Improvement in renal dysfunction and symptoms after laparoscopic adrenalectomy in a patient with pheochromocytoma complicated by renal dysfunction

A 70-year-old patient who was undergoing treatment for diabetes mellitus and chronic hepatitis was admitted to our hospital for evaluation of a tumor in the left adrenal gland (50 × 45 mm) and renal failure. On the basis of the patient’s increased serum concentrations of catecholamines and other metabolites and the results of positron emission tomography (PET), the patient was diagnosed with a pheochromocytoma; iodinated metaiodobenzylguanidine ([¹³¹I]MIBG) scintigraphy was insufficient to establish this diagnosis. Subsequently, he underwent surgery for tumor resection. Histological examination suggested the tumor to be a malignant pheochromocytoma. After left adrenalectomy was performed, the elevated catecholamine and metabolite concentrations and the blood pressure were restored to normal, and the patient’s symptoms of severe headaches and vertigo reduced. Furthermore, his renal function improved (Cr 2.0–1.2 mg/dl). Our patient exhibited a rare condition of pheochromocytoma complicated by renal failure, which was successfully treated with laparoscopic surgery.     

Simultaneous adenocarcinoma and leiomyoma of the stomach presenting as a collision tumor

A 68-year old Japanese man was referred to the Cancer Institute Hospital for the treatment of a rectal cancer. Preoperative esophagogastroduodenoscopy revealed a submucosal tumor with ulcer formation near the esophagogastric junction of the stomach. The initial treatment strategy was to perform a proximal gastrectomy with limited lymph node dissection as well as a simultaneous anterior resection. However, histopathological examination of a biopsy specimen of the submucosal tumor revealed a moderately differentiated adenocarcinoma, and therefore a total gastrectomy with D2 lymph node dissection was performed. Histopathological examination of the resected specimen revealed both adenocarcinoma and leiomyoma presenting as a collision tumor. Preoperative accurate histopathological diagnosis of a gastric submucosal tumor is generally difficult. Consequently, surgical resection of large gastric submucosal tumors may be indicated in the absence of histopathological confirmation of the diagnosis. However, in this case preoperative histopathological diagnosis enabled surgeons to perform the appropriate surgery. We conclude that to determine the appropriate treatment strategy, preoperative histopathological examination of tumors should be performed even in a case of suspected submucosal tumor, particularly if mucosal ulceration is present.     

Better Prognosis of T2 Gastric Cancer with Preoperative Diagnosis of Early Gastric Cancer

Background  Gastrectomy with D2 lymph node dissection is the standard treatment for locally advanced gastric cancer in Japan. However, in patients with a preoperative diagnosis of early gastric cancer, gastrectomy with limited lymph node dissection is generally selected as a treatment option, despite a pathological diagnosis of advanced gastric cancer. The aim of the present study was to clarify the clinicopathological characteristics and feasibility of limited lymph node dissection in patients with clinically early, but pathologically advanced, gastric cancer. Materials and Methods  Clinicopathological characteristics, including the incidence and susceptible sites for lymph node metastasis, were investigated in 1528 patients with a final diagnosis of T2 gastric cancer treated at the Cancer Institute Hospital. For these patients, the results were compared between two groups including 266 patients preoperatively diagnosed as early T1 gastric cancer (EpT2) and 1262 patients preoperative diagnosed as locally advanced gastric cancer (ApT2). Results  The pathological stage was lower (P < .001), and the 5-year survival rate was better (91.0% vs. 73.1%, P < .001) for the EpT2 group compared with the ApT2 group. Moreover, the N stage was smaller in the EpT2 group than in the ApT2 group, and the extension of lymph node metastasis was limited in 261 out of 266 patients (98%). Conclusion  Patients with EpT2 gastric cancer had a better 5-year survival rate than the patients in the ApT2 group. Gastrectomy with limited lymph node dissection could be indicated for patients with EpT2 gastric cancer unless intraoperative finding indicated obvious lymph node metastasis.     

