Clinicopathological features and prognosis of advanced biliary carcinoma centered in the cystic duct

Background

Whether to classify “advanced (subserosal layer or greater invasion)” biliary carcinoma centered in the cystic duct (BCCD) as gallbladder carcinoma (GBC) or perihilar cholangiocarcinoma (PHCC) remains unclear.

Mechanisms for development of functional tricuspid regurgitation determined by pulsed Doppler and two-dimensional echocardiography

Mechanisms for the development of functional tricuspid regurgitation (TR) were studied in 41 patients by ultrasound. The severity of TR was classified into 4 grades according to the extent of the regurgitant signal by pulsed Doppler echocardiography (echo). No TR signal was detected in 11 patients;the grade of TR was 1+ in 9 patients, 2+ in 10, 3+ in 8 and 4+ in 9. Using 2-dimensional echo, the tricuspid anular area was estimated from a horizontal and a sagittal diameter of the anulus, and systolic configurations of the tricuspid valve was observed. The tricuspid anular area corrected for body surface area increased with the grade of TR. Anterior displacement of the tips of the tricuspid leaflets was seen in 10 patients with TR of 2+ or greater severity, and its frequency also increased with the grade of TR. Loss of coaptation was seen in 3 patients with 4+ TR and malaligned coaptation was seen in 4 patients with TR of variable degrees. Tricuspid anular dilatation and anterior displacement of the tricuspid leaflet tips causes a separation between the leaflet tips and appears to be the main mechanisms for the development of functional TR. Malaligned coaptation also plays a role in the development of functional TR.     

Acute and chronic effects of verapamil in patients with paroxysmal supraventricular tachycardia

Efficacy of acute intravenous verapamil, 10 mg, and chronic oral verapamil, 320 mg, daily were studied electrophysiologically in 15 patients with paroxysmal supraventricular tachycardia (PSVT). Plasma verapamil concentrations were measured concurrently. Both intravenous and oral verapamil significantly increased the AV node conduction time, the cycle length producing a Wenckebach period, and the refractory period of the AV node. These changes were reflected in changes in plasma verapamil concentration. The echo zone and the supraventricular tachycardia (SVT) zone markedly narrowed after administration of both intravenous and chronic oral verapamil. Verapamil's efficacy was found to be related to the type of SVT. For instance, verapamil was more effective in SVT due to AV nodal re-entry than in SVT due to concealed accessory pathway. Fourteen patients were followed from 3 to 31 months and all except one were well controlled. In conclusion, verapamil was effective in prophylaxis of paroxysmal SVT.     

Verification of the effectiveness of fucosylated haptoglobin as a pancreatic cancer marker in clinical diagnosis

BackgroundFucosylated haptoglobin detected by Pholiota squarrosa lectin (PhoSL) that had specificity for fucose α1-6 was reported as an effective biomarker for several gastrointestinal diseases. The aim of this study was to verify Fucosylated haptoglobin detected by Pholiota squarrosa lectin (PhoSL-HP) as a pancreatic cancer (PC) marker using a new method of PhoSL-ELISA.MethodsPhoSL-HP in sera from 98 PC patients and 158 non-PC samples including 32 intraductal papillary mucinous neoplasm (IPMN) patients, 21 chronic pancreatitis (CP) patients and 105 non-pancreatic disease controls (NPDC) were measured. We compared sensitivities, specificities and areas under the curves (AUC) of PhoSL-HP, CA19-9 and CEA as single markers. We also evaluated PhoSL-HP as combination marker by comparing AUC of CA19-9 combined with PhoSL-HP or CEA.ResultsThe sensitivities of PhoSL-HP, CA19-9 and CEA for PC were 58%, 76% and 42%, respectively. Although the specificity of PhoSL-HP for NPDC was inferior to both of CA19-9 and CEA, that for pancreatic diseases was higher than both of CA19-9 and CEA. Combined CA19-9 with PhoSL-HP, the AUC was significantly higher at 0.880 than single use of CA19-9 at 0.825 in case of distinguishing PC from other pancreatic diseases. In contrast, the AUC of CA19-9 was not elevated significantly when combined with CEA.ConclusionPhoSL-HP would be a useful marker for PC and have sufficient complementarity for CA19-9.     

Effect of thyroid hormone on the levels of erythrocyte carbonic anhydrase isozymes and 2,3-diphosphoglycerate in rabbits.

Levels of rabbit erythrocyte carbonic anhydrase B and C isozymes were determined in experimental hyperthyroidism using a quantitative immunologic technique. Levels of erythrocyte 2,3-diphosphoglycerate and protein binding iodine were simultaneously determined. Thyroxine and 3,5,3'-triiodothyronine were administered to rabbits orally for 30 days. A significant decrease in carbonic anhydrase B type was observed after 30 days, although no significant change was observed in carbonic anhydrase C type. These findings suggest that the steady state level of carbonic anhydrase B type in red cells is affected by thyroid hormone more readily than that of carbonic anhydrase C type. The level of red cell 2,3-diphosphoglycerate increased markedly after 10 days of treatment, corresponding to the increase of protein binding iodine. The clinical or pathologic significances were discussed in relation to the changes in the levels of these isozymes and 2,3-diphosphglycerate in red cells.     

