Correlation between serum immunosuppressive substance and clinico-pathological findings in patients with gastric carcinoma

Serum levels of immunosuppressive substance (IS) were determined in 99 patients with gastric cancer and in 32 healthy individuals. The serum IS levels in the patients (769.6 +/- 314.8 micrograms/ml) were significantly higher than those in the healthy individuals (549.7 +/- 104.7 micrograms/ml). A multivariate analysis on the correlation between serum IS levels and clinicopathological findings in the patients disclosed that there was a close correlation between the serum IS levels and the depth of invasion, in particular, the prognostic serosal invasion, metastasis to the distal lymph nodes and peritoneal dissemination. There was, however, no correlation between the serum IS level and hepatic metastasis. Serum IS levels were higher in patients with well-differentiated adenocarcinoma than in those with poorly differentiated adenocarcinoma or signet ring cell carcinoma. A serum IS level higher than 1000 micrograms/ml indicates the possibility that the tumor is only palliatively resectable because of involvement of the distal lymph nodes or peritoneal dissemination.     

Clinical significance of serum immunosuppressive substance as a marker of colorectal cancer

Serum immunosuppressive substance (IS) was determined in 95 patients with colorectal cancer, 61 patients with benign gastrointestinal diseases and 32 healthy individuals. Serum carcinoembryonic antigen (CEA) was determined in 79 patients with colorectal cancer and 53 patients with benign gastrointestinal diseases. Serum IS in healthy individuals was 549.7 +/- 104.7 micrograms/ml, and 800 micrograms/ml (mean 'SD) was defined as cut-off value for positive serum IS. Cut-off values for serum CEA was defined as 2.5 ng/ml. The present study disclosed that determination of serum IS can not be used as a screening test for colorectal cancer, but combination assay of both serum IS and CEA improved the sensitivity of the test detecting colorectal cancer. Curative resection was possible in most patients with serum IS less than 1100 micrograms/ml, whereas resection was palliative or impossible in most patients with serum IS more than this value. Elevation of serum IS correlated closely with peritoneal dissemination, serosal invasion or extensive nodal metastasis. There was however, no correlation between the serum IS level and liver metastasis.     

Peritoneal Dissemination of Early Gastric Cancer: Report of a Case

Recurrence of early gastric cancer is rare, with an incidence of less than 10% in Japan. Using peritoneal lavage cytological examination, we detected tumor cells in the peritoneal cavity of a 73-year-old man undergoing surgery for early gastric cancer. Peritoneal dissemination of early gastric cancer is rare. Thus, we summarized the clinicopathological findings of the total 15 cases of peritoneal dissemination of early gastric cancer documented in the English medical literature, including this case. All of the patients had a tumor size >2 cm, submucosal invasion, differentiated adenocarcinoma, lymph node metastasis, and a shorter disease-free interval (average 33.1 months) than patients with other types of recurrent early gastric cancer, and the involvement of both recurrent lymph nodes and peritoneal dissemination. Based on this analysis, we conclude that patients with early gastric cancer, especially if the tumor is >2 cm with submucosal invasion, should be examined carefully for any form of recurrence.     

Preoperative Serum Angiopoietin-2 Levels Correlate with Lymph Node Status in Patients with Early Gastric Cancer

