A case of effective paclitaxel therapy for gastric cancer with brain metastasis

A case of effective paclitaxel therapy for gastric cancer with brain metastasis is reported. The patient was a 76-year-old male, who underwent total gastrectomy for advanced gastric carcinoma with direct invasion of the pancreas. One year and six months later, he was resected for a right temporal-occipital brain metastatic tumor, and local cerebral irradiation at 30 Gy was performed. Four months later, new multiple brain metastases were detected in the cerebellum. We tried paclitaxel administration. It was continued on a weekly basis at 70 mg/m(2), and the brain metastases continued to diminish; in addition, gamma knife therapy led to an improvement in the quality of life. Although the patient had been told that he had only a month to live, he was improving dramatically. However, he died of sepsis due to Fournier's gangrene about 5 months later. Paclitaxel seems to have a strong antineoplastic effect by brain metastasis of gastric cancer.     

Hepatocellular carcinoma with a central scar and a scalloped tumor margin resembling focal nodular hyperplasia in macroscopic appearance

BACKGROUND: We sometimes encounter hepatocellular carcinoma (HCC) with a central scar and a scalloped tumor margin resembling focal nodular hyperplasia (FNH) in macroscopic appearance. The fibrolamellar variant sometimes shows this appearance; however, this type of HCC can be clearly differentiated from fibrolamellar variants on the basis of clinical and histopathological findings. The clinical features of patients with this type of HCC need to be clarified. METHODS: From 1988 to 1999, 1,043 patients with HCC underwent hepatectomy at our institution. Histopathological examinations show that fibrolamellar HCC was not included in the series. We selected HCC with a central scar and a scalloped tumor margin resembling FNH in macroscopic appearance. We refer to such tumors as scalloped HCC. We compared the clinical findings and surgical outcomes between patients with scalloped HCC and patients with simple nodular HCC. RESULTS: Of the 1,043 cases of HCC, 31 (3%) and 571 (55%) were scalloped HCC and simple nodular HCC, respectively. The mean age of the patients with scalloped HCC was 60.7 years, and that of the patients with simple nodular HCC was 62.6 years, without significant difference. The rates of hepatitis C virus infection and liver cirrhosis and serum alpha-fetoprotein levels were significantly lower, and Child-Pugh class and surgical outcomes were significantly better in patients with scalloped HCC than in those with simple nodular HCC. In multivariate analysis, Child-Pugh class (P < 0.001), tumor size (P = 0.046), and gross appearance (P = 0.009) were independent significant prognostic factors. CONCLUSION: HCC with a central scar and a scalloped tumor margin resembling FNH occurs in non-cirrhotic patients in their 60s and is associated with a good surgical outcome.     

Associations between lifestyle and mental health in a group of Japanese overseas workers and their spouses resident in Düsseldorf, Germany

This study investigated associations between lifestyle factors and selected aspects of mental health in a group of Japanese overseas workers and their accompanying spouses who were residing in and around Düsseldorf, Germany, in February 1994. Considering four aspects of mental health (depression, mental instability, nervousness and neurosis) and six lifestyle factors (alcohol consumption, sleeping hours, cigarette smoking, physical exercise, eating breakfast and eating snacks), a cross-sectional study involving 822 volunteers (486 workers and 336 spouses) was performed using the Todai Health Index (THI) for surveying self-perceived health and a lifestyle related self-administered questionnaire. Alcohol consumption had no associations with any of the four aspects of mental health, and only very weak inverse associations were found between the other five lifestyle factors and the four aspects of mental health in the workers group. In the spouses group, physical exercise was the only lifestyle factor significantly associated with mental health.     

Perioperative changes in the circulatory blood volumes in patients undergoing the abdominal aortic aneurysm repair

