Clinical analysis of esophageal cancer associated with other primary cancers

This study aims to investigate the therapeutic and prognostic implications of esophageal cancer in patients with other primary cancer. Between April 1992 and December 2008, in 83 patients underwent surgery for esophageal cancer at our department. Among them, 24 patients (28.9%) had medical history of additional primary cancer. There were 16 metachronous cancers and 8 synchronous cancers. Six patients had antecedent other primary cancers, and subsequent primary cancers developed in 10 patients. The other primary cancers included head and neck cancer in 8 patients, gastric cancer in 8, lung cancer in 6, colorectal cancer in 3, and other cancer in 3. The patients with other primary cancers were both heavy smokers and heavy drinkers in comparison to those without other primary cancers. The post-operative 5-year survival rate in patients with subsequent cancers, antecedent cancers, and synchronous cancers were 100%, 70.0%, and 46.9%. The 5-year survival rate was 33.4% in patients without other primary cancers. A high incidence of multiple primary cancers was observed in patients with esophageal carcinoma but the prognosis of these patients with metachronous cancers are better than that of patient with synchronous cancers and patients without other primary cancers. Post-operative follow up is considered to be necessary for early detection of multiple occurrences of carcinoma, especially in the upper aerodigestive tract.     

Total arch repair versus hemiarch repair in the management of acute DeBakey type I aortic dissection

Objective: In acute DeBakey type I aortic dissection, it is still controversial whether to perform extended aortic replacement to improve long-term outcome or to use a conservative strategy with ascending aortic and hemiarch replacement to palliate a life-threatening condition. Methods: Between 1999 and 2009, 188 consecutive patients (93 women; mean age, 57.4 ± 11.7 years) with acute DeBakey type I aortic dissection underwent hemiarch (Hemiarch group; n = 144) or total arch replacement (Total arch group; n = 44) in conjunction with ascending aorta replacement. Clinical outcomes were compared after adjustment for baseline characteristics using inverse-probability-of-treatment weighting. Results: Median follow-up was 47.5 months (range 0–130.4 months) and was 92.0% (n = 173) complete. Five-year unadjusted survival and permanent-neurologic-injury-free survival rates were 65.8 ± 8.3% and 43.1 ± 9.7% in the Total arch group, and 83.2 ± 3.3% and 75.2 ± 4.0% in the Hemiarch group, respectively (P = 0.013 and <0.001). After adjustment, the Total arch group patients were at greater risks of death (hazard ratio (HR) 2.38, 95% confidence interval (CI) 1.21–4.67; P = 0.012), and permanent neurologic injury (HR 3.25, 95% CI 1.31–8.04; P = 0.011) compared to the Hemiarch group patients. The risks of the re-operation for aortic pathology or distal aortic dilatation (>55 mm) were similar for both groups (HR 0.33, 95% CI 0.08–1.43; P = 0.14). Conclusions: Total arch repair was associated with greater morbidity and mortality compared with hemiarch repair in acute DeBakey type I aortic dissection. Rates of aortic re-operation or aortic dilatation were not significantly different between the two surgical strategies. These findings support a conservative surgical approach to circumvent this life-threatening situation.     

Sinus histiocytosis with massive lymphadenopathy (Rosai-Dorfman disease) and oligoarthritis

A 24-year-old woman who had sinus histiocytosis with massive lymphadenopathy (SHML, Rosai-Dorfman disease) also had oligoarthritis. We found only four previously reported cases of SHML with clinical joint disease. The clinical picture may suggest rheumatoid arthritis or a spondylarthropathy with peripheral joint involvement. SHML should be considered routinely among the differential diagnoses in young patients with arthritis and large lymphadenopathies. There is no consensus regarding the treatment. In our patient, conventional disease-modifying antirheumatic drugs followed by 3 months of adalimumab then 3 months of etanercept had no effect on the symptoms.     

Penile fracture with bilateral corporeal rupture and complete urethral disruption: case report and literature review

Penile fracture is a rare injury most commonly sustained during sexual intercourse. We report the case of a 35-year-old man who presented with bilateral rupture of the corpora cavernosa and complete disruption of the urethra. A review of the literature on penile fracture is also presented. Urgent surgical exploration was performed and the injuries repaired primarily. In follow-up, the patient reported satisfactory erectile function. This case highlights the importance of early surgical repair and evaluation for concomitant urethral injuries in cases of penile fracture.     

Unusual gastric tumors: radiologic-pathologic correlation.