Background  Lymph node metastasis is the most important factor to consider when deciding on the modality of resection in patients with early gastric cancer. The aim of the present study was to assess the relationship between preoperative serum angiopoietin-2, a lymphangiogenic growth factor, and lymph node metastasis in patients with early gastric cancer. Methods  A total of 62 preoperative serum samples from patients diagnosed with early gastric adenocarcinoma, and 30 serum samples from healthy donors were obtained. The serum levels of angiopoietin-2 (Ang-2) were quantified by immunoassay. Intra- and peritumor lymphatic vessel density (I-LVD and P-LVD) were counted after immunohistochemical staining. The relationship between the serum Ang-2 levels and other prognostic variables (tumor size, histological type, depth of tumor invasion, I-LDV, P-LDV, presence of lymph node involvement, and distant metastasis) were then examined by univariate and multivariate linear regression analyses. Results  The median serum levels of Ang-2 in patients were higher than those of healthy controls [311.1 ng/mL, interquartile range (IQR) 256.7–311.1 ng/mL versus 286.5 ng/mL, IQR 226.9–286.5 ng/mL; Mann–Whitney test, P = 0.016]. Eight patients had metastatic lymph nodes; the Ang-2 levels from the patients with metastatic lymph nodes were higher than from those with negative lymph nodes (297.5 ng/mL, IQR 251.1–385.8 ng/mL versus 416.0 ng/mL, IQR 337.1–485.5 ng/mL; Mann–Whitney test, P = 0.019). Elevated serum Ang-2 levels were associated with positive lymph node involvement and this finding was significant on univariate (P = 0.008) and multivariate logistic regression analysis (P = 0.011). Conclusion  Serum Ang-2 levels were clinically useful markers for lymph node metastasis in patients with early gastric cancer.     

Sentinel node mapping during laparoscopic distal gastrectomy for gastric cancer

Background The goal of this study was to evaluate the feasibility and accuracy of sentinel node (SN) mapping with endoscopic submucosal blue dye injection during laparoscopic distal gastrectomy for gastric cancer. Methods Thirty-four patients affected by gastric adenocarcinoma without gross clinical serosal invasion and distant metastasis were prospectively enrolled. At the start of the surgery, 2 ml of 2% patent blue was endoscopically injected into the submucosal layer at four points around the site of the primary tumor. Sentinel nodes were defined as nodes that were stained by the blue dye within 5–10 min after the dye injection. After identification and removal of sentinel lymph nodes, each patient underwent laparoscopic distal gastrectomy with D1 (n = 2) or D2 (n = 32) lymphadenectomy. Results Of the 34 patients, 14 had positive nodules (41%). SNs were detectable as blue nodes in 27 (80%) of 34 patients. The mean number of dissected lymph nodes per patient was 31 ± 10 (range = 16–64) and the mean number of blue nodes was 1.5 (range = 1–4). Only five (sensitivity 36%) of 14 N(+) patients had at least one metastatic lymph node among the SNs identified. In these 14 patients the sentinel node was traced in 12 cases. Sentinel node status diagnosed the lymph node status with 74% accuracy. In early gastric cancer (n = 18), three patients had lymph node metastasis. These early gastric cancer patients with nodal metastases had at least one metastatic lymph node among the SNs identified (sensitivity 100%). Conclusions Blue dye SN mapping during laparoscopic distal gastrectomy seems to be a feasible and accurate diagnostic tool for detecting lymph node metastasis in patients with early-stage gastric cancer in which the accuracy of the method was 100%. However, in more advanced gastric cancer the results are not satisfactory. Validation of this method requires further studies on technical issues, including selection of the tracers.     

High serum adiponectin concentration in children with chronic kidney disease

Adiponectin (ADPN) counteracts the inflammatory response of the endothelium, which plays an important role in the development of atherosclerosis in patients with chronic kidney disease (CKD). Data in children with CKD are scarce. We examined serum ADPN concentration in 90 children with various renal disorders: 28 with CKD on conservative treatment (CKD), 21 on regular dialysis treatment (D), and 41 after kidney transplantation (Tx); 27 age-matched healthy children served as controls (C). Body mass index (BMI), estimated glomerular filtration rate (eGFR), lipids, homocysteine, high sensitivity CRP (hsCRP), and systolic blood pressure (SBP) were also measured. Mean serum ADPN concentration was significantly higher in patients with CKD (27.3 μg/ml ±15.0), on D (34.2 μg/ml ±14.9), and after Tx (23.6 μg/ml ±9.5) compared with ADPN levels in C (13.5 μg/ml ±6.1) (p < 0.0001). Serum ADPN concentration was inversely related to BMI (p = 0.001) and SBP (p = 0.004). In the multiple linear regression analysis, only SBP remained independently associated with ADPN plasma levels. Data show that children with CKD have significantly higher serum ADPN, even after Tx. The protective antiarthrosclerotic effect of ADPN may be mediated by lower SBP, a finding that deserves further study.     