BACKGROUND: The effect of the intraoperative volume load on the circulating blood volume is unclear. Therefore, we investigated the changes of the perioperative blood volume in patients undergoing major surgery. METHODS: In 16 patients undergoing abdominal aortic aneurysm repair, we measured the circulating blood volume (BV x kg(-1)) with the pulse dyedensitometry method (DDG analyzer) before operation, just after operation, on the first postoperative day (1POD) and 2POD. Anesthesia was maintained with general anesthesia and epidural analgesia. The volume of infusion depended on empiric judgment by an anesthesiologist. RESULTS: Mean anesthesia time was 390 minutes, the mean volume of infusion 4225 ml, transfusion 1329 g, blood loss 1567 g, urine output 729 ml, and mean water balance +3287 ml. The mean body weight (BW) was 59.2 +/- 13.7 (before), 60.2 +/- 14.4 (just after), 60.5 +/- 14.3 (1POD), and 60.3 +/- 14.3 (2POD) kg, respectively. The mean BV x kg(-1) was 78.0 +/- 19.0 (before), 65.6 +/- 13.4 (just after), 70.4 +/- 15.7 (1POD), and 76.5 +/- 18.2 (2POD) ml x kg(-1), respectively. The mean BW after operation increased significantly from the value before surgery. However, the mean BV x kg(-1) decreased significantly. There was a significant correlation between the intraoperative increase in BW and intraanesthetic water balance (Y = -2.91 + 0.071X; R = 0.66, P = 0.0412), but there was no significant correlation between the change in BV x kg(-1) and intraanesthetic water balance. CONCLUSIONS: Intraoperative water balance influenced a change of BW significantly, but did not affect BV x kg(-1).     

Fabrication of porous particulate for the scaffold by applying solution spraying method

A simple and novel method--in the form of solution spraying--was developed to fabricate biodegradable, porous poly(L-lactic acid) (PLLA) particulates for scaffold. PLLA pellets were dissolved in an organic solvent. Then, 5 % PLLA-dioxane solution was sprayed using an air-assisted atomizer with a nozzle diameter of 2.5 mm at an air flow rate of 15 L/min. After the sprayed solution solidified in liquid nitrogen, spherical particulates with median diameter of 225microm were obtained. Morphology of sprayed products could be altered by varying the fabrication conditions. When nozzle diameter was reduced to 1.5 mm, sprayed products became fibrous. When the concentration of PLLA-dioxane solution was increased, the diameter of particulates increased too. On the other hand, when air flow rate was increased, the diameter of particulates decreased. Likewise, solidification conditions also affected the morphology of sprayed products, such that they were either thin film-like or in particulate form. Based on the results of the present study, we concluded that PLLA particulates of varying morphologies could be obtained by adjusting the fabrication conditions.     

Thymic epithelial cells: working class heroes for T cell development and repertoire selection

The thymus represents an epithelial-mesenchymal tissue, anatomically structured into discrete cortical and medullary regions that contain phenotypically and functionally distinct stromal cells, as well as thymocytes at defined stages of maturation. The stepwise progression of thymocyte development seems to require serial migration through these distinct thymic regions, where interactions with cortical thymic epithelial cell (cTEC) and medullary thymic epithelial cell (mTEC) subsets take place. Recent work on TEC subsets provides insight into T cell development and selection, such as the importance of tumour necrosis factor (TNF) receptor superfamily members in thymus medulla development, and the specialised antigen processing/presentation capacity of the thymic cortex for positive selection. Here, we summarise current knowledge on the development and function of the thymic microenvironment, paying particular attention to the cortical and medullary epithelial compartments.     

Diagnostic yield of the plasma free amino acid index for pancreatic cancer in patients with diabetes mellitus

ObjectivesA multivariate index calculated using plasma free amino acids (PFAA index) was reported as a diagnostic biomarker for pancreatic cancer (PaC). Although diabetes mellitus (DM) is expected to be an early diagnostic indicator of PaC, identifying the high-risk individuals among patients with DM is warranted. We evaluated the diagnostic yield of the PFAA index for PaC in patients with DM.MethodsWe compared the diagnostic yield of the PFAA index between individuals with and those without DM. Cases and controls were recruited prospectively, and controls were matched to cases at a 1:1 ratio for age, sex, and DM status.ResultsA total of 180 case–control pairs were included in the analysis. The prevalence of DM was 53.3%. The sensitivity of the PFAA index was 66.7% in cases with DM and 56.0% in those without DM (P = 0.14), and the specificity was 92.7% in controls with DM and 94.0% in those without DM (P = 0.95).ConclusionsThis matched case-control study revealed a comparable diagnostic yield of the PFAA index for PaC in individuals with and those without DM. The PFAA index can be used as a biomarker for further diagnostic imaging in selected patients with DM.