Histological features of primary tumors after induction or high-dose chemotherapy in high-risk neuroblastoma

Purpose

In the recent years in Japan, an increasing number of patients with neuroblastoma (NB) are being treated by the “delayed local treatment (DL)” policy, undergoing surgery after the completion of high-dose chemotherapy with hematopoietic stem cell rescue (HDC). We reviewed the histopathological findings of second-look operations, including those of patients treated with DL.

Patients

From 1998 to 2013, 26 patients with high-risk NB underwent radical operation following chemotherapy. Surgery was performed after induction chemotherapy in 17 cases (standard; STD), whereas 9 cases completed induction chemotherapy and HDC before undergoing tumor resection (DL). The amount of necrosis and the degree of differentiation within the post-treatment tumor were assessed.

Results

Eighty-eight percent of the tumors showed necrosis in more than 1/3 of the specimen. Two DL cases showed complete disappearance of viable tumor cells. Amount of necrosis did not affect the prognosis of the patient. Tumors with immature, poorly differentiated phenotypes showed an extremely aggressive thereafter. Though not statistically proven, ¹²³I-MIBG (metaiodobenzylguanidine) uptake may be correlated with the amount of viable cells remaining within the tumor, but not with the degree of differentiation.

Conclusions

Our results support the previous reports advocating that tumors that sustain unfavorable histology after chemotherapy behave aggressively thereafter.     

Motivation of primary care physicians for participating in early intervention for psychosis in Japan

People with psychosis as represented by schizophrenia experience lengthy delays between the onset and the start of treatment. This duration is called Duration of Untreated Psychosis (DUP). Since it has been indicated that shorter DUP leads to their better prognosis, early intervention has been a hot topic for decades in clinical psychiatry. In Japan, as any patient can visit either specialists or primary care physicians using medical insurance, a considerable portion of psychosis patients are supposed to visit the latter first. Thus, a role of primary care physicians seems keys of success in implementation of early intervention system in the Japanese society. In this study, to clarify the motivation of physicians to participate in early intervention, we sent postal questionnaires to 4030 private clinics throughout Japan, inquiring physicians' situations around psychiatric disorders. Seven hundred and fourteen questionnaires were used for analysis (17.7%). Among these 714 respondents, 364 (51.0%) reported that they have willingness to participate in early intervention. Similarly, 494 (69.2%) were interested in psychiatric disorders, whereas only 168 (23.5%) were confident in identifying schizophrenia. The interest in psychiatric disorders was most strongly associated with their willingness to participate (Odds ratio = 3.54 by logistic regression analysis). These results, therefore, suggest that the interest in psychiatric disorders motivates them to participate in early intervention for psychosis; this has considerable implications for future approach to build up early intervention system in Japan.     

Surgical-site infection risk in oncologic digestive surgery

Surgical-site infection (SSI) is the most prevalent type of hospital infection in surgical patients and is associated with an increase in hospital stay, costs and morbidity/lethality. The knowledge of the main risk factors for this type of infection is important for the establishment of prevention measures regarding modifiable risks factors. The objective of the preset study was to assess the occurrence of SSI and study the risk factors in oncologic surgeries of the digestive system at Hospital de Câncer in Barretos, São Paulo, Brazil. Individuals undergoing oncologic surgeries of the digestive system in the period of 08/01/2007 to 08/10/2008 were prospectively followed for 30 days after surgery. Possible risk factors related to the patient and to the surgical procedure were also studied. A total of 210 surgeries were analyzed, with a global SSI incidence of 23.8%. The following variables were independently associated with SSI: time and type of surgery, radiotherapy before surgery and surgeon's years of experience. The risk factors found in this study have been described by other authors and are not amenable to intervention for SSI prevention. Further studies are recommended with the objective of investigating interventions that could reduce the risk for SSI in this type of surgery.     

Effects of spironolactone during an angiotensin II receptor blocker treatment on the left ventricular mass reduction in hypertensive patients with concentric left ventricular hypertrophy.

BACKGROUND: Angiotensin II receptor blockers (ARB) are now commonly used to treat hypertension because of their beneficial effects on cardiovascular remodeling. However, ARB treatment can not inhibit the left ventricular (LV) remodeling sufficiently, which may be related with aldosterone secretion. To inhibit the action of aldosterone during ARB treatment, the additional effects of an aldosterone blocker and spironolactone (SPRL) on LV hypertrophy in patients with essential hypertension was studied. METHODS AND RESULTS: The patients with essential hypertension were randomly divided into 2 groups; 1 group was treated with an ARB, candesartan (8 mg/day), for 1 year (ARB group) and other group was treated with the ARB for the first 6 months and with the ARB plus SPRL (25 mg/day) for the next 6 months (combination group). Seventy patients who underwent echocardiography every 6 months were analyzed and were also classified into 4 subgroups of LV geometric pattern according to the LV mass index (LVMI) and the relative wall thickness (RWT). The ARB treatment and the addition of SPRL significantly reduced the blood pressure, however, both treatments did not affect the LV geometry in both groups. The ARB treatment in the subgroups of concentric LV remodeling (RWT>or=0.45 and LVMI<125) and concentric LV hypertrophy (RWT>or=0.45 and LVMI>or=125) significantly reduced RWT. However, ARB treatment in all subgroups did not affect LVMI. The addition of SPRL only in the concentric LV hypertrophy subgroup significantly reduced the LVMI, despite similar changes in blood pressure. CONCLUSIONS: These results indicated that the addition of SPRL treatment during the ARB treatment and conventional treatments is clinically useful to reduce the LVMI in hypertensive patients with concentric LV hypertrophy; however, does not improve the eccentric LV hypertrophy.     

