“On Table” Positioning for Optimal Access for Cancer Excision in the Lower Rectum

Poor visualization and restricted access often make tumor lesions in the lower rectum difficult to excise, particularly in a narrow male pelvis. The aim of this study was therefore to study whether (and if so to what extent) different positions of the patient on the operating table might improve accessibility. Twenty consecutive patients (men and women) undergoing laparotomy with surgery of the lower rectum were studied. The geometric configuration of the pelvis was studied and compared on lateral radiographs obtained at the operating table in each of four positions. Compared with the conventional lithotomy position, the thighs-flat position caused significant extension movement of the lumbosacral joint. Augmentation of the lumbar lordosis widened the pelvic view and enabled a more vertical view of the lower rectum (27.5 degrees in lithotomy position, 13.0 degrees in the thighs-flat position). Insertion of a lumbar pad contributed further to the augmentation (7 degrees). When compared on radiographic studies, the thighs-flat position is preferable to the conventional lithotomy position in terms of facilitating low rectal surgery by improving both visibility and accessibility to the pelvic cavity.     

Hand-assisted laparoscopic splenectomy for solitary splenic metastasis from uterine corpus carcinoma

Solitary splenic metastasis is a rare condition. We performed hand-assisted laparoscopic splenectomy (HALS) for a solitary splenic metastasis from a uterine corpus carcinoma that had directly invaded the wall of the stomach. HALS is a superior technique that offers the advantages of both open and laparoscopic splenectomy, and it may become one of the options for the management of primary and secondary cancer of the spleen. Presented at the Eighth World Congress of Endoscopic Surgery, New York City, New York, USA, 13–16 March 2002     

Socioeconomic health inequalities in Latvia: a cross-sectional study

AIMS: Socioeconomic health differences have been studied elaborately for many Western societies. Relatively little is know about the social variations in health in the former communist states of Eastern Europe. This study investigated socioeconomic health inequalities in Latvia. METHODS: Cross-sectional analysis was undertaken of the 1999 Norbalt-II Living Conditions Survey, a random population-based sample in Latvia, and included males and females aged 25 to 70. RESULTS: Lower educated subjects had higher rates of self-assessed poor health than those with tertiary education (men OR 2.21; 1.31-3.71 95% CI, and women OR 2.48; 1.74-3.54 95% CI). After adjusting for income, educational differences were significant only for women. Income differences were larger than educational differences in self-assessed poor health for both genders (OR of highest vs. lowest quintile for men: 5.10; 2.26-11.5 95% CI, women: OR 3.26; 1.92-5.51 95% CI). For long-standing health problems socioeconomic differences were smaller. After adjusting for income no educational differences were found, but income differences were significant (men: OR 2.06; 1.15-3.69 95% CI, women: OR 1.42; 1.12-2.63 95% CI). The economically non-active were in worse health than the (self-)employed subjects (men: OR 6.12; 3.65-10.3 95% CI, women: OR 2.79; 1.66-3.39 95% CI). CONCLUSIONS: Substantial social inequalities in self-assessed poor health and longstanding health problems exist in Latvia for both sexes. Inequalities by material circumstances, as measured by income, appear to be larger than educational differences. Economic activity was also strongly associated with health. There were no inequalities with regard to urbanization and ethnic differences were found only for long-standing health problems among women.     

Preoperative intraperitoneal chemotherapy for patients with serosa-infiltrating gastric cancer