Elevated serum pro-MMP2 levels in patients with stage IV thymoma

Abstract. Purpose: There is increasing evidence that matrix metalloproteinases (MMPs) play important roles in tumor invasion and metastasis. Using a one-step sandwich enzyme immunoassay, we investigated whether serum pro-MMP2 levels could be predictors of the development and extension of thymoma. Methods: The subjects of this study were 33 patients with thymoma and 26 patients with nonmalignant thoracic disease. Results: Serum pro-MMP2 levels were elevated in patients with stage IV thymoma (938.6 ± 80.2 ng/ml) compared with those in the controls (P= 0.03). Patients with stage IVb thymoma had significantly higher serum pro-MMP2 levels than patients with other stages, being 1088.7 ± 440 ng/ml in stage IVb, 686.0 ± 74.0 ng/ml in stage I (P= 0.01), 685.8 ± 48.6 ng/ml in stage II (P= 0.01), and 691.7 ± 74.0 ng/ml in stage III (P= 0.02). Serum pro-MMP2 levels were elevated in patients with polygonal cell type thymoma compared with those with mixed cell type thymoma, being 823.1 ± 55.5 ng/ml vs 613.6 ± 59.9 ng/ml, respectively (P= 0.04). Using the reference limit of 850 ng/ml (mean ± 2SD) set from analyses in the control group, all patients who had pro-MMP2 levels below the cutoff level survived. On the other hand, four of nine patients who had an elevated pro-MMP2 level died from recurrence. Conclusion: Serum pro-MMP2 levels may serve as a marker that could be used as an indicator of distant metastases in thymoma. Elevated pro-MMP2 levels may be correlated with poor survival. Received: June 29, 2001 / Accepted: November 20, 2001     

Pattern of lymph node involvement and prognosis in pancreatic adenocarcinoma: direct lymph node invasion has similar survival to node-negative disease

Lymph node status is one of the most important predictors of survival in pancreatic ductal adenocarcinoma. Surgically resected pancreatic adenocarcinoma is often locally invasive and may invade directly into peripancreatic lymph nodes. The significance of direct invasion into lymph nodes in the absence of true lymphatic metastases is unclear. The purpose of this study was to retrospectively compare clinical outcome in patients with pancreatic ductal adenocarcinoma with direct invasion into peripancreatic lymph nodes with patients with node-negative adenocarcinomas and patients with true lymphatic lymph node metastasis. A total of 380 patients with invasive pancreatic ductal adenocarcinoma classified as pT3, were evaluated: ductal adenocarcinoma with true lymphatic metastasis to regional lymph nodes (248 cases), ductal adenocarcinoma without lymph node involvement (97 cases), and ductal adenocarcinoma with regional lymph nodes involved only by direct invasion from the main tumor mass (35 cases). Isolated lymph node involvement by direct invasion occurred in 35 of 380 (9%) patients. Overall survival for patients with direct invasion of lymph nodes (median survival, 21 mo; 5-year overall survival, 36%) was not statistically different from patients with node-negative adenocarcinomas (median survival, 30 mo; 5-year overall survival, 31%) (P=0.609). Patients with node-negative adenocarcinomas had an improved survival compared with patients with lymph node involvement by true lymphatic metastasis (median survival, 15 mo; 5-year overall survival, 8%) (P<0.001) regardless of the number of lymph nodes involved by adenocarcinoma. There was a trend toward decreased overall survival for patients with 1 or 2 lymph nodes involved by true lymphatic metastasis compared with patients with direct invasion of tumor into lymph nodes (P=0.056). However, this did not reach statistical significance. Our results indicate that patients with isolated direct lymph node invasion have a comparable overall survival with patients with node-negative adenocarcinomas as opposed to true lymphatic lymph node metastasis.     