Histopathological and genetic differences between polypoid and non-polypoid submucosal colorectal carcinoma

AIM： To investigate the histopathological and geneticdifferences between polypoid growth （PG） and nonpolypoid growth （NPG） submucosal invasive colorectal carcinoma （CRC）.
METHODS： A total of 96 cases of submucosal CRC were divided into two groups according to their growth type;60 cases of PG and 36 cases of NPG. The size, histological degree of dysplasia, depth of submucosal invasion and lymph node metastasis were compared between the two groups. Furthermore, expression of p53 was detected by immunohistochemical staining, and K-ras gene mutation was examined by polymerase chain reaction based single-strand conformation polymorphism （SSCP）.
RESULTS： The average size of the lesions in the NPG group was significantly smaller than those in the PG group （7.5 mm vs 13.8 mm, P 〈 0.001）. The histological degree of dysplasia tended to be more severe in NPG group, while the incidence of submucosal massive invasion and the lymph node metastasis were both significantly higher in the NPG type than in the PG group （64.3% vs 43.3%, P = 0.004; 43% vs 7%, P =0.008, respectively）. In addition, K-ras gene mutations were detected in 67% of lesions in the PG group, but none in the NPG group, while no difference in p53immunohistochemical expression was found between the two groups.
CONCLUSION： Compared with PG submucosal CRC,NPG type demonstrates more frequent submucosal massive invasion, more lymph node metastasis and a higher degree dysplasia. Genetically, NPG type shows much less frequent K-ras mutation.     

A novel technique for catheter engagement of protruding aorto‐ostial stent

We present a case of stenoses in the right coronary artery with a previously deployed stent showing gross protrusion into the aorta. Despite difficulty in cannulation of a guiding catheter into the coronary artery, percutaneous intervention was accomplished using a novel technique to engage the protruding stent. © 2013 Wiley Periodicals, Inc.     

Effects of oral tacrolimus as a rapid induction therapy in ulcerative colitis

AIM:To determine the efficacy and safety of rapid induction therapy with oral tacrolimus without a meal in steroid-refractory ulcerative colitis(UC)patients.METHODS:This was a prospective,multicenter,observational study.Between May 2010 and August 2012,49 steroid-refractory UC patients(55 flare-ups)were consecutively enrolled.All patients were treated with oral tacrolimus without a meal at an initial dose of 0.1mg/kg per day.The dose was adjusted to maintain trough whole-blood levels of 10-15 ng/m L for the first 2 wk.Induction of remission at 2 and 4 wk after tacrolimus treatment initiation was evaluated using Lichtiger’s clinical activity index(CAI).RESULTS:The mean CAI was 12.6±3.6 at onset.Within the first 7 d,93.5%of patients maintained high trough levels(10-15 ng/m L).The CAI significantly decreased beginning 2 d after treatment initiation.At 2wk,73.1%of patients experienced clinical responses.After tacrolimus initiation,31.4%and 75.6%of patients achieved clinical remission at 2 and 4 wk,respectively.Treatment was well tolerated.CONCLUSION:Rapid induction therapy with oral tacrolimus shortened the time to achievement of appropriate trough levels and demonstrated a high remission rate 28 d after treatment initiation.Rapid induction therapy with oral tacrolimus appears to be a useful therapy for the treatment of refractory UC.     

Conservative reduction by lever action of chronic bilateral mandibular condyle dislocation

Aims:

The treatment of long-standing dislocation of the temporomandibular joint is broadly classified into open reduction and closed reduction. The current study presents a case of long-standing dislocation of the temporomandibular joint treated 3 years after dislocation. In this study, the authors evaluated the long-term outcome of conservative reduction by lever action of chronic bilateral mandibular condyle dislocation.

Methodology:

Manual repositioning of temporomandibular joint dislocation lasting for 3 years in a 31-year-old woman was attempted without success; therefore, conservative reduction by lever action was carried out because the patient declined treatment under general anesthesia.

Results:

The treatment was discontinued after 6 days because of the subluxation of the retaining tooth. The retainer was changed from tooth to screw for intermaxillary fixation, and treatment was reinstituted. Fifteen days later, reduction was achieved and retention was started and continued for 2 months. The outcome was good, with no recurrent dislocation within 24 months of the treatment.

Conclusions:

Conservative reduction by lever action, involving minimally invasive treatment and little dysfunction, should be considered an optional conservative treatment.