Primary serous adenocarcinoma of the retroperitoneum with a response to platinum-based chemotherapy: a case report

A CAT-scan-guided biopsy of the retroperitoneal tumor of a 54-year-old female revealed a serous adenocarcinoma resembling a serous adenocarcinoma of ovarian origin. Partial response to platinum-based chemotherapy was observed. Exploratory laparotomies and an autopsy found no possible primary lesion for the tumor. Therefore, we concluded that this tumor is a primary serous adenocarcinoma of the retroperitoneum. Although further accumulation of cases is required, it appears that primary treatment for serous adenocarcinoma of the retroperitoneum is platinum-based chemotherapy if surgical removal is incomplete.     

External and Skeletal Observations on a New Lethal Mutant of the Rat: Congenital Osteochondrodysplasia with Systemic Subcutaneous Edema

Abstract Malformed rat newborns showing severe subcutaneous edema were frequently found dead in our Wistar-Imamichi rat colony. Their family record suggested that this malformation would be an inherited disorder. Experimental crosses of the phenotypically normal litter-mates revealed that this malformation was a new lethal mutant of the rat, following a single autosomal recessive inheritance. External features and skeletal anomalies of the mutant were carefully checked and compared to those of the phenotypically normal litter-mates. The comparison revealed that (1) this mutant has a characteristic external appearance that includes shortening of the head, trunk, tail and extremities, systemic subcutaneous edema, protruding of the tongue and cleft palate, (2) the axial bones and appendices are shortened and deformed severely and (3) ossification status of the newborn is delayed in digital bones and advanced in the vertebral centra and arches, stemebrae, choracoid process and talus. Observation of the parturition showed that this mutant is born alive but die shortly after birth because of breathing insufficiency. Based on these observations, this mutant was diagnosed as congenital osteochondrodysplasia with systemic subcutaneous edema (ocd for the gene symbol). The mode of inheritance and the similarities to some genetical disorders of other species, including human, are discussed.     

Synthesis and stabilization of amino and carboxy terminal constrained collagenous peptides

Short collagenous peptides cross-linked at their amino and carboxy termini with Lys-Lys-dimer template(s) were synthesized, and the effect of the cross-linking on their stabilities was investigated by thermal denaturation experiments. Two chemoselective ligations were used for the construction of the amino and the carboxy cross-linked peptides. The thermal transition temperature (T_m) and the standard free energies (ΔG°) of the cross-linked collagenous peptides increased, and the thermal stabilization effect corresponded to an elongation by two units of the Gly-Pro-Hyp triad. The van't Hoff enthalpy (ΔH°) and the entropy (ΔS°) values of the cross-linked peptides increased with chain elongation, although the increments were smaller than those of the linear peptides. When the same chain lengths were compared, the ΔH° was increased and the ΔS° was nearly the same or increased by the cross-linking. These results suggest that the cross-linking of the collagenous peptides with the Lys-Lys-dimer template(s) for stabilization contributes to the enthalpic effect, rather than the entropic effect.     

The Distribution of Helicobacter pylori in Human Gastric Mucosa in vivo

Abstract: To estimate the distribution of Helicobacter pylori in human gastric mucosa in vivo, the phenol red dye spraying endoscopy lias been successfully developed and is performed after an oral and/or intravenous premedication of famotidine 20mg. This technique was conducted on 25 patients with chronic, atrophic gastritis, on 21 patients with a gastric ulcer and on 14 patients with duodenal ulcers. The red color changes which occurred on the gastric mucosa were classified into three types; the diffuse staining type, the regional staining type and the patchy staining type. In the chronic gastritis group, the diffuse staining type, the regional staining type and the patchy staining type occurred in 11 patients (44%), 7 patients (28%) and 2 patients (8%), respectively. The remainder of the patients' mucosa was unstained. In addition, the regional staining type occurred most frequently in the gastric ulcer group, while the diffuse staining type was dominant in the duodenal ulcer group. Notably, a recurrent and intractable ulcer was surrounded by regional staining fields in the stomach, and showed a diffuse staining at the antrum of the duodenum. These facts suggest that Helicobacter pylori prevented ulcer healing. This concurs with the results of our previous experimental study which found that the low concentration NH₃ solution, produced by Helicobacter pylori, prevented an acetic acid ulcer healing in rats and resulted from the suppression of the cell kinetics of the regenerative epithelial cells and the fibroblasts in the connective tissues at the ulcer margins.     