The overlap of radiologic findings in many gastric tumors makes differentiation difficult. However, some unusual gastric tumors have characteristic radiologic features that may suggest a specific diagnosis. At barium study, lipomas typically manifest as a smooth submucosal mass or an ulcerated lesion with a "bull's-eye" appearance that is indistinguishable from other mesenchymal tumors. At computed tomography (CT), lipomas usually manifest as well-circumscribed submucosal masses with fat attenuation. At radiology, glomus tumors appear as smooth submucosal masses with or without ulceration and may contain tiny flecks of calcification. These tumors frequently demonstrate strong enhancement on early-phase contrast material-enhanced images. At barium study, lymphangiomas may appear as smooth intramural masses that are indistinguishable from other mesenchymal tumors. At CT, they manifest as non-enhancing extramucosal masses with homogeneous low attenuation. Diffuse lesions in Brunner gland hamartoma manifest as multiple small nodules, producing a characteristic "cobblestone" appearance. Lymphomas may have typical imaging features (eg, more pronounced and homogeneous mural thickening) that can help differentiate them from adenocarcinoma. In addition, adenocarcinomas may demonstrate unusual findings such as transpyloric spread, unusually large polyps, or intratumoral calcifications. Familiarity with these radiologic features of gastric tumors can help ensure correct diagnosis and proper management.     

Laparoscopic resection of retroperitoneal benign schwannoma

Schwannomas are particularly rare neoplasms among tumors of the retroperitoneal space. Only 0.3-3.2% of benign schwannomas are found in retroperitoneal locations. As these tumors are usually asymptomatic and discovered by chance or in the course of the evaluation of an unrelated health problem, they may cause the delay of early diagnosis and treatment. With recent advances in the field of minimally invasive surgery, several laparoscopic approaches to retroperitoneal schwannomas have been reported. In this paper, we present the case of a 59-year-old female patient with an asymptomatic retroperitoneal mass that was found during a regular medical checkup. The mass was located between the inferior vena cava (IVC) and aorta under the pancreaticoduodenal unit (site of lymph node 16b1), compressing the IVC. She underwent successful laparoscopic surgery for retroperitoneal schwannoma. In addition, we summarized the literature on cases regarding the laparoscopic management of the retroperitoneal schwannoma.     

Normal urinary calcium/creatinine ratios in African-American and Caucasian children

A random urine calcium/creatinine ratio (UCa/Cr) is of practical use in screening for hypercalciuria. However, due to worldwide variations, reference values for the pediatric population are not yet well established. Furthermore, no study has been conducted to establish normal UCa/Cr values in young African-American (AA) children. It has also been previously reported that an elevated UCa/Cr is related to a high urine Na/K ratio (UNa/K). The objectives of the present study were: (1) to set normal values of random UCa/Cr by age and race in the pediatric population of Metropolitan Kansas City, (2) to identify potential racial differences in UCa/Cr between Caucasian (CS) and AA children, and (3) to determine the relationship between UCa/Cr and UNa/K in healthy children.A total of 368 healthy children of both genders were enrolled in the study. They were divided into four age groups as follows: (1) <7 months, (2) 8–18 months, (3) 19 months to 6 years, and (4) 7–16 years. Each group was subdivided into AA and CS. A non-fasting random urine specimen from each subject was analyzed for Ca, Na, K and creatinine.The median UCa/Cr values for AA were: (1) 0.13, (2) 0.09, (3) 0.06, and (4) 0.04 and for CS they were (1) 0.26, (2) 0.11, (3) 0.10, and (4) 0.09. The data showed a strong inverse relationship between UCa/Cr and age, the youngest children demonstrating the highest UCa/Cr. In each age group, UCa/Cr in CS exceeded the corresponding value in AA. The age-dependent 95th percentiles of UCa/Cr values for CS were (1) 0.70, (2) 0.50, (3) 0.28, and (4) 0.20 and for AA they were (1) 0.38 and (3) 0.24. Due to outliers, the 95th percentile could not be established for the other two AA subgroups. The relationship between UCa/Cr and UNa/K was found to be extremely weak in both AA (r ² =0.00005) and CS (r ² =0.02). On the other hand, a strong linear correlation was observed between UNa/K and age (CS r ² =0.23, P<0.001, AA r ² =0.19, P<0.001), explaining in part the lack of correlation between UNa/K and UCa/Cr.We conclude that the child’s age, ethnicity and geographic location should be taken into consideration when assessing UCa/Cr ratio. Contrary to what has previously been reported in hypercalciuric children, no significant relationship was found between UCa/Cr and UNa/K in healthy children. Received: 7 June 2000 / Revised: 21 September 2000 / Accepted: 23 September 2000     

