Clinical Remission Criteria for Epithelial Carcinoma of the Ovary

After primary cytoreductive surgery 188 patients with epithelial ovarian cancer were treated with combination chemotherapy between 1986 and 1989 in the Tokai Ovarian Tumor Study Group. Clinical remission criteria were set in this study and patients were examined to determine if they were in remission or not. Forty-seven cases (25%) had no remission and 85.9% of them died within 20 months after primary surgery. Fifty-seven cases (30.3%) had a remission and a subsequent recurrence. Eighty-four cases (44.7%) had no recurrence and all are currently alive. Independent remission factors by multivariate analysis were higher stage (P = 0.018), clear-cell carcinoma (P = 0.0048), larger maximum residual tumor (P = 0.0023), and PVB therapy (P = 0.026). Independent recurrence factors were higher stage (P = 0.0012), serous cystadenocarcinoma (P = 0.0001), clear-cell carcinoma (P = 0.00409), and PVB therapy (P = 0.0499). A significantly high remission rate and low recurrence rate was achieved using PVB therapy. This criteria has value for the treatment of epithelial ovarian carcinoma. The disease-free survival rate after clinical remission was the same as that after a negative second-look laparotomy, which implies that a second-look lapcarotomy may be unnecessary in the management of epithelial carcinoma of the ovary.     

Adenomyoepithelioma of the breast: a case report and a review of the literature

A 74-year-old woman complained of a small nodule in the outer lower quadrant of her left breast. On physical examination, a 0.9 x 0.8 cm, round-shaped and firmly elastic nodule was palpated. Excisional biopsy was performed. Histologically, the tumor was separated into, with a bicellular pattern, containing both numerous glandular structures and numerous spindle-shaped cells. Immunohistochemical staining for EMA and cytokeratin showed strongly positive immunoreactivity for epithelial cells. Staining for &aipha;-SMA showed strongly positive immunoreactivity for myoepithelial components. Staining for keratin and S-100 protein showed weakly positive immunoreactivity for myoepithelial cells. Microscopically, the tumor was diagnosed as adenomyoepithelioma of the breast. Immunohistochemical examination is needed to distinguish epithelial cell proliferation from myoepithelial cell proliferation. Immunohistochemical examination using antibodies against EMA, alpha-SMA, Keratin, cytokeratin and S-100 protein, is indispensable.     

Urodynamic Analysis of Age-Related Changes of alpha sub 1 -Adrenoceptor Responsiveness in Female Beagle Dogs

Purpose

We have evaluated age-related changes of alpha₁-adrenoceptor responsiveness in the lower urinary tract of female beagle dogs by urodynamic analyses.

Materials and Methods

Six aged parous and 6 young nonparous female beagle dogs were studied. Mean ages (plus/minus standard error of the mean) of the 2 groups were 68.3 plus/minus 2.3 and 12.4 plus/minus 0.08 months. Before and after 4 administrations of alpha₁-adrenoceptor agonist (midodrine hydrochloride 0.03, 0.1, 0.3 and 1.0 mg./kg. intravenously), cystometry, urethral pressure profilometry and external urethral sphincter electromyography were performed.

Results

After 0.3 mg./kg. midodrine administration, mean bladder capacity in the aged dogs significantly decreased, compared with that in the young dogs (p less than 0.05). After the minimum dose administration (0.03 mg./kg.), the urethral closing pressure in both groups increased significantly (p less than 0.05) with no changes in bladder capacity or arterial blood pressure. The proximal urethral closing pressure in the aged dogs increased dose dependently. After administration of 1.0 mg./kg. drug it reached 257 percent of the initial values (p less than 0.01), which was significantly greater than that in the young dogs (p less than 0.05).

Conclusions

These findings suggest that 1) age-related increase of alpha₁-adrenoceptor responsiveness occurs in the bladder and in the proximal urethra. The former may be one of the etiologies of detrusor instability in the elderly. 2) A lower dose of midodrine hydrochloride may be useful for the treatment of stress incontinence, independent of age.     