Pancreatoduodenectomy for Distal Cholangiocarcinoma: Prognostic Impact of Lymph Node Metastasis

Background The aim of this study was to identify useful prognostic factors in patients undergoing pancreatoduodenectomy for distal cholangiocarcinoma. Methods The records of 36 patients with distal cholangiocarcinoma undergoing pancreatoduodenectomy were retrospectively reviewed. Potential clinicopathological prognostic factors that may affect survival were examined by univariate and multivariate analysis. Results There was no mortality. Overall survival rates were 75%, 54%, and 50% for 1, 3 and 5 years, respectively (median survival time, 26 months). Univariate analysis found that age (≧ 65 years), pancreatic invasion, duodenal invasion, lymph node metastasis, perineural invasion and a positive surgical margin were significant predictors of poor prognosis (P < 0.05). Furthermore, lymph node metastasis was found to be a significant independent predictor of poor prognosis by multivariate analysis (P = 0.043). Moreover, there were significant differences in the 5-year survival between patients with 2 or less involved lymph nodes and those with 3 or more positive nodes (P < 0.001). There were no 2-year survivors of the group of patients with 3 or more positive nodes. Conclusions These results suggest that the presence and number of lymph nodes exhibiting metastatic disease might be useful in predicting the postsurgical outcome in patients undergoing pancreatoduodenectomy for distal cholangiocarcinoma.     

Liver metastasis as an initial recurrence has no impact on the survival of patients with resectable pancreatic adenocarcinoma

Background  Prognosis of the patients with pancreatic adenocarcinoma is still poor due to a recurrence, and liver metastasis is a distant metastasis that is foreboded the short survival period. Methods  Between 1999 and 2005, 68 patients for pancreatic adenocarcinoma underwent a pancreaticoduodenectomy (n = 17), a pylorus-preserving pancreaticoduodenectomy (n = 27), distal pancreatectomy (n = 22), or total pancreatectomy (n = 2) with an extensive lymph node dissection. Results  A tumor recurrence occurred to 55 patients (13 of the liver, 21 of the local recurrence, 16 of peritoneal dissemination, three of the lymph node, and two of lung). The low tumor grade and female demonstrated a risk factor for a liver metastasis (P = 0.043, P = 0.031). A logistic regression analysis demonstrated female (P = 0.02) and low tumor grade (P = 0.04) as independent risk factors for recurrence with liver metastasis. The median survival time (MST) was 13.6 months, and MST of patients with a liver metastasis as an initial recurrent site was 13.7 months; the liver metastasis as an initial recurrent site has no impact on the MST after pancreatic resection. Conclusions  We concluded potentially supporting the hypothesis that even patients thought to be at higher risk of liver metastasis may still be given the chance of resection, considering the satisfying survival.     

结肠癌患者术前血清间皮素水平表达的临床意义

目的 探讨结肠癌患者术前血清间皮素水平表达差异.方法 选取2014年3月-2016年6月本院收治的首次诊断为早期结肠癌患者125例(病例组)和健康者75例(对照组).酶联免疫吸附法法检测病例组术前和对照组体检时血清间皮素水平.采用受试者工作曲线分析血清间皮素对结肠癌的诊断价值;Kaplan-Meier法和Log-rank检验分析生存资料.结果 对照组血清间皮素水平显著低于病例组[分别为(0.91 ±0.80) pg/ml和(7.63±3.25) pg/ml,t=17.57,P＜0.001].病例组肿瘤大小、TNM分期、浸润深度、淋巴结转移、远端转移患者的血清间皮素水平差异均有统计学意义(均P ＜0.05).术前血清间皮素预测结肠癌的最佳诊断界值为2.36 pg/ml,术前血清间皮素预测结肠癌进展的最佳诊断界值为8.62 pg/ml.以临界值8.62 pg/ml将125例结肠癌患者分为低血清间皮素组(n=56,间皮素≤8.62 pg/ml)和高血清间皮素组(n=69,间皮素≥8.62 pg/ml),两组生存期比较差异有统计学意义(t=36.01,P＜0.001).结论 间皮素可能足潜在诊断结肠癌及其进展的血清生物标志物.     

