Five condensed furanocoumarins from the root of <Emphasis Type="Italic">Heracleum candicans</Emphasis> Wall.

Three new spirotrifuranocoumarins, canditririns C–E (1–3), a new spirotetrafuranocoumarin, canditetrarin A (4), and a new tetrafuranocoumarin, canditetrarin B (5), were isolated from the roots of Heracleum candicans Wall. Their structures were established using spectral methods.     

Sentinel Node Concept in Clinically N0 Laryngeal and Hypopharyngeal Cancer

Background  Sentinel nodes (SNs) are the lymph nodes that directly receive lymphatic flow from a primary cancer lesion. The SN concept implies that lymphatic metastasis initially occurs at SNs. SN navigation surgery can be introduced for cancers in which the SN concept is established. In SN navigation surgery, lymph node dissection beyond SNs can be omitted if SNs are metastasis free. Although the SN concept has been investigated frequently for oral and oropharyngeal cancer, it has so far been investigated less for laryngeal and hypopharyngeal cancer. In this study, we investigated whether the SN concept is applicable for laryngeal and hypopharyngeal cancer. Methods  Twenty patients with T2–T4 and clinically N0 laryngeal and hypopharyngeal cancer were recruited. ^99mTc-phytate was injected into several sites surrounding the tumor on the day before surgery. Lymphoscintigrams were acquired from at least two different viewpoints. SNs were surveyed intraoperatively, and neck dissections including at least levels II, III, and IV were performed. Results  SNs had occult metastases in five cases. In the remaining 15 cases, neither SNs nor other lymph nodes contained metastases, consistent with the SN concept. There was one false-negative case showing delayed nodal metastasis 2 years after initial surgery. The overall accuracy of the SN concept was 95%. Conclusion  Our study shows that SN biopsy is a reliable strategy to determine correct lymph node status in N0 laryngeal and hypopharyngeal cancer. SN detection was valuable in evaluating the need for neck dissection, whether ipsilaterally or bilaterally. Presented at the 2004 Annual Meeting of the American Academy of Otolaryngology, New York.     

Agenesis of the internal carotid artery with transcavernous anastomosis presenting with an anterior communicating artery aneurysm--a case report and review of the literature

Arterial communication between cavernous segments of the carotid arteries associated with unilateral agenesis of the internal carotid artery (ICA) is extremely rare. We herein present a case of unilateral ICA agenesis with transcavernous anastomosis that presents with an anterior communicating artery (ACoA) aneurysm, and discuss its embryogeny and clinical implications. A 55-year-old woman with no significant medical history was admitted to our hospital for further examination of agenesis of the left ICA, which was detected in a routine medical examination. She was free of clinical symptoms and had no neurological deficits. Radiological evaluation revealed agenesis of the left ICA with transcavernous anastomosis. Moreover, an incidental multilobulated aneurysm was detected at the ACoA. She underwent microsurgical clipping for this aneurysm, and the post-operative course was uneventful. Investigation of collateral pathways helps our understanding of the segmental nature of carotid artery development. Recognition of this anomaly also has important implications in the surveillance and detection of associated cerebral aneurysms.     

Recanalization after endovascular occlusion of a dissecting aneurysm of the posterior cerebral artery--A case report and review of the literature

Endovascular occlusion has been accepted as a safe, minimally invasive, and reliable treatment for ruptured dissecting aneurysms. Occlusion of the entire affected area is ideally the most complete treatment for such lesions. However, it is difficult to occlude the entire dissected lesion when it involves side branches due to the short-term risk of side branch occlusion, emboli dislodgement, and the long-term risk of parent artery recanalization. We herein present an extremely rare case where recanalization occurred after endovascular occlusion of a ruptured dissecting aneurysm of the posterior cerebral artery, and discuss its clinical implications. There are three mechanisms of recanalization: coil compaction due to loose or short segment packing, secondary dissection and occlusion of the false lumen. In endovascular occlusion of dissecting aneurysms that involve side branches, it is important to consider the risk of both recanalization and ischemic complications. We should attempt to insert the microcatheter into the true lumen and maintain dense packing as long as possible, unless the coils occlude the side branches following the procedure. Careful follow-up is necessary in all patients that received endovascular treatment.     

Clinical significance of intercellular adhesion molecule-1 in ulcerative colitis

This study was conducted to assess the clinical significance of intercellular adhesion molecule-1 (ICAM-1) in ulcerative colitis (UC). The subjects were 53 cases of UC and 43 control cases. ICAM-1 was expressed to a greater degree in the UC specimens. Serum ICAM-1 concentrations in the UC group showed values that were lower than those in the control group (P = 0.0081). Serum ICAM-1 concentrations were found to vary according to degree of clinical severity, activity, and affected range. Considering the cases of surgery, there was only one case in which a lowering of early postoperative values was found. In all cases in which therapeutic drugs including steroids were not administered, late postoperative values were significantly increased. ICAM-1 dynamics in UC were frequently seen in tissue and exhibited a significantly low value in blood serum; however, the influence of clinical severity, activity, diseased area, measuring time, and therapeutic drugs need further study.     

Filiasparosides A-D, cytotoxic steroidal saponins from the roots of Asparagus filicinus

Four new steroidal saponins, filiasparosides A-D (1-4), together with known aspafiliosides A (5) and B (6) were isolated from the roots of Asparagus filicinus. The structures of these new compounds were elucidated by detailed spectroscopic study and chemical analysis. Compounds 1-6 were cytotoxic against human lung carcinoma (A549) and breast adenocarcinoma (MCF-7) tumor cell lines with EC(50) values of 2.3-16.8 microg/mL. Compound 3 showed the most potent cytotoxicity, with EC(50) values of 2.3 and 3.0 microg/mL toward A549 and MCF-7 cell lines, respectively.     

Separation and characterization of active flavonolignans of Silybum marianum by liquid chromatography connected with hybrid ion-trap and time-of-flight mass spectrometry (LC-MS/IT-TOF)

Silychristins A (1) and B (2), silydianin (3), silybins A (4) and B (5), and isosilybins A (6) and B (7) are major bioactive flavonolignans in silymarin, a herbal remedy derived from the milk thistle Silybum marianum. In this study, the seven major active flavonolignans including the diastereomers 1/ 2, 4/ 5, and 6/ 7 were completely separated using semi-micro-high performance liquid chromatography (HPLC) with a Nucleosil 100-3 C 18 HD column and a MeOH/water/formic acid mobile phase system. The collision-induced dissociation (CID) MS/MS and MS (3) spectra of these flavonolignans were studied systematically using hybrid ion-trap and time-of-flight (IT-TOF) mass spectrometry. Efficient differentiation between the seven flavonolignans (1- 7) was possible based on comparison of the resultant CID-MS/MS or MS (3) spectra. Each characteristic MS/MS or MS (3) fragmentation pattern was elucidated with high-resolution mass spectra by IT-TOF. The results with the present methodology show that liquid chromatography-mass spectrometry IT-TOF (LC-MS/IT-TOF) can be useful for general screening of active natural products from plant extracts and for the specific quality control of silymarin.     

Case of Gastric Lymphoma Diagnosed by Laparoscopic Excision Biopsy

Primary gastric lymphoma is a relatively uncommon disease and sometimes forms submucosal growth causing difficulty of diagnosis. We have reported a case of primary gastric lymphoma successfully diagnosed by laparoscopic wedge resection, after repeatedly performing endoscopic forcep biopsies. Diagnostic laparoscopy for obtaining definite histological diagnosis can be regarded as minimally invasive, accurate and safe.