IL-5 production by CD4+ T cells of asthmatic patients is suppressed by glucocorticoids and the immunosuppressants FK506 and cyclosporin A

IL-5 was produced in vitro by peripheral blood mononuclear cells(PBMC) of mite-sensitive atopic patients upon challenge withspecific allergen, while PBMC of healthy controls produced essentiallyno IL-5. Stimuli delivered by the combination of phorbol esterand Ca²⁺ ionophore induced marked IL-5 production by PBMC obtainedfrom atopic and non-atoplc asthmatics, suggesting that bothprotein kinase C and Ca²⁺ Influx are required for IL-5 production.CD2- or CD4-bearlng cell depletion almost completely removedIL-5-produclng cells while CD8-bearing cell depletion ratherenriched them. These findings indicate that CD4⁺ T cells arethe principal source of IL-5 in PBMC. The capacity of PBMC ofatopic asthmatics, non-atopic asthmatics and healthy controlsto produce IL-2, IL-4, IL-5 and IFN- was compared, to find thatcytokine-producing capacities other than that of IL-5 (IL-2,IL-4 and IFN-) were not significantly different among the threegroups. Dexamethasone, FK506 and cyclosporin A suppressed IL-5production in vitro in a dose-dependent manner. Clear dose-dependentsuppression of IL-5 gene expression by FK506 was also observed.Treatment of asthmatic patients with inhaled glucocorticoid(beclomethasone dipropionate) ameliorated clinical symptoms,improved lung function and markedly suppressed IL-5 productionby PBMC, suggesting the essential role of IL-5 in the pathogenesisof bronchial asthma and the clinical importance of its regulation.     

Left Atrial Systolic Performance in the Presence of Elevated Left Ventricular End-Diastolic Pressure: Evaluation by Transesophageal Pulsed Doppler Echocardiography of Left Ventricular Inflow and Pulmonary Venous Flow Velocities

We recorded left ventricular inflow (LVIF) and pulmonary venous flow (PVF) velocities by transesophageal pulsed Doppler echocardiography in 25 patients with a ratio of peak atrial systolic to early diastolic LVIF velocity of <1 and a left ventricular end-diastolic pressure (LVEDP) of 15 mmHg or greater, as well as in 30 normal subjects. The group consisted of 14 patients with prior myocardial infarction, 7 with dilated cardiomyopathy, and 4 with cardiac amyloidosis, and were divided into: (1) group A (n = 7): peak atrial systolic LVIF velocity of 40 cm/sec or greater; (2) group B (n = 7): peak atrial systolic LVIF velocity of <40 cm/sec and peak atrial systolic PVF velocity of 30 cm/sec or greater; and (3) group C (n = 11): peak atrial systolic LVIF velocity of <40 cm/sec and peak atrial systolic PVF velocity of <30 cm/sec. Although LVEDPs in groups B and C were significantly greater than in group A, there was no difference between groups B and C. The mean pulmonary capillary wedge pressure (mPCWP) in group C was significantly greater than in groups A and B, but there was no difference between groups A and B. The difference between LVEDP and mPCWP (LVEDP - mPCWP) in group B was significantly higher than in groups A and C. Dilatation of the left atrium (LA) was seen in all three groups, particularly in groups B and C. There were no differences in peak atrial systolic LVIF velocity and LA volume change during atrial contraction between group A and the control group, and there were no differences in LA volume change and peak second systolic PVF velocity between groups A and B. LA volume change and peak second systolic PVF velocity were significantly less in group C than in groups A and B. Among the four patients whose courses could be observed after medical treatment with diuretic and vasodilator, one changed from group B to A, one from group B to C, one from group C to A, and one remained in group C. Thus, recording of peak atrial systolic LVIF and PVF by transesophageal pulsed Doppler echocardiography permits detailed evaluation of LA systolic performance in the presence of elevated LVEDP. These two variables provide important information for less invasive differentiation of LA afterload mismatch from LA myocardial failure.     

Outcome of metastatic urothelial carcinoma treated by systemic chemotherapy: Prognostic factors based on real-world clinical practice in Japan

Aim

To clarify prognostic factors of metatstatic urothelial carcinoma treated by systemic chemotherapy in real-world clinical practice in the Japanese population.

Morphology and clinical importance of epidural membrane and periradicular fibrous tissue in lumbar spinal stenosis

Purpose

Compared to the ligamentum flavum (LF), morphology of the epidural membrane (EM) and the periradicular fibrous tissue (PRFT) has been largely ignored in studies of lumbar spinal stenosis (LSS). The aim of this prospective study was to elucidate the morphologies and clinical importance of the EM and PRFT in LSS.