The uptake of anticancer drugs by tumor tissues and lymph node and the effectiveness of postoperative adjuvant chemotherapy on survival time

Forty-one patients with advanced gastric cancer underwent gastrectomy and the correlation between tissue uptake of the adjuvant drug and the prognosis were studied. The patients were preoperatively administered Tegafur (Futraful, Taiho Pharmaceutical Co. Ltd, Japan) and samples of tissue were obtained intraoperatively. 5-FU levels in the tumor and lymph nodes were measured by gas chromato-massfragmentography (GCMF). The patients in whom the 5-FU uptake by the tissues was measured and who were given over 60 g of Tegafur as postoperative adjuvant chemotherapy, were divided into two groups; namely, one group in whom the 5-FU uptake by the tumor tissue and lymph nodes was over 0.05 μg/g and the other in whom the uptake was lower than 0.05 μg/g. There were no significant differences in the background factors of either group. Each survival rate was calculated by the Kaplan-Meier method, and the generalized Wilcoxon method was used for statistical analysis. There was no statistically significant correlation between the 5-FU uptake by the tumor and the prognosis, however the 5-year survival rate in the group whose 5-FU uptake of the lymph nodes was over 0.05 μg/g was statistically significant (p=0.018).     

Clinical value of diagnostic laparoscopy with laparoscopic ultrasound in patients with cancer of the esophagus or cardia

Accurate pretherapeutic tumor staging becomes increasingly important for the selection of therapy in patients with cancer of the upper gastrointestinal tract. We prospectively assessed the clinical value of diagnostic laparoscopy with laparoscopic ultrasound and peritoneal lavage in 127 consecutive patients with cancer of the esophagus or cardia but no evidence of hepatic metastases, peritoneal tumor dissemination, or other systemic tumor manifestations on standard staging techniques. There was no mortality or morbidity associated with diagnostic laparoscopy. Diagnostic laparoscopy with laparoscopic ultrasound showed relevant previously unknown findings, particularly in patients with locally advanced adenocarcinoma of the distal esophagus or cardia (hepatic metastases in 22% and peritoneal tumor spread or free tumor cells in the abdominal cavity in 25%), whereas the diagnostic gain was low in those with squamous cell esophageal cancer. The sensitivity and specificity of laparoscopic ultrasound in predicting positive celiac axis lymph nodes were 67% and 92%, respectively. These data indicate that diagnostic laparoscopy with laparoscopic ultrasound and peritoneal lavage is safe and frequently provides therapeutically relevant new information in patients with locally advanced adenocarcinoma of the distal esophagus or cardia, whereas the clinical value in patients with squamous cell esophageal cancer is limited. Presented at the Thirty-Seventh Annual Meeting of The Society for Surgery of the Alimentary Tract, San Francisco, Calif., May 19–22, 1996.     

