Clinical relevance of frozen diagnosis of ductal margins in surgery of bile duct cancer

It is anticipated that free surgical margin is crucial for curative resection of bile duct cancer. However, the clinical relevance of the ductal margin is somewhat controversial. A role of frozen section diagnosis used for evaluation of the ductal margin during surgery is also ambiguous. We reviewed the current knowledge about frozen section diagnosis and the clinical relevance of the margin status in surgery of the bile duct cancer. Frozen section diagnosis of the ductal margin of bile duct cancer is necessary to ensure free margins; however, it is quite challenging even for experienced pathologists because the bile duct involved with bile duct cancer is often inflamed severely due to obstruction and/or insertion of a draining tube, which induces epithelial regeneration with atypia. Also accessory ducts/peribiliary glands and their conduits in ductal wall can mimic invasive ductal components, which requires careful examination to evaluate regenerative change, carcinoma in situ, or invasive carcinoma. Published studies assessing an association between the ductal margin state and prognosis in relatively large cohorts of patients undergoing surgery for bile duct cancer indicate that the ductal margin status is an independent prognostic factor; and the ductal margin with carcinoma in situ is comparable to free margin; however, the margin with invasive carcinoma is significantly adverse for patients' prognoses.     

Diabetic ketoacidosis accompanied by hypothermia: a case report

Diabetic ketoacidosis (DKA) is an acute, life-threatening complication of diabetes mellitus and is caused by insulin insufficiency. Hypothermia is defined as a core temperature of less than 35°C and is sometimes accompanied by DKA. We report two patients with diabetes who were admitted for DKA accompanied by hypothermia.     

Association of cytokeratin 17 expression with differentiation in oral squamous cell carcinoma

Purpose

The aim of this study was to confirm the expression profile of cytokeratin (CK)17 in comparison with that of CK13 in oral squamous cell carcinoma (OSCC) and leukoplakia and to clarify an association of CK17 with the OSCC differentiation.

Materials

The expression of CK17 and CK13 was immunohistochemically examined in 105 patients with OSCC and 108 patients with leukoplakia. A correlation of CK expression with clinicopathological variables was carried out. The over-expression levels of CK17 mRNA were analyzed by real-time RT-PCR in 5 OSCC cell lines (HSC-2, HSC-3, SAS, SQUU-A, SQUU-B).

Results

CK17 and CK13 were detected in 101 (96.2?%) and three (2.9?%) of the 105 OSCCs, respectively. CK17 was significantly expressed in well-differentiated OSCC compared to moderately/poorly differentiated OSCC (p?p?p?p?p?Conclusion CK17 expression could be associated with the differentiation and the malignancy of OSCC. A combination pattern of CK17/CK13 might be a suitable marker of malignant transformation.     

Hypertension and concomitant arteriosclerotic diseases are risk factors for colonic diverticular bleeding: a case–control study

Purpose

Colonic diverticular bleeding is a major cause of lower gastrointestinal bleeding. However, a limited number of studies have been reported on the risk factors for diverticular bleeding. Our aim was to identify risk factors for diverticular bleeding.

Methods

Our study design is a case (diverticular bleeding)–control (diverticulosis) study. We prospectively collected information of habits, comorbidities, history of medications and symptoms by a questionnaire, and diagnosed diverticular bleeding and diverticulosis by colonoscopy. Logistic regression models were used to estimate odds ratio (OR) and 95% confidence interval (CI).

Results

A total of 254 patients (diverticular bleeding, 45; diverculosis, 209) were selected for analysis. Cluster (≥10 diverticula) type (OR, 4.0; 95% CI, 1.8–8.9), hypertension (OR, 2.2; 95% CI, 1.0–4.6), ischemic heart disease (OR, 2.4; 95% CI, 1.1–5.4), and chronic renal failure (OR, 6.4; 95% CI, 1.3–32) were independent risk factors for diverticular bleeding.

Conclusions

Large number of diverticula, hypertension, and concomitant arteriosclerotic diseases including ischemic heart disease and chronic renal failure are risk factors for diverticular bleeding. This study identifies new information on the risk factors for diverticular bleeding.     

Horizontal impaction of primary mandibular bilateral central incisors identified in 2-year-8-month-old girl

A girl aged 2 years and 8 months came to our clinic for consultation with regard to unerupted primary mandibular bilateral central incisors. An intraoral examination revealed that the teeth had not emerged into the oral cavity and showed a tooth crown morphology similar to that of the primary mandibular incisors, which appeared in the lingual submucosal area outside of the mandibular dental arch. Periapical radiographs demonstrated that the tooth crowns of both affected teeth were severely displaced to the lingual side. Computed tomography examinations were performed to clarify the three-dimensional positions of the affected teeth and their permanent successors, which revealed that the affected teeth were located in their estimated positions and had a standard root morphology. In addition, the permanent successors, which had not initiated root formation, were located close to the affected teeth. We decided to postpone extraction of the affected teeth and perform periodical examinations until the roots of the permanent successors are sufficiently formed. At the age of 2 years and 10 months, the edge of the tooth crown of the primary mandibular left central incisor was found emerged into the oral cavity. According to her parents, the patient did not complain of the emerging edge and no abnormal conditions were observed around the tooth.     

Evaluation of molecular targeted cancer drug by changes in tumor marker doubling times

Background  

We evaluated the usefulness of tumor marker doubling time (DT) as an efficacy indicator of a molecular targeted anticancer agent.