Increased Fat Content and Body Shape Have Little Effect on the Accuracy of Lymph Node Retrieval and Blood Loss in Laparoscopic Distal Gastrectomy for Gastric Cancer

Background  Fat volume and large abdominal shape are known to disrupt the procedures of lymph node retrieval used in gastric cancer surgery. The present study examined the effect of increasing fat content on surgical outcomes, including estimated blood loss and the number of lymph nodes retrieved during gastrectomy. Methods  Of 154 patients, 50 underwent the conventional open procedure (OPEN) and 104 underwent laparoscopy-assisted distal gastrectomy (LADG). The BMI-related factors of total fat, subcutaneous fat, and visceral fat area, as well as the peritoneum–celiac axis distance were calculated by computed tomography. Regression analysis was used to determine the effects of BMI-related factors that obstruct the surgical procedures on the specific outcomes of estimated blood loss and the number of lymph nodes retrieved. Results  In the OPEN, but not in the LADG, increases in all BMI-related factors were related to increases in estimated blood loss. The increases in BMI, subcutaneous fat, and the peritoneum-celiac axis distances were related to decreased numbers of retrieved lymph nodes only in the OPEN. Only the factor of visceral fat at the celiac level was modestly associated with a decreased number of dissected lymph node in both groups. Conclusions  The present study demonstrated that increased fat content and large body shape have little effect on the number of lymph nodes retrieved and blood loss in LADG. However, for patients undergoing conventional open distal gastrectomy, increased fat content and large body shape do impact on the amount of blood lost and the number of lymph nodes retrieved.     

Age-related spatial and nonspatial short-term memory in Cav2.1α1 mutant mice, Rolling Nagoya

Aged heterozygous Rolling Nagoya mice carrying Cav2.1α₁ mutation show deficits with regard to spatial short-term memory using hippocampus-related object location test, but not with regard to nonspatial memory using perirhinal cortex-related object recognition test. In hippocampus, wild-type Cav2.1α₁ mRNA exhibited lower expression and mutant-type expression was higher in aged heterozygous mice. In perirhinal cortex, there were no significantly different expressions. Alteration of age-dependent expressions of Cav2.1 channels differs in different regions with related effects on behavioral performances.     

Local conduction block of the atria by premature stimulus in a patient with Brugada syndrome

A 46-year-old man with type II Brugada electrocardiogram pattern changed to a type I Brugada type electrocardiogram pattern by class I antiarrhythmic drug (pilsicainide) underwent electrophysiologic study. Ventricular fibrillation was induced by double extrastimuli from the right ventricular (RV) apex. Monophasic action potentials (MAPs) were then recorded from the high right atrium. Duration of MAP at a coupling interval of 220 milliseconds was 122 milliseconds, and local activation of S2 spread to the left atrium. However, MAP at a coupling interval of 210 milliseconds was 112 milliseconds, and local activation of S2 failed to spread to the rest of atrium.     

Secretion of bioactive interleukin-6 and tumor necrosis factor-alpha proteins from primary cultured human fetal membrane chorion cells infected with influenza virus

Influenza virus infection during pregnancy is implicated in one of the causes of premature delivery, abortion and stillbirth. Pro-inflammatory cytokines, such as interleukin (IL)-6 and tumor necrosis factor (TNF)-alpha produced by fetal membranes, are postulated to facilitate premature delivery. We investigated the secretion of IL-6 and TNF-alpha from primary cultured human fetal membrane chorion and amnion cells infected with influenza virus at protein and bioactivity levels in order to understand the pathology of premature delivery during influenza virus infection. Concentrations of IL-6 and TNF-alpha proteins were significantly increased in culture supernatants of chorion cells by influenza virus infection. Culture supernatants of the virus-infected chorion cells stimulated the proliferation of IL-6-sensitive 7-TD-1 cells and induced the cytolysis of TNF-alpha-sensitive L929 cells, both activities of which were inhibited by the addition of respective antibody, whereas no such phenomena were observed in amnion cells. The results demonstrated that only chorion cells secreted significant amounts of bioactive IL-6 and TNF-alpha proteins responding to influenza virus infection. The present study suggests a possibility that the secretion of bioactive IL-6 and TNF-alpha proteins from fetal membrane chorion cells is implicated in the pathogenesis of premature delivery during influenza virus infection.     

