Persistent and aggressive treatment for thymic carcinoma. Results of a single-institute experience with 25 patients

OBJECTIVES: The aim of this study is to retrospectively evaluate the role of several therapies, mainly chemotherapy, for thymic carcinoma (TC). METHODS: From July 1973 to July 2005, 25 patients (15 males and 10 females) with histologically proven TC were treated at our department. The median age of the patients was 59 years, with a range of from 30 to 78 years. According to Masaoka's staging system, there was 1 stage I patient, 3 stage II, 7 stage III, 6 stage IVa, and 8 stage IVb patients. The histological subtype was in all cases squamous cell carcinoma, nonkeratinizing type. RESULTS: There were 6 complete surgical resections, 1 incomplete resection followed by chemoradiotherapy, 6 with radiotherapy alone, 3 with radiotherapy plus chemotherapy, and 9 with chemotherapy alone as the initial treatment. Eighteen patients were administered second-line therapy. The regimen obtaining the best response rate was doublet chemotherapy consisting of carboplatin (CBDCA) and paclitaxel. The median survival time and survival rate at 5 years for the patients excluding surgical cases with stage I/II disease were 32 months and 31%, respectively. CONCLUSION: The doublet of CBDCA and paclitaxel thus appears to be a promising regimen for TC and further investigation in a multi-institutional phase II trial is, therefore, strongly called for.     

Methylation status of genes upregulated by demethylating agent 5-aza-2'-deoxycytidine in hepatocellular carcinoma

BACKGROUND/AIMS: To determine the clinical significance of gene promoter methylation in hepatocellular carcinoma (HCC), we examined in clinical samples the methylation status of those promoters that showed elevated activity in hepatoma cell lines after 5-aza-2'-deoxycytidine treatment. METHODS: Regarding the genes with promoter hypermethylation in the cell lines, their expression levels and methylation status in HCC and non-HCC tissues were assessed by semiquantitive RT-PCR and methylation-specific PCR. To confirm the result, the expression levels and methylation status in 16 additional HCC and non-HCC tissues were assessed. RESULTS: The promoter regions of caveolin 1 (CAV1), cysteine and glycine-rich protein 1 (CSRP1), Kruppel-like factor 6 (KLF6), myosin (light polypeptide 9) (MYL9), and transgelin (TAGLN) were highly methylated in the cell lines. CAV1 and CSRP1 were methylated in HCC more frequently than in non-HCC. KLF6, MYL9, and TAGLN were fully methylated in both HCC and non-HCC. Using additional clinical samples, downregulation of CAV1 and CSRP1 was observed in 38 and 56%, respectively, of the 16 HCC samples and aberrant methylation of CAV1 and CSRP1 was observed in 56% of HCC in both cases. CONCLUSION: CAV1 and CSRP1 were inactivated in HCC by aberrant methylation and they may serve as important biomarkers of malignancy.     

Effects of in utero and lactational exposure to di(2-ethylhexyl)phthalate on somatic and physical development in rat offspring

Di(2-ethylhexyl)phthalate (DEHP) has been reported to act as an antiandrogen and to affect the reproductive organs and accessory genital glands. Thus, to assess the reproductive toxicity of DEHP it is important to examine both its adverse effects on the development of offspring following maternal exposure and its effects on sexual function and fertility. In the present study, we examined whether in utero and lactational exposure to DEHP affects postnatal somatic growth of offspring in the rat. Pregnant females were orally administered various doses of DEHP (0, 25, 100 or 400 mg/kg body weight/day) from gestational day (GD) 6 through postnatal day (PND) 20. There were no significant changes in body weight, body length, tail length, or the weight of individual organs between the control and DEHP-treated groups. Somatic hormonal parameters were the same for all DEHP doses. These findings suggest that in utero and lactational exposure to various concentrations of DEHP has very little effect on postnatal development or endocrine and physical status of male and female rat offspring under the experimental conditions of the present study.     

Surgical Site Infection in General and Thoracic Surgery: Surveillance of 2 663 Cases in a Japanese Teaching Hospital

Purpose We conducted a prospective survey of 2 663 surgical patients in a Japanese teaching hospital to look for any risk factors predisposing to surgical site infection (SSI) other than the National Nosocomial Infection Surveillance (NNIS) System risk indices; namely, performance status, operative time, wound classification, and endoscopic use. Methods Our Infection Control Team recorded data for 5 years using the Japanese SSI surveillance system. We divided the incidence of SSI for each risk index category by the NNIS reference data to produce the standardized infection ratio (SIR). Results The representative procedure, SSI rate, and SIR in the 2663 patients were as follows: colectomy, 6.0%, 0.917; esophagectomy, 19.4%, 6.020; mastectomy, 0.5%, 0.401; rectal surgery, 8.7%, 1.136; thoracic surgery, 1.5%, 1.137; and biliary surgery, 13.4%, 1.937. We also found age to be a significant risk factor. Conclusions The NNIS system risk indices should separate rectal surgery from colorectal surgery, and separate esophagectomy from other gastrointestinal surgery. Age should also be included as an SSI risk index.     

New open stent-graft delivery system: the CLATE flexible metal graft holder

The surgical approach to the treatment of distal aortic arch aneurysms is still a matter of controversy. Median sternotomy is usually selected when the patient has the pulmonary emphysema, and the atherosclerotic change involves the ascending aorta or the aortic arch as well as the distal aortic arch. However, when the end of the aneurysm is deep and distant, distal anastomosis becomes more difficult. Left thoracotomy is another approach, but in the patients with impaired respiratory function or when dense lung adhesions to the chest wall are anticipated because of a history of inflammation, the risk of intraoperative bleeding and postoperative respiratory complications becomes a major concern. Total arch replacement by an open stent graft insertion method through a median sternotomy has been devised as a procedure that overcomes these problems. However, since no ideal device for delivering long stent grafts beyond the aneurysm is available, we developed a new delivery system, and we successfully applied it clinically in a patient with an enlarged distal aortic arch.     

A gastric fibrolipoma presenting as acute gastrointestinal hemorrhage

A 56-year-old woman was admitted to our hospital with upper gastrointestinal hemorrhage from a gastric submucosal tumor that was treated by a laparoscopic technique. Endoscopy and endoscopic ultrasonography (EUS) revealed a 2-cm submucosal tumor located in the posterior wall of the upper gastric body, showing a heterogeneous hyperechoic tumor. A laparoscopic wedge resection of the stomach was performed. Pathological examinations revealed that the tumor was composed of spindle cells like fibroblasts and mature adipocytes. Immunohistochemical examinations revealed that the tumor was negative for desmin and alpha-smooth muscle actin. Based on these findings, a diagnosis of fibrolipoma was made. EUS is useful for differentiating a fibrolipoma from a gastrointestinal stromal tumor or lipoma by the findings of characteristic echogenesity and detection of the tumor origin.