Prostate specific antigen in the diagnosis and treatment of adenocarcinoma of the prostate. II. Radical prostatectomy treated patients

Serum prostate specific antigen was determined (Yang polyclonal radioimmunoassay) in 102 men before hospitalization for radical prostatectomy. Prostate specimens were subjected to detailed histological and morphometric analysis. Levels of prostate specific antigen were significantly different between patients with and without a Gleason score of 7 or greater (p less than 0.001), capsular penetration greater than 1 cm. in linear extent (p less than 0.001), seminal vesicle invasion (p less than 0.001) and pelvic lymph node metastasis (p less than 0.005). Prostate specific antigen was strongly correlated with volume of prostate cancer (r equals 0.70). Bivariate and multivariate analyses indicate that cancer volume is the primary determinant of serum prostate specific antigen levels. Prostate specific antigen was elevated 3.5 ng. per ml. for every cc of cancer, a level at least 10 times that observed for benign prostatic hyperplasia. Prostate specific antigen is useful as a preoperative marker because no patient with lymph node metastasis had serum levels of less than 10 ng. per ml. (4 times the upper limit of normal range). Of the patients with greater than 50 ng. per ml. two-thirds had microscopic lymph node metastasis and 90 per cent had seminal vesicle invasion. Serum prostatic acid phosphatase levels showed a significantly weaker correlation with cancer volume (r equals 0.51) and every other pathological parameter. Of the patients 73 per cent had serum prostatic acid phosphatase levels in the normal range (0 to 2.1 ng. per ml.), including 7 per cent who had pelvic lymph node metastasis. Postoperative prostate specific antigen values were available in 97 of 102 patients, with a mean and maximum followup of 12 and 38 months. No patient with pelvic lymph node metastasis achieved an undetectable prostate specific antigen level without adjunctive therapy (hormonal or radiation). No difference in preoperative or postoperative prostate specific antigen levels, cancer volume, seminal vesicle invasion or incidence of pelvic lymph node metastasis was seen between patients with no capsular penetration and those with minimal capsular penetration (1 cm. or less total linear extent of full thickness penetration), providing the first quantitative evidence that small amounts of capsular penetration may not be of biological or prognostic significance.     

Increased blood cortisol in alcoholic patients with aseptic necrosis of the femoral head

Summary Although aseptic necrosis of the femoral head secondary to alcoholism is a very frequent entity, its etiology remains unknown. The same pathogenic mechanism is thought to be shared both by aseptic necrosis secondary to alcoholism and steroid therapy. Since alcohol stimulates adrenal steroid secretion, we have studied serum cortisol and urinary free-cortisol levels in 8 patients with aseptic necrosis of the femoral head due to alcoholism and compared them with those found in 8 age-matched patients with aseptic necrosis of idiopathic origin. Serum cortisol levels and urinary free-cortisol levels were significantly higher in the alcoholic than in the idiopathic group: serum 227±21.7 vs 154±22.1 ng/ml,P<0.001; urine 0.20±0.002 vs 0.13±0.04 μg/mg cr/day,P<0.001. The data indicate that alcohol-induced aseptic necrosis of the femoral head results, at least in part, from increased circulating cortisol.     

Kidney Metastasis of Resected Early Gastric Carcinoma: Report of a Case

We report a rare case of kidney metastasis of resected early gastric cancer in a 67-year-old man. We performed distal gastrectomy with D2 lymph node dissection for early gastric cancer, which was histologically diagnosed as moderately differentiated adenocarcinoma (T1N0M0, stage IA). Preoperatively, his serum carcinoembryonic antigen (CEA) level was 9.5 ng/ml, and this dropped to 7.0 ng/ml postoperatively. However, 1 year 10 months after the operation, we performed partial kidney resection and the lesion was confirmed to be a metastasis of the gastric cancer. Unfortunately, 5 months later, multiple liver metastasis was found, accompanied by a further increase in the serum CEA level to 2 650.8 ng/ml. This case illustrates the poor prognosis associated with a high preoperative serum CEA level, even if early gastric cancer is resected curatively.     