Methods

Before starting this study, neural compressive EM (c-EM) and PRFT (c-PRFT) were defined as follows based on our microsurgical experience and a literature review. The c-EM is a constriction band or membrane obstructing dural tube expansion, and the c-PRFT is a fibrous tissue that compresses the nerve root and/or restricts its mobility. This study enrolled 134 patients who underwent microscopic decompression at L4/5. The morphologies of each patient’s EM and PRFT were observed and recorded. Specimens were obtained from randomly selected patients for histological evaluation.

Results

The EM and PRFT exhibited a wide morphological spectrum, from a fine strand to a substantial membrane. The c-EM alone was observed in four cases, the c-PRFT alone in 37 cases, and both in three cases. The c-PRFT was more frequently observed in patients with degenerative spondylolisthesis than in those without olisthesis (P < 0.05). Several cases exhibited interesting histological findings including many small arteries, chondrometaplasia, ganglion-like cyst formation, and hyalinized collagen fibers.

Conclusions

Some EM and PRFT transform into degenerative and substantial fibrous tissues during the process of symptomatic LSS development. Such morphological and histological changes can cause dural tear, symptomatic epidural hematoma, and/or inadequate decompression.

     

Comparison of laparoscopic Nissen and Toupet fundoplication using a propensity score matching analysis

Purpose

Laparoscopic fundoplication (LF) has become a standard operative procedure for GERD-related diseases in Japan, although meta-analyses have mainly evaluated findings from Western countries. The propensity score matching method was used to compare and investigate the treatment outcomes of two fundoplication procedures (the Nissen and Toupet methods).

Methods

Among 474 patients who underwent initial LF from December 1994 to April 2016, we extracted 401 cases (Nissen: 92 cases, Toupet: 309 cases), excluding 73 patients in whom follow-up was insufficient. We then matched 126 of these patients (63 per group).

Results

The esophageal acid reflux time (%) was 12.2:2.8, being higher in the Nissen group than in the Toupet group (p?<?0.001). Regarding the surgical outcome, the amount of bleeding was higher in the Nissen group (p?=?0.001), and the number of hospitalization days following surgery was longer (p?=?0.003). Furthermore, a significantly rate of postoperative difficulty in swallowing (%) was observed in the Nissen group, at 13:0 (p?=?0.004). The recurrence rate (%) was 8:3, with no difference between the two groups (p?=?0.243).

Conclusions

Although there was no marked difference in the recurrence rate between the two procedures, postoperative dysphagia was observed at a higher frequency with the Nissen method than the Toupet method.

     

Comparative benefits of laparoscopic surgery for colorectal cancer in octogenarians: a case-matched comparison of short- and long-term outcomes with middle-aged patients

Purpose

The aim of this study was to compare the postoperative short- and long-term outcomes after laparoscopic colorectal surgery (LCS) between octogenarians and healthy middle-aged patients.

Methods

Between January 1997 and July 2009, 655 consecutive laparoscopic surgeries for colorectal cancer patients were operated by 1 colorectal surgeon. Ninety-three patients were octogenarians (≥80 years), and 133 patients were case-matched middle-aged (60–69 years) patients. We analyzed the mean operative time, blood loss, type of surgery for rectal cancer, length of hospital stay, mortality, and morbidity. The overall survival curve was constructed using the Kaplan–Meier method.

Results

The American Society of Anesthesiologists classification was significantly higher in the octogenarians than in the middle-aged controls. However, there were no significant differences between the two groups in terms of the incidence of morbidities (11.7 vs. 9.2 %) and length of hospital stay (12.1 vs. 10.9 days). The number of lymph nodes harvested was significantly fewer (p < 0.05) and the operative time significantly shorter (p < 0.05) in the octogenarians than in the middle-aged controls. At a mean follow-up of 38.2 months, the overall 5-year survival rate was 64.8 % in the octogenarians and 92.4 % in the middle-aged group, whereas the cancer-specific 5-year survival rate was 91 % in the octogenarians and 95.7 % in the middle-aged group.

Conclusions

We suggest that advanced age should not be a contraindication for LCS, even for complex procedures, such as laparoscopic rectal resection.

     

Relationship between clinical symptoms of osteoporotic vertebral fracture with intravertebral cleft and radiographic findings

Background

With aging of the population, the numbers of osteoporotic vertebral fractures with intravertebral cleft have been increasing. However, the details of clinical symptoms of osteoporotic vertebral fractures with intravertebral cleft are poorly understood. The purpose of this study was to evaluate the relationship between clinical symptoms of osteoporotic vertebral fractures with intravertebral cleft and radiographic findings.