Clinical outcome of jejunal pouch double-tract reconstruction after total gastrectomy

BACKGROUND/AIMS: The importance of the duodenal passage and the need for pouch reconstruction after total gastrectomy are matters of controversy. METHODOLOGY: Twenty consecutive patients with early gastric cancer were studied 20who underwent jejunal pouch double-tract (JPD) reconstruction after total gastrectomy. Nutritional variables were examined for > or =10 years postoperatively. RESULTS: The mean operation time was 204 minutes. There was no anastomotic leakage and no hospital mortality. Anastomotic stenosis between the esophagus and a jejunal pouch developed in 2 patients (10%), and reflux esophagitis was observed in 4 (20%). Symptoms were controlled by conserva tive treatment within 3 years after surgery. Body mass indices in all patients were significantly decreased from 1 month (p<0.05) to 10 years (p<0.005) after the operation. The mean body weight decrease occurring during the first to the tenth postoperative year was 12.7% overall, but 17.8% and 9.1% in patients aged > or =60 years and <60 years, respectively. The body weight decreases from 3 (p<0.05) to 6 (p<0.01), and at 9 years (p<0.01) were significantly lower before 60 years of age than after. CONCLUSIONS: JPD reconstruction facilitates long-term recovery of body weight after total gastrectomy and should be considered before the aged of 60.     

Sporadic amyotrophic lateral sclerosis with pallido‐nigro‐luysian degeneration: A TDP‐43 immunohistochemical study

Recently, Nishihira et al. demonstrated the presence of two types of TDP‐43 pathology in sporadic amyotrophic lateral sclerosis (ALS) (Acta Neuropathol 2008; 116: 169–182). Type 1 represents the TDP‐43 distribution pattern observed in classic ALS, whereas type 2 shows the presence of TDP‐43 inclusions in the frontotemporal cortex, hippocampal formation, neostriatum and substantia nigra and is significantly associated with dementia. However, ALS with pallido‐nigro‐luysian degeneration (PNLD) is very rare. We recently encountered a case of ALS with PNLD of 9 years duration, in which the patient received artificial respiratory support for 6 years. In our case, neuronal loss and TDP‐43‐positive neuronal cytoplasmic inclusions were found in the globus pallidus, substantia nigra and subthalamic nucleus. Neither neuronal loss nor TDP‐43‐immunoreactive inclusions were found in the frontotemporal cortex and hippocampus. These findings suggest that the pallido‐nigro‐luysian system is also involved in the disease process of ALS and that ALS with PNLD is different from ALS with dementia based on the distribution pattern of neuronal loss and TDP‐43 accumulation.     

Prevalence of hepatitis virus infection in association with oral diseases requiring surgery

OBJECTIVE: We evaluated the prevalence of hepatitis virus infection in a large population of patients in terms of diseases requiring oral surgery. DESIGN: Retrospective case survey. SUBJECTS AND METHODS: Prevalence of hepatitis B and C virus (HBV, HCV) infection were compared between oral diseases such as inflammation, cysts, cancer, trauma, benign tumors, impacted teeth, or jaw deformity in dental inpatients (n = 5830) with adjustment for age, gender, and history of surgery. RESULTS: Of 4402 inpatients, 94 had HB surface(s) antigen (2.1%), while 151 of 2613 were seropositive for HCV (5.8%). Prevalences of HBs antigen and HCV antibody exceeded those in the general population. HBs antigen was more prevalent in patients with benign oral tumors than in patients with impacted teeth, whether or not adjustment was made for age (odds ratios, 4.246 and 5.055 with and without age adjustment, respectively; P < 0.05). On the other hand, HCV antibody was more prevalent in patients with oral cancer than in those with impacted teeth before adjustment for age (odds ratios, 2.433; P < 0.05), but this difference was reversed with age adjustment (odds ratios, 0.443; P < 0.05). CONCLUSION: HBs antigen was more prevalent in patients with benign oral tumors, while HCV antibody was higher in patients with oral cancer. However, this increased incidence of HCV antibody apparently was a reflection of age. HCV infection may not have an etiologically important association with oral cancer.     

A case of advanced gastric cancer with multiple liver metastases responding to TS-1 and CDDP

A 44-year-old male presented to our hospital with abdominal pain. The upper endoscopy revealed advanced gastric cancer. On the abdominal CT, there was evidence of multiple, massive liver metastases. After total gastrectomy, the patient was treated with daily oral administration of 120 mg TS-1 for 4 weeks followed by 2 weeks' rest and 6 weekly infusions of 10 mg CDDP in an intra-hepatic artery as 1 cycle. On the follow-up CT, the liver metastases had decreased significantly both in size and number after 2 cycles. The current case suggests that TS-1 and CDDP may have a potent therapeutic efficacy in cases of advanced gastric cancer with multiple liver metastases.     

Induction of HLA-DQ antigen expression on a human promyelocytic leukemia cell line HL-60

A variant strain of HL-60, which is positive for HLA-DR antigen, was induced to express HLA-DQ antigen following treatment with phorbol esther. It was preceded by cell cycle arrest in the G1 phase and was accompanied by augmented phagocytosis. This differential expression of HLA class II antigens on this subline may contribute to understanding the functional role of HLA class II antigens in the hematopoietic differentiation of macrophage cells.     