A comparative study of weight of regional lymph nodes in association with the presence of metastasis in primary lung cancer patients

The weight of regional lymph nodes was measured in 173 patients who underwent surgical resection of the primary lung cancer and lymph nodes from January, 1986 to January, 1989 in our hospital. Histological examination was also performed and correlation of metastasis and the weight of lymph nodes were studied. The average weight of metastatic lymph nodes was 2.34 g while that of non-metastatic ones was 0.83 g indicating a significant (p less than 0.05) increase of weight in metastatic lymph nodes. Although the percentage of metastasis increased as the weight of lymph nodes increased, 7.6% of lymph nodes weighing less than 0.5 g was positive for metastasis. On the other hand, 66.7% of the lymph nodes weighing more than 3.0 g in adenocarcinoma and 34.5% in squamous cell carcinoma were positive for metastasis indicating the difference of the metastatic tendency to the lymph nodes between the two histological types. The comparative study of the weight of each lymph node station according to the JJC criteria demonstrated the difference of average weight of non-metastatic lymph nodes among each lymph node station. The average weight of pretracheal (#3), subcarinal (#7), interlobar (#11), and segmental (#12) lymph nodes without tumor metastasis were more than 1.0 g, however those of anterior mediastinal (#3a), paraesophageal (#8), and pulmonary ligament (#9) were less than 0.5 g. The average weight of metastatic lymph nodes in each lymph node station was in proportion to those of non-metastatic ones.     

The oxalate level in ultrafiltrate fluid collected from a dialyzer is useful for estimating the plasma oxalate level in hemodialysis patients

Background Patients on chronic hemodialysis are likely to develop secondary hyperoxalemia. It is, however, difficult to measure plasma oxalate levels. To measure plasma oxalate levels, rapid plasma separation, deproteinization, and acidification are essential in preventing the formation of oxalate and the deposition of calcium oxalate within the test tube. The present study was undertaken to examine whether the oxalate level in dialyzer ultrafiltrate is potentially useful for estimating plasma oxalate levels. Methods In nine patients on chronic hemodialysis, the plasma, after deproteinization with a filter, and the ultrafiltrate from the dialyzer before hemodialysis were acidified to a pH level of less than 3, followed by the measurement of oxalate levels by ion chromatography. Also, oxalate levels were compared between acidified and non-acidified ultrafiltrates from the dialyzer. In the second part of the study, seven patients on chronic hemodialysis receiving erythropoietin therapy, in whom the ferritin level was more than 300 ng/ml and transferrin saturation was less than 25%, were intravenously administered ascorbic acid, 100 mg, three times a week, after each dialysis session to facilitate the utilization of stored iron. This treatment was continued until the serum ferritin level decreased to a level below 300 ng/ml (for 3 months, at a maximum). The oxalate level in the dialyzer ultrafiltrate after this treatment was compared with that before treatment. Results The mean ± SE oxalate level in the dialyzer ultrafiltrate was 45 ± 6 μmol/l, essentially equal to the plasma oxalate level (46 ± 7 μmol/l). The plasma oxalate level had a significant positive correlation with the dialyzer ultrafiltrate oxalate level (plasma oxalate level = 0.99 × dialyzer ultrafiltrate oxalate level + 1.5; r = 0.95; P < 0.0001). The oxalate level in the acidified ultrafiltrate (45 ± 6 μmol/l) did not differ significantly from that in the non-acidified ultrafiltrate (45 ± 6 μmol/l). The mean ± SE duration of ascorbic acid administration was 64 ± 13 days. The hemoglobin level remained unchanged at 9.6 ± 0.4 g/dl, whereas the serum iron level increased significantly, from 34 ± 2 μg/dl to 43 ± 4 μg/dl (P < 0.05), and serum ferritin levels decreased significantly, from 645 ± 219 ng/ml to 231 ± 30 ng/ml after the treatment (P < 0.05). The oxalate level in the acidified ultrafiltrate showed no significant change after ascorbic acid administration (31 ± 8 μmol/l vs 47 ± 7 μmol/l). Conclusions In patients on chronic hemodialysis, the oxalate level in acidified ultrafiltrate from the dialyzer was found to be useful for estimating the plasma level of non-protein-bound oxalate. When administering ascorbic acid to hemodialysis patients, the plasma oxalate level can be monitored using this method.     

