Multicenter study of endoscopic preoperative biliary drainage for malignant distal biliary obstruction

AIM: To determine the optimal method of endoscopic preoperative biliary drainage for malignant distal biliary obstruction.METHODS: Multicenter retrospective study was conducted in patients who underwent plastic stent(PS) or nasobiliary catheter(NBC) placement for resectable malignant distal biliary obstruction followed by surgery between January 2010 and March 2012. Procedurerelated adverse events, stent/catheter dysfunction(occlusion or migration of PS/NBC, developmentof cholangitis, or other conditions that required repeat endoscopic biliary intervention), and jaundice resolution(bilirubin level 3.0 mg/d L) were evaluated. Cumulative incidence of jaundice resolution and dysfunction of PS/NBC were estimated using competing risk analysis. Patient characteristics and preoperative biliary drainage were also evaluated for association with the time to jaundice resolution and PS/NBC dysfunction using competing risk regression analysis.RESULTS: In total, 419 patients were included in the study(PS, 253 and NBC, 166). Primary cancers included pancreatic cancer in 194 patients(46%), bile duct cancer in 172(41%), gallbladder cancer in three(1%), and ampullary cancer in 50(12%). The median serum total bilirubin was 7.8 mg/d L and 324 patients(77%) had ≥ 3.0 mg/d L. During the median time to surgery of 29 d [interquartile range(IQR), 30-39 d]. PS/NBC dysfunction rate was 35% for PS and 18% for NBC [Subdistribution hazard ratio(SHR) = 4.76; 95%CI: 2.44-10.0, P 0.001]; the pig-tailed tip was a risk factor for PS dysfunction. Jaundice resolution was achieved in 85% of patients and did not depend on the drainage method(PS or NBC).CONCLUSION: PS has insufficient patency for preoperative biliary drainage. Given the drawbacks of external drainage via NBC, an alternative method of internal drainage should be explored.     

Sonazoid‐Enhanced Ultrasonography for Evaluation of the Enhancement Patterns of Focal Liver Tumors in the Late Phase by Intermittent Imaging With a High Mechanical Index

Objective. The purpose of this study was to evaluate the enhancement patterns of focal liver tumors in the late phase of Sonazoid‐enhanced ultrasonography by intermittent imaging with a high mechanical index (MI). Methods. A total of 142 patients with 208 lesions, including 109 hepatocellular carcinomas (HCCs), 61 metastases, 30 hemangiomas, and 8 focal nodular hyperplasias (FNHs), were enrolled in this prospective study. Contrast‐enhanced ultrasonography with intermittent scanning at 2 frames per second (MI, 0.7–1.2) was conducted in the late phase (>5 minutes after bolus intravenous injection of the perflubutane‐based contrast agent Sonazoid; Daiichi Sankyo, Tokyo, Japan). Two blinded readers classified the enhancement patterns of the lesions. The sensitivity, specificity, and positive predictive value (PPV) of the dominant enhancement patterns and inter‐reader agreement were assessed. Results. A combination of diffuse enhancement with intratumoral vessels and intratumoral vessels alone yielded sensitivity of 85% (average of both readers), specificity of 88%, and a PPV of 88% for HCC. For metastasis, a combination of peripheral ringlike enhancement with peritumoral vessels and peripheral ringlike enhancement with intratumoral vessels yielded sensitivity of 79%, specificity of 95%, and a PPV of 85%. For hemangiomas, a combination of peripheral nodular enhancement with peritumoral vessels and peripheral nodular enhancement without peritumoral vessels yielded sensitivity of 75%, specificity of 99%, and a PPV of 92%. Diffuse enhancement with spoked wheel arteries yielded sensitivity of 82%, specificity of 100%, and a PPV of 87% for FNHs. Good inter‐reader agreement was achieved. Conclusions. Sonazoid‐enhanced ultrasonography using intermittent imaging with a high MI can potentially be used for evaluating the enhancement patterns of focal liver tumors in the late phase.     

Effect of oxytocin on spontaneous electrical and mechanical activities in pregnant human myometrium

Spontaneous intracellular electrical activity and contraction of pregnant human myometrium were recorded by the single sucrose-gap method, and the effects of oxytocin on the muscle were studied. In pregnant human myometrium at term, both plateau and spike types of action potentials were observed. All contractions were well synchronized with each action potential. Oxytocin, 10(-2) U/ml, potentiated spontaneous contractions by enhancing the plateau part of action potentials; spike-type configuration became plateau. When extracellular ionized calcium was removed, spontaneous activities disappeared, while 10(-2) U/ml of oxytocin could evoke action potentials and contractions but these were smaller than those of the controls. Spontaneous activities also disappeared when ionized calcium was increased to 5 mmol/L, but oxytocin evoked plateau potentials and contractions remarkably. Diltiazem (ionized calcium antagonist), 10(-6) gm/ml, suppressed the spontaneous activity, but oxytocin evoked action potentials and contractions in high frequency, the duration of the action potential being short and the contraction being small. In the presence of 10(-4) gm/ml of diltiazem, 10(-2) U/ml of oxytocin could not evoke any action potentials but did evoke small and long contractures, while in a high ionized potassium contracture experiment, oxytocin potentiated the tonic phase. These results suggest that oxytocin can increase spontaneous contractions by enhancing plateau potentials and that this effect requires sufficient extracellular ionized calcium. In this potentiation, the effects on frequency and amplitude of contractions might vary. It is also suggested that oxytocin may evoke a contracture in the absence of an action potential by releasing calcium from intracellular storage sites.     

