Comparative study of neuroectodermal tumor and Ewing's sarcoma of the bone. Histopathologic, immunohistochemical and ultrastructural features

We carried out a histologic, immunohistochemical and ultrastructural study of 19 tumors, previously classified as Ewing's sarcoma of the bone (ESB). The tumors were categorized histologically into four groups according to the presence or absence and the distribution of Homer-Wright rosettes, together with the immunohistochemical and ultrastructural features: 1) neuroectodermal tumor of bone (NTB) with diffusely dispersed rosettes (4 cases), 2) conventional ESB totally lacking the rosettes (9 cases), 3) intermediate-type tumor with characteristics of both NTB and ESB (4 cases), and 4) spindle cell-type tumor with focal rosettes (2 cases). Ultrastructurally, NTB contained neurotubules and neurosecretory granules, whereas ESB consisted of only undifferentiated cells. Immunoreactivity with antineural antibodies, such as Leu-7, and those against synaptophysin, NSE, neurofilament, and chromogranin, was detected in the majority of NTB, in intermediate- and spindle cell-type tumors and in two of the nine cases of ESB. In view of these findings, we propose that use of the term "neuroectodermal tumor of the bone" should be restricted to tumors with an extensive distribution of rosettes, and that those without unequivocal rosettes should be classified as ESB, although ESB may be the most undifferentiated form of NTB and some overlap may occur between the two tumor types.     

Ten-year experience in the use of double balloon catheter for kidney procurement from non-heart beating donors in cadaveric kidney transplantation

One-hundred-and-twenty patients underwent first cadaveric kidney transplantation from the non-heart beating donors. All of the organs were procured with the use of double balloon catheter for in situ cooling. The mean warm ischemic time and cold ischemic time were 10.7 +/- 17.0 minutes and 18.9 +/- 11.4 hours, respectively. One- and 5-year graft survival rates were 85.0 and 72.7%, respectively. Among 120 recipients, 30 (25%) grafts functioned immediately (immediate function), 82 (68.3%) grafts functioned after varying length of oliguric periods (delayed function) and 8 (6.7%) grafts never functioned (non-function). The mean age of the donors in the group of immediate function (31.5 +/- 16.1 yr) was significantly lower than those of other two groups. The mean warm ischemic time in the group of immediate function (6.0 +/- 11.2 min) was significantly shorter than that of delayed function. However, there was no significant difference in donor hypotensive episode, types of preservation fluid and cold ischemic time between the groups. The conclusion is that the ultimate result of cadaveric kidney transplant from the non-heart beating donors with the use of double lumen catheter is acceptable despite a relatively high incidence of delayed graft function.     

Results of combined therapy of irradiation and intra-arterial one-shot injection of cisplatin for head and neck cancers

Thirty-six previously untreated cases of head and neck cancer were given a combined therapy of irradiation and intra-arterial, one-shot injection of Cisplatin. As a result, the primary lesions in 35 cases were seen to achieve a 66% complete remission (CR) and a 100% overall response (OR). The lymph metastases in twenty-one cases with positive node achieved a 62% CR and a 100% OR. Good, local control of supraglottic and hypopharyngeal cancers were found to be an advantageous factor considered from the standpoint of the "quality of life". The cumulative survival rate, using Kaplan-Meier's method, was 82% for the first year, and 62% for the second year. No severe side effects were observed.     

Therapeutic effect of a CDDP-epirubicin-Lipiodol emulsion on advanced hepatocellular carcinoma

Prior injection of an anticancer agent and Lipiodol mixture is a key point for the treatment of hepatocellular carcinoma (HCC). We therefore prepared a new, improved emulsion of Lipiodol containing a high dose ofcis-diamminedichloroplatinum (CDDP) and epirubicin by replacing the ionic contrast medium (Urografin 67) with a nonionic contrast medium (Iopamidol; Iopamiron 300) and adding phosphatidyl choline. This CDDP-epirubicin-Lipiodol emulsion (CELE) was examined pharmacologically and chemically with the following results. The size of these particles is less than 10 m (diameter) for up to 24 h; the release of 28%–34% of the CDDP and 80%–90% of the epirubicin was estimated in the dissolution test, and 85% of the CDDP and 35% of the epirubicin was retained in the organs in the moment calculation. CELE was injected into 58 HCC patients via a celiac angiographic catheter. In 36 of these patients, the CELE injection was followed by transcatheter arterial embolization (TAE) therapy. Following the administration of CELE as one-shot injection therapy for stage IV HCC, the 1-year survival rate was 59% and the 2-year survival rate was 27%. Moreover, in patients (stage II, 12; stage III, 8; stage IV, 16) who received CELE and subsequently underwent TAE therapy, the 1-year survival rate was 90% and the 2-year survival rate was 67%. The nonionic contrast medium with Lipiodol forms finer emulsified particles, and these particles are more capable of penetrating into the tumor. In addition, the greater pharmacological stability of these particles provides a slow-release effect and prolonged stability of their shape. Finally, theoretically, the use of two major anticancer agents such as CDDP and epirubicin showed a greater clinical effect in the treatment of HCC than either our earlier suspension or a single anticancer agent.Work presented at the Third International Symposium on Treatment of Liver Cancer, Seoul, Korea, 12–13 February 1993     

Use of a pericardial fat pad flap for preventing bronchopleural fistula: An experimental study focusing on the angiogenesis and cytokine production of the fat pad