Fibrolamellar Hepatocellular Carcinoma in a Japanese Man: Report of a Case

Fibrolamellar hepatocellular carcinoma (FHCC), a rare variant of hepatocellular carcinoma, is becoming more prevalent; however, up until 1999, only 18 cases had been reported in Japan. We recently diagnosed a case of FHCC in a 46-year-old Japanese man who had visited four hospitals before being finally admitted to our department. On admission, he was diagnosed as having multiple liver tumors, with lymph node metastasis and peritoneal dissemination. Both hepatitis B antigen and hepatitis C antibody were negative, and the levels of serum α-fetoprotein and PIVKA-II were within normal limits. Under a provisional diagnosis of atypical hepatocellular carcinoma (HCC), a right hepatic lobectomy with resection of the metastatic lymph nodes and peritoneal dissemination was performed. The histopathological diagnosis made by our pathologist was atypical HCC. He underwent another operation for a recurrence in the left external iliac lymph node. It has been 29 months since his first surgery in this hospital and he is progressing well, which led us to establish the diagnosis of FHCC. Moreover, his serum carbohydrate antigen 125 levels have been well correlated with this condition. Received: August 4, 2000 / Accepted: July 17, 2001     

Serologic and Histologic Findings in Patients with Capsular Contracture After Breast Augmentation with Smooth Silicone Gel Implants: Is Serum Hyaluronan a Potential Predictor?

Background In this study, breast implant capsular tissues and blood samples from 25 cases were studied to characterize the relationship between capsular findings and serum analysis. The serum fibrosis indexes hyaluronan and the aminoterminal propeptide of procollagen type III (PIIINP) are fairly well correlated in several other studies with the inflammation grade and fibrosis in patients with progressive fibrotic disorders such as liver cirrhosis. Methods The study enrolled 25 female patients (average age, 40 ± 12 years) with capsular contracture after bilateral cosmetic breast augmentation using smooth silicone gel implants (Mentor). The implants were placed in a submuscular position through an incision in the inframammary fold. The implant removals were prompted by development of capsular fibrosis (Baker grades 1–4). Samples of capsular tissue were obtained from all the patients for standard histologic and immunohistochemical analyses. Blood samples were drawn from all the patients immediately before surgery. Sera from 20 healthy female patients (average age, 34 ± 9 years) who had undergone plastic surgery for reduction mammaplasty were used as controls. Results Histology. Capsular tissue was significantly thicker in patients with grades 3 and 4 contracture than in women with grade 2 contracture according the classification by Baker. There was a moderate (n = 15) or severe (n = 10) chronic inflammatory reaction in the capsules around the implants. Fibroblasts and macrophages represented the major cell population found in the fibrous capsules. In addition, activated CD4+ cells were detected. An inner layer with synovia-like metaplasia and multinucleated giant cells was found. Fibroblast-like cells formed the most common cell type in the capsules, along with macrophages, scattered polymorphonuclear leukocytes, lymphocytes, plasma cells, and mast cells. Serum analysis. There was a significantly higher level (p < 0.05) of hyaluronan serum concentration in patients with capsular contracture (26 ± 14 μg/l) than in control subjects (12 ± 6 μg/l). There was a positive correlation between the grade of capsular contracture (Baker 1–4) and the hyaluronan serum concentration (Baker 1–2: 15 ± 3 μg/l; Baker 3–4: 35 ± 12 μg/l) (r² =0.73; p < 0.05). Conclusion : In this study, serum hyaluronan levels were significantly elevated in patients with constrictive fibrosis after breast augmentation, and there was a positive correlation with the stage of capsular contracture. Serum hyaluronan concentration may help in defining patients at risk for capsular fibrosis. If treatment with new drugs can be started as a preventive measure, it may be possible to reduce the rate of patients who require surgical intervention.