Laparoscopic cholecystectomy in the elderly: Analysis of pre-operative risk factors and postoperative complications

A retrospective study was conducted of two groups of patients over (group 1, n= 57) and under (group 2, n= 655) the age of 70 years who underwent laparoscopic cholecystectomy (LC). The pre-operative physical status and systemic complications, operation time, postoperative complications, postoperative hospital stay and other clinical features of the two groups were compared. The incidence of pre-operative complications in group 1 was significantly higher than that in group 2 (P < 0.05). Postoperatively no severe complication was found in any patient. Group 1 showed significantly prolonged operation time and postoperative hospital stay compared with group 2 (P < 0.05). The difference between the groups in the intra-operative treatment time and postoperative treatment is attributed to the greater prevalence of common bile duct stone in group 1 as there was little difference between the groups in the postoperative recovery after exclusion of these patients. No pulmonary complications, which are associated with LC, were observed; the postprocedure pain was slight and the period of bedrest was short. If complications associated with pneumoperitoneum can be prevented, this surgery is an excellent measure to improve the quality of life of even elderly patients with cholecystolithiasis.     

Laparoscopic Wedge Resection of the Stomach for Submucosal Tumor

We performed laparoscopic wedge resection of the stomach in two patients with submucosal gastric tumor. Three trocars were inserted in addition to a laparoscope. After the blood vessels surrounding the tumors had been ligated with ENDO CUPs, we used ENDO GIA (a linear endoscopic stapling device) four times and then wedge resection was performed. The operative time was 3h33m in Case 1 and 2.5h in Case 2, and bleeding was minimal in both cases. The postoperative courses were uneventful, and intestinal peristalsis recovered rapidly with minimal wound pain. These results suggest that laparoscopic wedge resection of the stomach, a radical procedure, is indicated for submucosal tumor of the stomach.     

Prognostic significance of thrombocytosis in renal cell carcinoma patients

Background: Thrombocytosis has been reported in many types of malignancies and has been studied as a prognostic factor. In the present study, we examined the incidence of thrombocytosis in patients with renal cell carcinoma (RCC) in order to evaluate the prognostic value of thrombocytosis. Methods: One hundred and ninety‐six patients treated by radical nephrectomy for RCC were enrolled in this study. We divided the patients into a normal platelet count group and a thrombocytosis group according to the presurgical platelet count. The two groups were compared pathologically and clinically, including prognosis. Results: Thrombocytosis was present in 16 patients (8.2%). Platelet counts had normalized after nephrectomy in all patients with thrombocytosis. There was no correlation between histological type or grade and thrombocytosis. However, there were correlations between thrombocytosis and tumor size and tumor stage. Patients with thrombocytosis had a worse prognosis than patients without thrombocytosis (P = 0.0028). When adjusted for stage or tumor size, the correlation was limited to low stage (stage 1 + 2: P = 0.0041, stage 3 + 4: P = 0.2983) or small tumors (tumor size: ≤4 cm, P = 0.0021; 4–7 cm, P = 0.0142; >7 cm, P = 0.8158). Conclusion: Thrombocytosis is an inexpensive and easy tool with which to evaluate the prognosis of RCC patients in daily medical practice.     

Congenital Malformations in Newborns from Diabetic Mothers*

It has been well known that there is a high incidence of congenital malformations in newborns from diabetic mothers when the mothers' diabetes control before and during pregnancy is poor. We treated 438 pregnant diabetics who bore 443 children between February 1964 and June 1992. Among these children, there were 51 cases (11.5%) with congenital malformations, 21 cases with major anomalies (4.7%) and 30 cases with minor anomalies (6.8%). The type of malformations are not related to special organs; heart malformations and cleft lips are relatively frequent compared to other types of malformations. The mechanism of the congenital malformations in newborns from diabetic mothers remains unclear. However, clinically and experimentally it has been found to be due to fuel-mediated teratogenesis. Since October 1978, HbAi has been used as an index of diabetic control and the relationship between congenital malformations and the mother's diabetes control has been observed. 1) There is no difference in the incidence of malformations in children from IDDM and NIDDM mothers. However, there are more severe malformations in the children from IDDM mothers compared to those from NIDDM mothers. 2) Mothers who bore children with major malformations had all made their first visit to our hospital after pregnancy. HbAi in the IDDM mothers who had children with malformations at the first visit was 11%. 3) In the NIDDM mothers, even if HbAi levels are near normal, children with major malformations were born and there was little relationship between congenital malformations and the mothers' diabetes control. These data suggest that there are two kinds of congenital malformations in children from diabetic mothers, fuel-mediated teratogenesis, and malformations as seen in children from non-diabetic mothers.