Progress in the treatment of cervical cancer

The cure rate of cervical cancer is undoubtedly improved by early detection accomplished by mass-screening programs. Improvements in surgical technique have also reduced the incidence of complications. Conization or laser vaporization for stage 0 and extended hysterectomy for stage Ia are demonstrated to be appropriate treatment modalities. Extended surgery, such as total pelvic exenteration, is applied for advanced cancer. For radiation treatment, fast-neutron irradiation, intraoperative irradiation and interstitial irradiation have been tested. Hyperthermia combined with irradiation is one of the most attractive methods, which deserves further investigation. Irradiation of the para-aortic lymph nodes has been started by many institutions. Great progress has been achieved in chemotherapy for cervical cancer. Multi-drug combination chemotherapy including cis-platinum has yielded promising results, and intra-arterial infusion and long-term maintenance chemotherapy have been tried with the expectation of favorable outcome. It is concluded that individualized multi-disciplinary treatment will be the best approach for cervical cancer.     

Characteristics of action potentials and contractions evoked by electrical-field stimulation of pregnant human myometrium

Evoked electrical and mechanical activities of pregnant human myometrium were recorded by the single sucrose-gap method. Each muscle strip has an individual rhythm of membrane excitability and the evoked activity was affected by spontaneous membrane fluctuation. However, high-frequency stimulation caused changes in the rhythm of fluctuation and the pattern of action potential converted from plateau to spike type. Twitch contractions evoked by spike potentials were summated and became fused tetanus in accordance with shortening of the pulse interval. This method is suitable for clarifying the excitation-contraction relationship in human myometrium.     

Establishment and characterization of a cell line derived from mucinous cystadenocarcinoma of human ovary

A human tumor cell line MCAS, which was derived from mucinous cystadenocarcinoma of the ovary, was established. The tissue specimen was obtained on December 1, 1983 and the culture was maintained in Ham's F-12 medium supplemented with 20% fetal calf serum. Continuous growth made possible cell transfer every 3-5 days and the seventy-third passage was achieved on August 15, 1984. This cell line has the following characteristics. The doubling time of the MCAS cell line was 27 hours and the saturation density was 5.1 X 10(4)/cm2. The cultured cells appeared monolayer and the cellular arrangement was a pavement-like pattern. Rather large cells with vacuoles in the cytoplasm appeared in the confluent state and PAS staining proved to be positive specifically in these large cells. A chromosomal analysis revealed a peritetraploid tendency. By heterotransplantation of MCAS cells to the nude athymic mouse, the tumor developed and had both cystic and solid components. The cystic content was mucinous. Histopathological diagnosis of the tumor was papillary adenocarcinoma and alcian blue staining was positive. The characteristics of the original mucinous cystadenocarcinoma have been precisely maintained in this cell line.     

Colposcopic assessment of stage I cervical cancer

A differential assessment by colposcopy of three subgroups of stage I in the new FIGO classification of cervical cancer was attempted. Colposcopic findings in invasive cancer were atypical white epithelium, atypical mosaic, papillary punctation, atypical vessels, abnormal 'rock-like' projection, papillomatous growth and ulcer. Ulcer and abnormal 'rock-like' projection were more suggestive of a frank invasive carcinoma than a microinvasive carcinoma. While 89% of the cases in stage Ib were correctly predicted, only about 50% of those in stage Ia were correctly predicted. We propose that a colposcopic assessment be included in the armamentarium to decide the method of treatment for cervical cancer patients.     

Intra-body dynamics of d-serine reflects the origin of kidney diseases

Clinical and Experimental Nephrology - d-Serine, present only in trace amounts in humans, is now recognized as a biomarker of chronic kidney disease (CKD). CKD is heterogeneous in its original...     

The role of an uncommon type of oral streptococcus sanguis in the etiology of behcet’s disease

The relationships of Behcet’s disease (BD) with oral diseases and the prevalence of an uncommon type of oralStreptococcus sanguis (Str. sanguis) in the oral cavity were investigated in a case-control study. BD patients were compared to patient controls (collagen disease) and healthy controls. An interview questionnaire survey of BD and oral diseases showed that during the pre-onset, onset, and post-onset periods, the incidences of tonsillitis and dental caries, or the history of dental treatment, were greater in BD cases. Typological analysis showed a higher prevalence of an uncommon type ofStr. sanguis, differing from the common type, among BD cases compared to control groups. These results, showing a higher incidence of tonsillitis and dental caries during the presymptomatic period, a greater frequency of dental treatments during the symptomatic period, and the presence of an uncommon type ofStr. sanguis, indicate thatStr. sanguis of an uncommon type is related to increased risk of BD, and the possibility of a causal role is suggested.