The prognostic role of the DNA ploidy pattern in colorectal cancer analysis using paraffin-embedded tissue by an improved method

To assess the prognostic value of DNA ploidy in colorectal cancer, compared with the histopathological findings, paraffin-embedded surgical specimens from 330 patients who underwent resection for primary adenocarcinoma were studied using a new modified method of flow cytometry. Of these specimens, 141 were DNA diploid and 189, DNA aneuploid, among which there were 3 DNA hypodiploid lesions. Of the ten variables studied in curative resection, DNA ploidy ranked fourth in prognostic significance according to the linear trend by the ₂ test, after nodal status, grade of cellular differentiation, and degree of invasive growth, if the DNA ploidy pattern was classified into three categories. Conversely, DNA ploidy was the sixth most significant factor if DNA hypodiploidy was included in the DNA aneuploidy. The Cox multivariate analysis showed that DNA ploidy was one of the five significant factors independently determining prognosis; however, if adjustment for the modified Dukes' stage was made by the Mantel-Haenszel test, the survival difference between the diploid and aneuploid groups did not reach a statistically significant level. Thus, we conclude that from a practical point of view, DNA ploidy is not an essential factor which must be combined with histopathological variables for a better prediction of patient outcome.     

Mucosal hyperplasia of the ileum after subtotal colectomy in rats

To evaluate factors contributing to ileal mucosal hyperplasia following extensive colectomy, the following three models were designed in rats: Subtotal colectomy and end-to-end ileoproctostomy; retransection of the terminal ileum with end-to-side proximal-ileoproctostomy (colectomy group), End-to-side ileoproctostomy without colectomy (bypass group), and End-to-side ileocecostomy (control group). In all groups the terminal ileum was left out of the intestinal stream as defunctionalized segments. Specimens were obtained from the terminal ileum during operation and from both the functioning and the defunctionalized segments at various intervals postoperatively. The mucosal hyperplasia was evaluated by measuring eight variables including numbers of villi around the bowel circumference, villous height, crypt depth, total mucosal thickness, epithelial cell counts per villus, DNA contents per unit length of the bowel and radioactivity of incorporated 3H-thymidine as well as DNA specific activity. The results showed that marked mucosal hyperplasia of the functioning segments was noted in all groups, and that mucosal hyperplasia was also observed in defunctionalized segments of colectomized rats, but not in those of both bypass rats and control. These findings were statistically confirmed by analysis of variance. It was concluded that although intraluminal factors played an important role in mucosal hyperplasia of the ileum following extensive colectomy, humoral factors might be also involved in intestinal adaptation.     

Diffusion tensor imaging of kidneys with respiratory triggering: Optimization of parameters to demonstrate anisotropic structures on fraction anisotropy maps

Purpose

To demonstrate the feasibility of diffusion tensor imaging (DTI) of kidneys with respiratory triggering, and determine the optimal imaging parameters for fraction anisotropy (FA) maps.

Materials and Methods

DTI of kidneys from 16 healthy volunteers was performed using a 1.5T scanner. Five different sequences with different parameters including respiration‐triggered acquisition or multiple breath‐holding, slice thicknesses of 3 or 5 mm, and different numbers of signal averaging and b values were compared. FA and apparent diffusion coefficients (ADCs) of the cortex and medulla were measured. Measurement error within the same and repeated examination was examined using within‐individual standard deviation (Sw).

Results

FAs of the renal cortex were lower than the medulla (mean value of a sequence ranging 0.148–0.224, 0.433–0.476) and the ADCs of the cortex were higher than the medulla (2.26–2.69 × 10^?3 mm²/s, 1.77–2.19 × 10^?3 mm²/s) in all sequences (P < 0.001). The renal cortex–medulla difference was the largest, with respiratory trigger‐ ing including a 3‐mm slice thickness, three signal averages,and a b‐value = 0, 200, or 400 s/mm² (P < 0.001). Sw tended to be smaller in the sequence with a b‐value of 400 s/mm².