BACKGROUND AND OBJECTIVES: Serosa-infiltrating gastric cancer poses a high risk for peritoneal recurrence. This study examined the feasibility and efficacy of preoperative intraperitoneal (i.p.) chemotherapy for such cancer. METHODS: Patients with serosa-infiltrating tumors, diagnosed by conventional examinations as well as by staging laparoscopy, were enrolled in this study. Those with unresectable T4 tumors, visible peritoneal metastasis or distant organ metastasis were excluded. Twenty-five eligible patients received preoperative i.p. chemotherapy, which consisted of i.p. injection of 20 mg of mitomycin C on day 1 and 10 mg of cisplatin for 5 days, followed by surgery. RESULTS: Of the 25 patients, 24 underwent gastrectomy with lymph node dissection and 1 underwent palliative gastrojejunostomy. The curability of the surgery was curability A in 6, B in 16, and C in 3. Preoperative T stages (T3 in 21 and T4 in 4) were downstaged postoperatively (T1 in 1, T2 in 10, T3 in 11, and T4 in 3). The 1- and 2-year overall survival was 83.3 and 51.3%, respectively. The median survival time was 24.4 months. The toxicity of the preoperative treatment was tolerable and no serious postoperative complication was seen. CONCLUSIONS: Preoperative i.p. chemotherapy seems to be a safe and effective therapy for serosa-infiltrating gastric cancer. Randomized clinical trials comparing preoperative i.p. chemotherapy followed by surgery and surgery alone are needed.     

Application of metallic stents for both inferior vena cava and biliary obstruction by lymph node involvement in a patient with recurrent hepatocellular carcinoma

The authors experienced a case with obstruction of the inferior vena cava (IVC) and the common bile duct due to a recurrent hepatocellular carcinoma. In order to improve severe edema of the lower extremities and obstructive jaundice, IVC metallic stent as well as biliary stent were applied. A Luminexx stent of 8 cm in length was placed in the bile duct via subcutaneous route after biliary drainage. A spiral zigzag stent of 8 cm in length was also inserted into the IVC through the femoral vein following balloon dilatation of the obstructed portion. Subsequently, jaundice and edema were dramatically improved in a short period of time, which resulted in patient discharge from the hospital. Although the patient died of the cancer in 2 months, the quality of life was well maintained until death.     

Interactions of phytoestrogens with estrogen receptors alpha and beta (III). Estrogenic activities of soy isoflavone aglycones and their metabolites isolated from human urine

Two glucuronides (4'-O-, and 7-O-) and a glucuronyl (7-O-) sulfate (4'-O-) of genistein, two glucuronides (4'-O-, and 7-O-) and a glucuronyl (7-O-) sulfate (4'-O-) of daidzein, 7-O-glucuronides of glycitein, dihydrodaidzein and O-desmethylangolensin were isolated from the urine of volunteer subjects fed soy bean curds (Tofu). The estrogenic activities, i.e., i) the effect on the estrogen-dependent growth of MCF-7 cells, ii) the binding ability to human estrogen receptors (hERs) alpha and beta, and iii) the effect on hER-dependent beta-galactosidase induction, of these isoflavone metabolites were examined. Two synthetic isoflavone aglycones (dihydrodaidzein and O-desmethylangolensin) and four synthetic sulfates (4'-O- and 4'-, 7-di-O-) of genistein and daidzein were also studied for their estrogenic activities for the purpose of comparison. With respect to estrogenic acivity, the tested isoflavone metabolites were classified into three groups. The first group shows a very poor stimulatory effect toward the growth of MCF-7 cells, binding activity, and beta-galactosidase induction. The sulfates belong to this group. The second group shows a moderate binding activity but poor stimulation and beta-galactosidase induction. Some glucuronyl conjugates belong to this group. The last group shows a moderate stimulation and beta-galactosidase induction but poor binding activity. A mixed type of conjugates having glucuronyl and sulfony moieties belong to this group.     

mRNA expression level of estrogen-inducible gene, alpha 1-antichymotrypsin, is a predictor of early tumor recurrence in patients with invasive breast cancers