A case report of adult croup: a new old problem

Larnygeotracheobronchitis is a common disease of childhood most often associated with infection by parainfluenza virus. Although rare, adult cases have been reported. Adult croup presents similarly to the childhood version; however, the severity is usually much worse, often leading to hospitalization. Presented is the case of an 80-year-old woman with croup, which is the twelfth reported in the English literature.     

Dental conditions in inpatients with schizophrenia:A large-scale multi-site survey

ABSTRACT: BACKGROUND: Clinical relevance of dental caries is often underestimated in patients with schizophrenia. The objective of this study was to examine dental caries and to identify clinical and demographic variables associated with poor dental condition in patients with schizophrenia. METHODS: Inpatients with schizophrenia received a visual oral examination of their dental caries, using the decayed-missing-filled teeth (DMFT) index. This study was conducted in multiple sites in Japan, between October and December, 2010. A univariate general linear model was used to examine the effects of the following variables on the DMFT score: age, sex, smoking status, daily intake of sweets, dry mouth, frequency of daily tooth brushing, tremor, the Clinical Global Impression-Schizophrenia Overall severity score, and the Cumulative Illness Rating Scale for Geriatrics score. RESULTS: 523 patients were included in this study (mean [PLUS-MINUS SIGN] SD age = 55.6 [PLUS-MINUS SIGN] 13.4 years; 297 men). A univariate general linear model showed significant effects of age group, smoking, frequency of daily tooth brushing, and tremor (all p's < 0.001) on the DMFT score (Corrected Model: F(23, 483) = 3.55, p < 0.001, R2 = 0.42) . In other words, older age, smoking, tremor burden, and less frequent tooth brushing were associated with a greater DMFT score. CONCLUSIONS: Given that poor dental condition has been related with an increased risk of physical co-morbidities, physicians should be aware of patients' dental status, especially for aged smoking patients with schizophrenia. Furthermore, for schizophrenia patients who do not regularly brush their teeth or who exhibit tremor, it may be advisable for caregivers to encourage and help them to perform tooth brushing more frequently.     

The prevalence of VAIN,CIN, and related HPV genotypes in Japanese women with abnormal cytology

Vaginal intraepithelial neoplasia (VAIN) is often found by chance. We investigated the prevalence of VAIN and related human papillomavirus (HPV) types in comparison with cervical intraepithelial neoplasia (CIN). This study enrolled 648 women who were referred to the outpatient clinic of Kanazawa Medical University Hospital for abnormal cytology from January 2009 to January 2019. HPV genotypes were determined using Genosearch-31 + 4, which can detect 35 different HPV types. Colposcopy was performed at the first visit by an experienced gynecological oncologist. Among 611 subjects with squamous cell lesions, 107 (17.5%) VAIN cases were identified, and 67 (11.0%) women had both VAIN and CIN. Ultimately, 72 VAIN1, 15 VAIN2/3, 203 CIN1, 249 CIN2/3, 32 cervical squamous cell carcinomas (SCC), and one vaginal SCC (Vag-SCC) were identified. The prevalences of VAIN1, VAIN2/3, and Vag-SCC were 35.5%, 6.0%, and 3.1% of equivalent cervical lesions, respectively. The VAIN patients were older than the CIN patients (P = .002). About half of the VAIN cases were diagnosed during the follow-up. Multiple HPV infections were found in 42.9% of the VAIN and CIN patients. HPV52, 16, 51, 53, and 56 were the most common types in VAIN, whereas HPV16, 52, 58, 51, and 31 predominated in CIN. HPV18 was rare in VAIN, HPV58 was more common in CIN than in VAIN, and HPV53 and HPV73 were more common in VAIN. In conclusion, VAIN1 was identified more frequently than we expected. Various HPV types were identified in the vagina, which is likely a reservoir for HPV.     

The effects of calcium antagonists and prostaglandin El on isolated canine coronary arterial tension

The effects of calcium antagonists (nifedipine, nicardipine, diltiazem, and verapamil) and prostaglandin E₁ (PGE₁) on the tension of isolated canine coronary arterial strips were studies. In a solution containing 20 mEq/L of K⁺, 127 mEq/L of Na⁺, the tension was increased by 500–1,000 mg with 4 mEq/L of Ca²⁺. This increase in tension was suppressed by Ca-antagonists and PGE₁ dose-dependently. Nifedipine 10^–5 M, nicardipine 3 X 10^–7 M, diltiazem 3 X 10^–6 M, and verapamil 3 X 10^–6 M completely suppressed the increased tension. The maximal suppression of the tension produced by PGE₁ was about 40% at 10^–10 M. In 20 mEq/L K⁺ solution (0 mEq/L Ca²⁺, 37°C), the reduction of the Na⁺ concentrations from 127 mEq/L to 12 mEq/L increased the tension by 50 to 100 mg. This increase in tension was not suppressed by Ca-antagonists or PGEI. In conclusion, this study demonstrated that Ca-antagonists and PGE₁ suppressed an increase in the tension caused by Ca²⁺ but did not suppress an increase in the tension caused by Na⁺ reduction.