Periodic variation in atrioventricular conduction time: Mechanisms of initiation,maintenance and termination of periods of long PR intervals

Five patients with periodic variation in atrioventricular (AV) conduction time are reported in whom periods of comparatively short PR intervals alternated with periods of comparatively long PR intervals. In all patients, the transition from a period of long PR intervals to a period of short PR intervals usually occurred without a blocked P wave. In 3 patients, however, the period of long PR intervals was occasionally terminated by a blocked P wave. The mechanisms of initiation, maintenance and termination of periods of long PR intervals are explained by the use of dual AV pathways consisting of fast and slow pathways. It is suggested that the effective refractory period of the fast pathway was abnormally prolonged by increased vagal tone and that, during the period of long P-R intervals, sinus impulses anterogradely passed only through the slow pathway and later retrogradely excited the fast pathway. Apparently, when vagal tone was decreased, the effective refractory period of the fast pathway was shortened, resulting in abrupt improvement in atrioventricular conduction without a blocked P wave.     

Biological and conditional factors should be included when defining criteria for resectability for patients with pancreatic cancer

BackgroundThis study aimed to evaluate novel resectability criteria for pancreatic ductal adenocarcinoma (PDAC) proposed by the International Association of Pancreatology (IAP) by comparing them with the National Comprehensive Cancer Network (NCCN) guidelines.Methods369 patients who underwent upfront surgery for PDAC were retrospectively analyzed. Overall survival (OS) of each group as defined by either of the guidelines were compared and preoperative prognostic factors for OS were identified.ResultsBased on the IAP-criteria, 157 patients were classified as resectable (R), 192 as borderline resectable (BR) and 20 as unresectable (UR), with the median survival time (MST) of 40 months, 17 and 11, respectively. In contrast to the NCCN-criteria, BR demonstrated significantly better OS than UR (P = 0.023) under the IAP-criteria. Performance status ≥2 (hazard ratio [HR]: 2.47, P = 0.014) and lymph node metastasis suspected by imaging (HR: 1.55, P = 0.003) were identified as independent prognostic factors by the multivariate analysis along with portal or arterial invasion, while carbohydrate antigen 19-9 ≥ 500 U/ml was not (HR: 1.23, P = 0.190).ConclusionThe IAP-criteria, which includes biological and conditional factors, resulted in superior separation of survival curves stratified by the resectablity when compared with the NCCN-criteria.     

Histological and molecular characterization of intrahepatic bile duct cancers suggests an expanded definition of perihilar cholangiocarcinoma

Background

Growing evidence has suggested that intrahepatic cholangiocarcinoma (iCCA) can be classified into small- and large-duct types. The present study aimed to elucidate how large-duct iCCA is similar and dissimilar to perihilar cholangiocarcinoma (pCCA).

Enhancer of zeste homolog 2 (EZH2) regulates tumor angiogenesis and predicts recurrence and prognosis of intrahepatic cholangiocarcinoma

Background

Enhancer of zeste homolog 2 (EZH2) is the catalytic subunit of the polycomb repressive complex 2 (PRC2) and regulates tumor malignancy by gene silencing via histone methylation. In this study we investigate the role of EZH2 in angiogenesis of intrahepatic cholangiocarcinoma (ICC).

Parenchyma-sparing liver resection for hepatocellular carcinoma in left lateral section is associated with better liver volume recovery

Background

Left lateral sectionectomy (LLS) is frequently performed for surgical treatment of hepatocellular carcinoma (HCC) located in the left lateral section. However, no reports have described liver resection for such HCCs using a parenchyma-sparing strategy involving anatomic resection (AR) of segment II (S2 AR) or segment III (S3 AR).

Second degree entrance block with supernormal conduction in intermittent ventricular parasystole

A patient with intermittent ventricular parasystole is reported in whom the presence of second degree entrance block with supernormal conduction was suggested for the first time. In this patient, ventricular extrasystoles with variable coupling frequently occurred. The QRS configuration of the extrasystoles was different from that of the parasystolic beats. When extrasystoles did not occur, the parasystolic beat was never seen because the conducted sinus impulse always reset the parasystolic rhythm. When an extrasystole occurred 0.52 sec or more after the preceding sinus beat, this extrasystolic impulse also reset the parasystolic rhythm. On the other hand, when an extrasystole occurred between 0.47 and 0.51 sec after the sinus beat, the parasystolic focus was protected from this extrasystolic impulse. When, however, an extrasystole occurred in a short terminal portion of the T wave of the preceding sinus beat, this extrasystolic impulse reset the parasystolic rhythm again, suggesting entrance block failure during the supernormal phase.     

“Color vectorcardiograms” recorded in 2 cases of inferior myocardial infarction

Two patients with inferior wall myocardial infarction are described in whom “color vectorcardiograms” in the horizontal plane were recorded with an apparatus we have devised. The dashes of the vector loop were colored to indicate variations in height of the deflections in the Y axis. In both cases, the early half of the QRS loop was mostly reddish in color, indicating that this segment of the loop, including its initial deflection, projected abnormally upward. Thus, the diagnosis of inferior wall myocardial infarction was made by the use of a colored vectorcardiogram in a single plane.     

Outcomes after vascular resection during curative-intent resection for hilar cholangiocarcinoma: a multi-institution study from the US extrahepatic biliary malignancy consortium

Background

Surgical resection is the cornerstone of curative-intent therapy for patients with hilar cholangiocarcinoma (HC). The role of vascular resection (VR) in the treatment of HC in western centres is not well defined.