The treatment strategy for type 4 gastric cancer with positive lavage cytology--a decision making of the therapeutic strategy by the change of the result of the lavage cytology

It has been difficult to improve the prognosis of the type 4 advanced gastric cancer because the peritoneal dissemination develops frequently. In the present study, the therapeutic strategy, an administration of chemotherapy followed by gastrectomy, for the type 4 advanced gastric cancer with positive lavage cytology (CY) was discussed. CY has changed to negative in 3 of 6 cases (50%) at the surgery and in 1 of another 3 cases during the post operative chemotherapy. MST was 1487 days (966-2354 days) in cases with negative CY after pre-operative treatment, while 193 and 395 days in another 2 cases remained in positive CY, respectively. It may be important to perform re-staging laparoscopy with the evaluation of CY after preoperative chemotherapy for the type 4 advanced gastric cancer with positive CY, because the survival was comparatively better in cases with the change from positive CY to negative CY after the treatment. In conclusion, the treatment strategy for the type 4 advanced gastric cancer with positive CY was to administer chemotherapy followed by curative intent surgery for the case with negative CY after pre-operative treatment, while the other regimen of chemotherapy administration for the case with positive CY remained.     

Observations on staging of advanced gastric cancer using contact rigid endoscopy

A rigid contact scope is a recent development of optical instrument which allows observations of the superficial layers of the mucosai epithelium in gynecology and otorhinolaryngology. To assess the evaluation of 25 patients with advanced gastric cancer, whose lesions had been diagnosed to be more than T3 or suspected to have peritoneal deeding, we performed pre operative laparoscope with rigid contact scope. After inspecting a usual laparoscopic observation of the abdominal cavity, serosal exporsure and peritoneal seeding were confirmed. All the patients who had serosal exporsure and cancer cells showed an irregularity of cell distribution with the extent of heterogeneity of the cells with nuclei size and shape. Five patients had peritoneal seeding, and the findings with rigid contact scope showed a similar view to cancer cells which were observed in serosal exposure. The result suggests that this new endoscopic technique enabled a new diagnostic approach in advanced gastric cancer.     

A case report-the marked response to S-1 + CDDP chemotherapy for post-operative local recurrence of advanced gastric cancer

A 55-year-old woman, underwent a total gastrectomy with super extended lymphadectmy for type 4 gastric cancer 4 years ago, suffered a locoregional recurrence at the esophagojejunostomy. She was given S-1 with cisplatin for a treatment against the recurrent site. Although grade 2 leucocytopenia and grade 3 anorexia were observed, consecutive twenty five courses of the regimen were carried out with a dose modification of anticancer drugs, and home parentenral nutrition system was used for severe anorexia. She has been alive for more than 3 years since the start of the treatment with a good control of locoregional recurrent lesion, and no other apparent metastatic sites were observed.     

Antitumor activity of histone deacetylase inhibitors in non-small cell lung cancer cells: development of a molecular predictive model

To ascertain the potential for histone deacetylase (HDAC) inhibitor-based treatment in non-small cell lung cancer (NSCLC), we analyzed the antitumor effects of trichostatin A (TSA) and suberoylanilide hydroxamic acid (vorinostat) in a panel of 16 NSCLC cell lines via 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide assay. TSA and vorinostat both displayed strong antitumor activities in 50% of NSCLC cell lines, suggesting the need for the use of predictive markers to select patients receiving this treatment. There was a strong correlation between the responsiveness to TSA and vorinostat (P < 0.0001). To identify a molecular model of sensitivity to HDAC inhibitor treatment in NSCLC, we conducted a gene expression profiling study using cDNA arrays on the same set of cell lines and related the cytotoxic activity of TSA to corresponding gene expression pattern using a modified National Cancer Institute program. In addition, pathway analysis was done with Pathway Architect software. We used nine genes, which were identified by gene-drug sensitivity correlation and pathway analysis, to build a support vector machine algorithm model by which sensitive cell lines were distinguished from resistant cell lines. The prediction performance of the support vector machine model was validated by an additional nine cell lines, resulting in a prediction value of 100% with respect to determining response to TSA and vorinostat. Our results suggested that (a) HDAC inhibitors may be promising anticancer drugs to NSCLC and (b) the nine-gene classifier is useful in predicting drug sensitivity to HDAC inhibitors and may contribute to achieving individualized therapy for NSCLC patients.     

