmonary bypass (CPB) on the magnesium (Mg) concentrations in pediatric patients. The purpose of the present study was to compare the postoperative Mg concentrations and their recovery time to pre-surgical values in pediatric patients undergoing CPB for surgical repair of congenital heart disease. The incidence of dysrhythmia was also determined. METHODS: Twenty-seven pediatric patients undergoing open-heart surgery with CPB were enrolled in this study. Controls were 23 pediatric patients undergoing palliative surgery without CPB. Serum Mg (SMg) concentrations and ionized Mg (iMg) concentrations were measured at four sample points: 24 h before the surgery, immediately after the surgery, 24 h after the surgery and 48 h after the surgery. RESULTS: Serum Mg and iMg concentrations were significantly decreased after open-heart surgery. Immediately after the surgery, the mean SMg concentration was 64.1% and the mean iMg concentration was 68.8% of the pre-surgical values. The concentration of iMg showed quicker recovery than that of SMg, and returned to normal range 48 h after surgery. However, SMg and iMg concentrations after palliative surgery did not show significant differences from the pre-surgical values. The incidence of dysrhythmia was almost the same between the two groups; dysrhythmia was observed in two patients in the open-heart surgery group and in three patients in the palliative surgery group. CONCLUSIONS: Mg concentrations showed significant decrease after CPB; however, they showed quick recovery and did not increase the incidence of dysrhythmia in pediatric patients.     

T cells increase with gastric mucosal interleukin (IL)-7, IL-1, and Helicobacter pylori urease specific immunoglobulin levels via CCR2 upregulation in Helicobacter pylori gastritis

Background and Aims: The purpose of this study was to investigate possible factors that could impact on γδ T cell accumulation in the gastric mucosa. Method: Subjects were 22 Helicobacter pylori (H. pylori)‐free and 75 H. pylori‐infected mucosa biopsies classified into grades I～III gastritis as per our previous study. The number of γδ‐ and 45 RO‐positive T cells were determined by immunostaining. Gastric mucosal anti‐H. pylori urease specific antibodies and interleukin (IL)‐1β, IL‐2, 4, 7, 10 and IL‐12 levels were assayed by enzyme‐linked immunosorbent assay (ELISA). CC chemokine receptor 2 (CCR2) expression levels, migration, and cytokine production in γδ T cells stimulated by H. pylori urease were also evaluated. Results: The γδ T cell count was significantly higher in grade III gastritis which exhibits strong immunoglobulin (Ig)A and IgG responses to H. pylori urease with lymphoid follicles than in other groups. γδ T cell count was significantly correlated with IL‐1β and interleukin‐7 (IL‐7) levels in the gastric mucosa. H. pylori urease immunoreactivity was detected in lamina propria of grade III gastritis, along with many γδ T cells. After H. pylori eradication therapy, the γδ T cell count in grade III gastritis significantly decreased. H. pylori urease stimulated significant increases in CCR2 expression levels, although to a lesser degree than those induced by IL‐7 stimulation in both peripheral and mucosal γδ T cells. Interferon (IFN)‐γ and IL‐10 production was also stimulated by H. pylori urease in peripheral γδ T cells. Conclusions: Gastric mucosal increases in IL‐7 and IL‐1β closely corresponded to the accumulation of γδ T cells in gastric mucosa. An association was also seen between γδ T cell accumulation and H. pylori urease‐specific Ig levels.     

Application of cardiopulmonary bypass for resection of renal cell carcinoma and adrenocortical carcinoma extending into the right atrium

AIM: The application of cardiopulmonary bypass to atrial involvement represents an important advance that has improved the safety and technical efficacy of a difficult surgical undertaking. Our experiences of the management of extended thrombi into the right atrium in patients with retroperitoneal malignancy using a cardiopulmonary bypass were discussed. METHODS: Data were reviewed for five patients (two men and three women; mean age, 60.4 years; range, 49-79 years) with retroperitoneal tumors displaying intracardiac tumor extension. Tumors originated in the right kidney in four patients, and in left adrenal gland in one patient. Cardiopulmonary bypass was used in all cases. RESULTS: Mean total blood loss was 6059 mL. Mean operative time was 14.7 h. No intra- or postoperative complications due to surgical technique were encountered, and no significant bleeding occurred during incision of the inferior vena cava or after removal of tumor thrombus. The follow-up period ranged from 3 to 20 months with a mean of 12.6 months. Of the five patients, three died of metastatic diseases, one died of liver dysfunction and one remains disease free as of 18 months postoperatively. CONCLUSIONS: Our experience indicates that this procedure can be safely used for atrial involvement. Although superior long-term survival cannot be shown yet, favorable early results and a lack of perioperative complications were identified.     

Foods and beverages in relation to urothelial cancer: Case-control study in Japan

BACKGROUND: The roles of several foods and beverages in the development of bladder cancer remain unclear. METHODS: We undertook a hospital-based case-control study at Aichi Cancer Center Hospital, Japan. Subjects included 124 men and women (bladder cancer cases) with newly diagnosed cancers of the renal pelvis (n = 5), ureter (n = 6) or bladder (n = 113) and 620 age- and sex-matched, cancer-free outpatients (controls) presenting at the hospital in the period from 1994 to 2000. Smoking-adjusted odds ratios (OR) were estimated to assess the strength of associations between self-reported intake of foods or drinks and bladder cancer risk, using conditional logistic models. RESULTS: We found a decreased risk in relation to frequent intake of green-yellow vegetables; the OR for the highest intake score compared with the lowest was 0.54 (95% confidence interval [CI] 0.29-0.99). The OR for carrot intake of >/=5 times/week compared with 相似文献