Simultaneous maxillary distraction osteogenesis using a twin-track distraction device combined with alveolar bone grafting in cleft patients: preliminary report of a technique

The simultaneous use of cleft reduction and maxillary advancement by distraction osteogenesis has not been applied routinely because of the difficulty in three-dimensional control and stabilization of the transported segments. This report describes a new approach of simultaneous bilateral alveolar cleft reduction and maxillary advancement by distraction osteogenesis combined with autogenous bone grafting. A custom-made Twin-Track device was used to allow bilateral alveolar cleft closure combined with simultaneous maxillary advancement, using distraction osteogenesis and a rigid external distraction system in a bilateral cleft lip and palate patient. After a maxillary Le Fort I osteotomy, autogenous iliac bone graft was placed in the cleft spaces before suturing. A latency period of six days was observed before activation. The rate of activation was one mm/d for the maxillary advancement and 0.5 mm/d for the segmental transport. Accordingly, the concave facial appearance was improved with acceptable occlusion, and complete bilateral cleft closure was attained. No adjustments were necessary to the vector of the transported segments during the activation and no complications were observed. The proposed Twin-Track device, based on the concept of track-guided bone transport, permitted three-dimensional control over the distraction processes allowing simultaneous cleft closure, maxillary distraction, and autogenous bone grafting. The combined simultaneous approach is extremely advantageous in correcting severe deformities, reducing the number of surgical interventions and, consequently, the total treatment time.     

Tissue-specific roles of Tbx1 in the development of the outer, middle and inner ear, defective in 22q11DS patients

Most 22q11.2 deletion syndrome (22q11DS) patients have middle and outer ear anomalies, whereas some have inner ear malformations. Tbx1, a gene hemizygously deleted in 22q11DS patients and required for ear development, is expressed in multiple tissues during embryogenesis. To determine the role of Tbx1 in the first pharyngeal pouch (PPI) in forming outer and middle ears, we tissue-specifically inactivated the gene using Foxg1-Cre. In the conditional mutants, PPI failed to outgrow, preventing the middle ear bone condensations from forming. Tbx1 was also inactivated in the otic vesicle (OV), resulting in the failure of inner ear sensory organ formation, and in duplication of the cochleovestibular ganglion (CVG). Consistent with the anatomical defects, the sensory genes, Otx1 and Bmp4 were downregulated, whereas the CVG genes, Fgf3 and NeuroD, were upregulated. To delineate Tbx1 cell-autonomous roles, a more selective ablation, exclusively in the OV, was performed using Pax2-Cre. In contrast to the Foxg1-Cre mutants, Pax2-Cre conditional mutant mice survived to adulthood and had normal outer and middle ears but had the same inner ear defects as the Tbx1 null mice, with the same gene expression changes. These results demonstrate that Tbx1 has non-cell autonomous roles in PPI in the formation of outer and middle ears and cell-autonomous roles in the OV. Periotic mesenchymal markers, Prx2 and Brn4 were normal in both conditional mutants, whereas they were diminished in Tbx1-/- embryos. Thus, Tbx1 in the surrounding mesenchyme in both sets of conditional mutants cannot suppress the defects in the OV that occur in the null mutants.     

Influence of food platform width of mandibular removable partial denture on food mixing ability

The aim of this study was to clarify the influence of food platform width on food mixing ability in patients with mandibular removable partial dentures (RPDs). Twelve subjects (six males and six females, mean age 56.8 years) with intact dentition except for unilaterally missing mandibular first and second molars participated in the study. The food platforms of their RPDs were made of light polymerized composite and three platform conditions were evaluated. A food platform (Control condition) had 7 mm width with a central focus on the top of the residual ridge. Narrowed platforms (5 mm) were created by trimming a lingual portion (Buccally oriented occlusion, Buccal condition) or a buccal portion (Lingually oriented occlusion, Lingual condition) from the control. Subjects chewed a standardized wax cube which provided an estimate of food mixing ability [Mixing Ability Index (MAI)] for each of the three platforms. A significant effect (P < 0.001) on the MAI was found for food platform type (repeated measures one-way analysis of variance). Tukey multiple comparisons found significant differences of MAI between Control condition (1.05 +/- 0.26) and Buccal condition (0.86 +/- 0.23) (P = 0.032), and between Control and Lingual condition (0.54 +/- 0.37) (P < 0.001). Furthermore, MAI with Lingual condition was significantly smaller than that with Buccal condition (P < 0.001). These results suggest that reduction in the width of the food platform may impair masticatory function and the buccal portion of mandibular food platform of RPD is more critical for food mixing than the lingual portion of the platform.