An experimental study was conducted to determine whether pericardial fat tissue could induce neovascularization and produce cytokines related to tissue repair. Neovascularization was examined using chick chorioallantoic membranes. Pieces of pericardial fat tissue, omentum, and intercostal muscle were individually placed on a number of chorioallantoic membranes and neovascularization induced by each material was assayed 6 days after the implantation. The intensity of neovascularization was in the order of pericardial fat omentum > muscle. Cytokines, such as interleukin 1 (IL-1) and , tumor necrosis factor- (TNF), interferon- (IFN-), and interleukin 6 (IL-6) were assayed in a culture supernatant of pericardial fat tissue. The latter was obtained 24h after the addition of lipopolysaccharide (LPS) following various incubation times. All cytokines other than IFN are known to play a part in tissue repair, whereas IFN is negatively related to tissue repair because it inhibits fibroblast growth. The pericardial fat tissue incubated with LPS produced a certain amount of IL-1 on day 1, and TNF on days 1 and 8, whereafter these values decreased to an undetectable level. Irrespective of the addition of LPS, a large amount of IL-6 was observed in the supernatant of pericardial fat tissue and it was detectable until day 29. On the contrary, INF was not detected at any assay time. These observations suggest that a pericardial fat pad flap could possibly be beneficial in the prevention of bronchopleural fistula after pulmonary resection.     

High Cervical Disc Lesions in Elderly Patients – Presentation and Surgical Approach

Summary  The incidence of high cervical disc lesions is extremely rare, and the mechanism of their development is unclear. We report these three cases, and discuss the possible mechanisms. We also describe surgical strategies for these lesions.  The first and second cases were an 82-year-old male and an 84-year-old male with retro-odontoid disc hernia. The third was an 83-year-old female with a herniated disc at C2/C3. To investigate Aetiological mechanisms of these lesions, we examined the findings on cervical images in extension and flexion, and compared the results in a younger than 80-year-old group and an older than 80-year-old group.  The patients underwent surgery via a posterolateral intradural approach. Wide laminectomy and incision of the dentate ligaments enabled access to the ventral space of the upper cervical spinal canal and sufficient decompression. All patients became ambulatory postoperatively without special fixation of the cervical spine. In the younger group, the level mostly loaded during cervical movement was C5/6, however, the levels in the older group were C2/3 and C3/4.  In elderly patients, less mobilization of the middle and/or lower cervical spine due to spondylotic change causes overloading at higher levels resulting in high cervical disc lesions. Retro-odontoid disc lesions can be caused by a herniated disc at C2/C3, which migrates upward. Regarding surgical strategy, the posterolateral intradural approach is less invasive and more advantageous for these lesions.     

Remnant omental transfer for the mediastinitis after coronary bypass surgery with right gastroepiploic artery.

A one-stage procedure for the treatment of mediastinitis after coronary bypass surgery utilizing the right gastroepiploic artery is described. This procedure consists of thorough debridement of mediastinal pus and necrotic tissue, excision of infected sternal bone, mediastinal irrigation, and immediate transfer of the "remnant" omental pedicle based on the "left" gastroepiploic artery without postoperative drainage or irrigation. Recently, this procedure was applied to our patients followed by excellent results.     

Extent and duration of isobaric 0.5% bupivacaine spinal anesthesia by using new open-end pencil point spinal needle

Extent and duration of isobaric 0.5% bupivacaine spinal anesthesia by using two spinal needles; a new 25 gauge open-end pencil point spinal needle (needle tip is open as a hole after pulling out the stylet, Doctor Japan Co., Japan) and a 25 gauge Quincke needle (TOP Co., Japan) were studied clinically in 24 patients for elective lower extremity surgery. Patients were randomly assigned into two groups of 12 patients each according to the spinal needle used. Lumbar puncture was performed between L3-4 with the patient in lateral decubitus position. After isobaric 0.5% bupivacaine 4.0 ml was injected in 20 seconds, the patient was placed in supine position, and the onset of anesthesia was assessed by loss of cold sensation (alcohol sponge), sensory block (pinprick) and motor block (modified Bromage's scale) in every 5 minutes until 30 minutes. Recovery of motor block and adverse effects were assessed by a blinded observer. Sensory block at 30 minutes by Quincke needle was Th 8.4 +/- 1.0 and by new open-end pencil point needle it was Th 8.5 +/- 3.2 dermatomes. Two groups did not differ significantly in sensory block and also in motor block. No adverse effect was observed in both groups. These results indicate that this new open-end pencil point spinal needle is very useful for preventing adverse effects of spinal anesthesia.     

Case study of paired cadaver renal allografts from the same donor: influence of local DIC kidney and concomitant acute rejection on early graft outcome

We report the clinical course of 2 recipients whose renal allografts were obtained from the same cadaver donor after cardiac arrest. The recipients showed different outcomes after transplantation. Graft biopsy after reperfusion revealed disseminated intravascular coagulation (so-called DIC kidney) and severe acute tubular necrosis (ATN) in both recipients. While one graft showed primary nonfunction, the other graft became functional after a post-operative anuric period. Serial graft biopsies performed during the oligo-anuric period revealed recovery of ATN and no intra-glomerular fibrin thrombi, but development of acute rejection was detected in both recipients. The left kidney graft showed more severe local DIC kidney than the right kidney, as well as more severe acute rejection in the oligo-anuric period. Despite aggressive anti-rejection therapy, the left kidney graft showed primary nonfunction. Therefore, severe acute rejection leading to primary nonfunction might have been related to more severe ischemic injury and more extensive local DIC kidney in the left kidney.