Excess lipid availability increases mitochondrial fatty acid oxidative capacity in muscle: evidence against a role for reduced fatty acid oxidation in lipid-induced insulin resistance in rodents

A reduced capacity for mitochondrial fatty acid oxidation in skeletal muscle has been proposed as a major factor leading to the accumulation of intramuscular lipids and their subsequent deleterious effects on insulin action. Here, we examine markers of mitochondrial fatty acid oxidative capacity in rodent models of insulin resistance associated with an oversupply of lipids. C57BL/6J mice were fed a high-fat diet for either 5 or 20 weeks. Several markers of muscle mitochondrial fatty acid oxidative capacity were measured, including (14)C-palmitate oxidation, palmitoyl-CoA oxidation in isolated mitochondria, oxidative enzyme activity (citrate synthase, beta-hydroxyacyl CoA dehydrogenase, medium-chain acyl-CoA dehydrogenase, and carnitine palmitoyl-transferase 1), and expression of proteins involved in mitochondrial metabolism. Enzyme activity and mitochondrial protein expression were also examined in muscle from other rodent models of insulin resistance. Compared with standard diet-fed controls, muscle from fat-fed mice displayed elevated palmitate oxidation rate (5 weeks +23%, P < 0.05, and 20 weeks +29%, P < 0.05) and increased palmitoyl-CoA oxidation in isolated mitochondria (20 weeks +49%, P < 0.01). Furthermore, oxidative enzyme activity and protein expression of peroxisome proliferator-activated receptor gamma coactivator (PGC)-1alpha, uncoupling protein (UCP) 3, and mitochondrial respiratory chain subunits were significantly elevated in fat-fed animals. A similar pattern was present in muscle of fat-fed rats, obese Zucker rats, and db/db mice, with increases observed for oxidative enzyme activity and expression of PGC-1alpha, UCP3, and subunits of the mitochondrial respiratory chain. These findings suggest that high lipid availability does not lead to intramuscular lipid accumulation and insulin resistance in rodents by decreasing muscle mitochondrial fatty acid oxidative capacity.     

Atypical femoral fractures after anti-osteoporotic medication: a Korean multicenter study

Purpose

Increasing numbers of atypical femoral fractures have been reported among long-term bisphosphonate users. We evaluated clinical characteristics of atypical femoral fractures throughout Korean multicenter studies.

Methods

We retrospectively analysed the bone mineral density, prodromal symptoms before femoral fracture, and medication history of osteoporosis in 76 cases of atypical femoral fracture.

Results

The mean age of cases was 71.4 ± 8.8 (range, 43–89) years old. The mean follow-up period after the fracture operation was 24.5 ± 12.9 (range, 12–79) months. BMI was 23.2 ± 3.0 on average. The mean BMD of femur was −1.9 ± 1.4 (range, −4.8 to 1.3). Prodromal symptoms including thigh pain before femoral fracture appeared in 22 (28.9 %) of 76 patients. All patients included in the study used bisphosphonate. The duration of taking bisphosphonate before fracture was 36.8 ± 50.8 (one–204 months) months. Fifty-seven (75 %) of 76 patients were taking the medication for more than three years. Delayed union occurred in 43 (56.5 %) of 76 patients. Delayed union was defined as a fractured bone that did not completely heal within six months of injury. The group of having taken anti-osteoporotic medication for more than three years showed relatively longer union period compared to that for a shorter period medication group (4.8 ± 2.5 months vs 9.3 ± 3.7 months, p = 0.017). The delayed union developed in 43 (56.5 %) of 76 patients and showed a significantly higher incidence in the group with long-term therapy (five/43 vs 38/43, p = 0.021). The bilateral femoral fractures developed in 23 (30.2 %) of 76 patients and showed a high incidence in the group medicated more than three years (two/23 vs 21/23, p = 0.039).

Conclusions

The longer bisphosphonates are used, the more the cases of delayed union and the more frequent the development of bilateral fractures following unilateral fractures. With regard to the delayed union, the methods of the acceleration of fracture healing may be beneficial in atypical femoral fracture patients who had been receiving long-term bisphosphonates therapy. Careful observation is required for contra-lateral femurs due to a high incidence of bilateral atypical femoral fractures.