We previously identified 18 genes that correlated with ER positivity by adapter-tagged competitive-PCR analysis of 2412 genes in human breast cancer tissues. The aim of the present study was to determine the prognostic significance of these genes. mRNA expression levels of 12 of the above 18 genes were quantified in breast cancer tissues by real-time PCR assay, and their association with patients' prognosis (n = 110) was studied according to hormone receptor (HR) status. In addition, the genes found to influence prognosis were further investigated to examine whether their mRNA expression could be induced by estrogen in MCF-7 cells in vitro. Of the 12 genes, mRNA expression levels of two [alpha 1-antichymotrypsin (ACT) and stanniocalcin 2 (STC2)] were significantly (P = 0.002 and P = 0.007, respectively) associated with good prognosis in HR-positive (ER and/or PR positive) breast cancer patients treated with adjuvant hormone therapy. Multivariate analysis showed that ACT mRNA level, but not STC2 mRNA level, in HR-positive patients, was a significant prognostic factor (P = 0.042), which was independent of tumor size and lymph node metastases. On the other hand, mRNA expressions of ACT and STC2 were not significantly associated with prognosis in HR-negative patients. Estradiol treatment resulted in a significant increase in the mRNA levels of both ACT and STC2 in MCF-7 cells. The mRNA level of ACT, which is an estrogen-inducible gene, is a significant predictor of good prognosis in HR-positive, but not HR-negative, patients with breast cancers. Since HR-positive patients were treated with adjuvant hormone therapy, we suggest that ACT mRNA level could potentially be used as a predictor of response to hormone therapy, rather than a prognostic factor (predictor of metastatic potential).     

A novel TRH-PFTAIRE protein kinase 1 pathway in the cerebellum: subtractive hybridization analysis of TRH-deficient mice

TRH has been reported to possess several neurophysiological actions in the brain. To gain insights into the molecular mechanisms underlying these effects, particularly in the cerebellum, we attempted to clone a cDNA that was regulated by TRH using TRH knockout mice and subtractive cDNA analysis. Over 100 clones obtained by subtractive hybridization analysis between the wild-type and TRH-1-cerebellum were analyzed. Four clones among them were identical and cdc2-related kinase (PFTAIRE protein kinase 1 (PFTK1)) cDNA, which was previously reported to be expressed only in the brain and testis. PFTK1 mRNA levels in the euthyroid TRH-1- cerebellum supplemented with thyroid hormone were significantly decreased compared with those in the wild-type. Induction of PFTK1 mRNA by TRH was also observed in a time- and dose-dependent manner in human medulloblastoma-derived HTB-185 cells that expressed TRH receptor subtype I mRNA. In addition, treatment of 8-Br-cGMP significantly increased PFTK1 mRNA levels, and a specific inhibitor of cGMP production, ODQ, completely blocked TRH-induced expression of PFTK1 mRNA. Furthermore, induction of PFrK1 mRNA by TRH was significantly inhibited by a NOS specific inhibitor, L-NAME, but not by a MEK inhibitor, PD98059 or a calcium channel inhibitor, nimodipine. These findings demonstrated, for the first time, a novel pathway between a neuropeptide and a cell cycle related peptide in the brain, and PFTK1 may be a key regulator for TRH action in t he cerebellum through t he NO-cGMP pathway.     

Living-related liver transplantation with renoportal anastomosis for a patient with large spontaneous splenorenal collateral

BACKGROUND: A large splenorenal collateral must be interrupted during liver transplantation to secure adequate portal perfusion. However, this process increases the complexity of the operative procedure and may cause hazardous bleeding. Recently, renoportal anastomosis in portal reconstruction was reported in cadaveric liver transplantation for patients with surgically created splenorenal shunts. We used this technique in a living-related liver transplantation. METHODS: A 29-year-old female with a large spontaneous splenorenal collateral and a portal venous thrombus underwent a living-related liver transplantation. At surgery, the left renal vein was divided and the distal stump was anastomosed to the portal vein of the graft without interrupting collaterals. RESULTS: Adequate portal venous blood flow was maintained throughout the postoperative course. The patient was discharged 9 weeks after transplantation and remains well. CONCLUSION: The renoportal anastomosis could be used for portal reconstruction in living-related liver transplantation for patients with a large splenorenal collateral. It provides adequate portal perfusion without interrupting collateral circulation.