Conclusion

DTI of kidneys with respiratory triggering is feasible with excellent cortex–medulla differentiation. J. Magn. Reson. Imaging 2009;29:736–744. © 2009 Wiley‐Liss, Inc.

     

Implantation metastasis of head and neck cancer after fine needle aspiration biopsy

One possible complication of the aspiration biopsy of malignant tumors is dissemination of tumor cells along the needle track. However, a search of the literature revealed few definite reports of implantation metastases of head and neck tumors after fine needle aspiration biopsy (FNAB). Here we report two cases of skin metastasis of head and neck cancer after FNAB, including a patient with papillary adenocarcinoma of the thyroid and one with adenoid cystic carcinoma of the submandibular gland. Surgical treatment prevented the spread of the tumor in both cases and there have been no evidence of recurrence to date. This report should alert head and neck surgeons to the possibility of implantation metastasis after FNAB.     

A randomized phase II study of gemcitabine and S-1 combination therapy versus gemcitabine monotherapy for advanced biliary tract cancer

Purpose

In order to confirm the impact of adding S-1 to gemcitabine, we conducted a randomized phase II study to compare the combination therapy of gemcitabine plus S-1 to gemcitabine monotherapy in patients with advanced biliary tract cancer.

Methods

Sixty-two patients with advanced cholangiocarcinoma or gallbladder cancer were randomized to either the combination therapy of gemcitabine and S-1 (gemcitabine 1,000 mg/m² on days 1 and 15 and S-1 40 mg/m² b.i.d. on days 1–14, repeated every 4 weeks) or gemcitabine monotherapy (gemcitabine 1,000 mg/m² on days 1, 8, and 15, repeated every 4 weeks). The primary endpoint of this study was response rate, and the regimen which showed the better response rate was selected as a candidate of phase III study. Tumor response was assessed every two cycles using Response Evaluation Criteria in Solid Tumors criteria version 1.0.

Results

The response rates of the combination therapy and the monotherapy were 20.0 and 9.4 %, respectively. The median time-to-progressions and overall survivals of these two treatments were nearly the same (5.6 vs. 4.3 months; 8.9 vs. 9.2 months). Adverse events occurred more frequently in the combination arm.

Conclusions

The combination therapy of gemcitabine and S-1 showed the better response rate, but the superiority of this combination therapy was not clear in total. Because the standard of care changed to the combination therapy with gemcitabine and cisplatin during this study, it is difficult to select this combination therapy with a 4-week regimen as a candidate of phase III study.     

Palliation in patients with malignant gastric outlet obstruction with a newly designed enteral stent: a multicenter study

BACKGROUND: Through-the-scope (TTS) stents facilitate palliative enteral stent placement. However, most TTS stents are braided, a characteristic that has been associated with significant foreshortening and relatively frequent migration. OBJECTIVES: To evaluate clinical experience with a new woven enteral stent in the treatment of gastric outlet obstruction. DESIGN: From January 2005 to August 2006, patients with unresectable malignant gastric outlet obstruction were offered stent placement with a new woven stent. SETTING: Three referral hospitals in Japan. PATIENTS: Thirty-seven consecutive patients with malignant gastric outlet obstruction. INTERVENTIONS: A newly designed enteral stent was placed by using the TTS placement technique. MAIN OUTCOME MEASUREMENTS: Palliation efficacy and safety of the new stents. RESULTS: Stent placement was successful in 36 of 37 patients (technical success, 97%). Thirty-four patients were able to tolerate oral intake without obstructive symptoms (clinical success, 94.4%). Complications occurred in 16.2% of patients, comprising 2 cases of primary stent dysfunction, 1 perforation, 1 GI bleeding, 1 stent obstruction, and 1 biliary stent dysfunction. No migration was seen during the median follow-up period of 68 days. LIMITATIONS: Small sample size and relatively brief follow-up. CONCLUSIONS: A newly developed enteral stent with higher flexibility and less foreshortening offers comparable clinical outcome to existing stents and a lower frequency of complications, including migration.