Connection between a dural artery and a dural vein in a dural arteriovenous fistula of the cranial vault

A 41-year-old man presented with consciousness disturbance and right hemiparesis. Computed tomography showed a hematoma in the frontal lobe. Left carotid angiography showed a dural arteriovenous fistula (AVF) located in the cranial vault, supplied by the left middle meningeal artery, and drained directly into the cortical vein adjacent to the superior sagittal sinus. Emergency decompressive craniectomy and evacuation of the intracerebral hematoma were performed. A red vein was found on the cortex but the location of the arteriovenous shunt was not clear due to severe brain swelling. Two months later, cranioplasty was performed and a part of the dura mater, expected to have been affected by the dural AVF, was resected. Histological examination disclosed thickening of the intima of the middle meningeal artery and a few small veins around this artery. The fistula was clearly demonstrated between the dural artery and the dural vein. The non-sinal type of dural AVF may originate in similar arteriovenous connections to the sinal type.     

Mutations of the PIK3CA gene in hereditary colorectal cancers

Somatic mutations of the PIK3CA gene have recently been detected in various human cancers, including sporadic colorectal cancer. However, mutations of the PIK3CA gene in hereditary colorectal cancers have not been clarified. To elucidate the mutation status in familial adenomatous polyposis (FAP) and hereditary nonpolyposis colorectal cancer (HNPCC), which are the most common hereditary colorectal cancers, we investigated PIK3CA mutations in 163 colorectal tumors, including adenomas, intramucosal carcinomas and invasive carcinomas. For comparison, we also analyzed mutations of the same gene in 160 sporadic colorectal tumors at various histopathological stages. Analysis at exons 1, 7, 9 and 20 of the PIK3CA gene revealed somatic mutations in 21% (8 of 39) of FAP invasive carcinomas, 21% (7 of 34) of HNPCC invasive carcinomas, 15% (8 of 52) of sporadic invasive carcinomas, and 14% (7 of 50) of sporadic colorectal metastases in the liver. Mutations in FAP and HNPCC carcinomas predominantly occurred in the kinase domain (exon 20), while the majority of mutations in sporadic cases occurred in the helical domain (exon 9). Adenomas and intramucosal carcinomas from all patients exhibited no mutations (0 of 148). Our data suggest that PIK3CA mutations contribute to the invasion step from intramucosal carcinoma to invasive carcinoma in colorectal carcinogenesis in FAP and HNPCC patients at a similar extent to that seen in sporadic patients.     

Micro-computed tomography analysis of the relationship between root canal number and root concavity in maxillary first and second molars in a Japanese population

Odontology - The aim of this study was to investigate root canal configurations in maxillary first and second molars from a Japanese population, as well as the relationship between the root canal...     

Severe Sequelae of Group B Streptococcal (Streptococcus Agalactiae) Meningitis in an 82-year-old Man

Abstract : Group B Streptococcal (GBS) meningitis is rare in adults, and only 2 cases have been reported in Japan. Here we report GBS meningitis in an 82-year-old man. The patient with a history of colon cancer developed a high fever and severe headache, and was taken to our hospital several hours later. On admission he was semi-comatose, light and corneal reflexes were normal, his neck was only mildly stiff. He was then on a respirator due to status epilepticus. Cerebrospinal fluid examination demonstrated marked pleocytoisis (46,2507/μ1, mostly polymorphonuclear cells) and GBS. With intensive care and antibiotic therapy, he regained consciousness 10 days later. However, he suffered severe dementia, hearing loss, limb muscle atrophy, and urinary retention in the chronic stage of the disease. Although survivors of adult GBS meningitis are reported to be free of severe neurologic sequelae, factors such as being the oldest patient among the reported cases, the premorbid malignancy and the marked inflammation were considered to be related to the severe neurologic sequelae in the present case.     

Postoperative antimicrobial prophylaxis following spinal decompression surgery: is it necessary?

Background  

Antimicrobial prophylaxis (AMP) can reduce the risk of surgical-site infection (SSI) following many types of surgery, particularly spinal surgery. After publication of the Guideline for Prevention of Surgical Site Infection by the Centers for Disease Control and Prevention in 1999, a large number of studies confirmed the effectiveness of AMP. However, because the concept of AMP is not clear in Japan, the duration of postoperative AMP tends to be long. The purpose of this study was to compare the infection rates following spinal surgery for postoperative AMP versus no postoperative AMP.