What types of colorectal cancer overexpress the MAGE protein?

BACKGROUND/AIMS: Tumor-specific antigens such as Melanoma-associated antigens could be attractive targets for immunotherapy. It will be a great help for cancer immunotherapy to distinguish what types of tumor expresses tumor-specific antigen. METHODOLOGY: We investigated the expression pattern of MAGE-A1 by immunohistochemical typing methods in human colorectal cancers obtained from consecutive patients undergoing surgical treatment at the hospital of the University of Tokyo. RESULTS: In 35 of 89 cases (39%), MAGE-A1 positive immunoreactivity was detected in the malignant glands. MAGE-A1 positive immunoreactivity was significantly higher among the patients under the age of 70 than among those 70 years of age and older (p=0.04). Among the patients under the age of 70, the tumors located in the distal colon (descending colon, sigmoid colon and rectum) showed significantly more positive MAGE-A1 immunoreactivity than those in the proximal colon (cecum, ascending colon and transverse colon) (p=0.04). The expression pattern of MAGE-A1 was not associated with gender, size, depth, histological type, vessel invasion, lymphatic invasion, lymph nodal invasion or stage of disease. CONCLUSIONS: Relatively better results can be expected with MAGE-A1 immunotherapy among patients with distal colon cancer under the age of 70.     

The etiologic role of intrauterine volvulus and intussusception in jejunoileal atresia

Purpose

Although intussusception has been reported as quite a rare cause of jejunoileal atresia (JIA), pediatric surgeons have noted the frequent presence of intussusception as well as volvulus at surgery. The aim of this study was to investigate the contribution of intrauterine intussusception and volvulus to the development of JIA.

Methods

In 48 newborns (24 boys and 24 girls) treated for JIA at our hospital between 1978 and 2004, the operative and pathologic findings were reviewed.

Results

Intussusception was responsible for gap and cord type atresia in 12 cases (25%). The cord showed an atrophic intestinal lumen in 2 cases. Volvulus was observed in 13 cases. Volvulus and intussusception were simultaneously noted in 1 case. This suggested that intussusception was the cause of the atresia, whereas volvulus was a secondary event. Neither intussusception nor volvulus was observed in high jejunal, apple peel, or multiple atresia.

Conclusions

Intrauterine volvulus and intussusception were commonly observed in single mid- and low JIA. Thus, intrauterine intussusception may be a common cause of gap and cord type JIA. Volvulus may not only cause JIA but also result from anatomic changes after the development of JIA in some cases.     

Reversible posterior leukoencephalopathy in a patient with Wegener granulomatosis

A 14-year-old girl with rapidly progressive glomerulonephritis was transferred to our hospital because of acute renal failure. A diagnosis of Wegener granulomatosis was made according to the symptom triad of a renal biopsy demonstrating crescentic glomerulonephritis, severe sinusitis, and serological findings of raised proteinase 3 anti-neutrophil cytoplasmic antibody level. In spite of combination therapy with methylprednisolone, cyclophosphamide, and plasma exchange, her renal function gradually deteriorated. Thereafter, she suffered a severe headache and generalized seizures. Brain computed tomography (CT) scan revealed bilateral low-density areas in the parieto-occipital lobes. Magnetic resonance imaging (MRI) disclosed a high-intensity area on T2-weighted images and a low-signal intensity area on T1-weighted images in the same lesion. Follow-up brain CT scan 3 weeks and MRI 2 months after the first studies showed complete resolution of the abnormal lesions, which indicated reversible posterior leukoencephalopathy syndrome. In addition to renal failure, hypertension, and cyclophoshamide, the primary disease may have played a role in the development of this uncommon syndrome in our patient.     

Non-invasive methods of assessing the tear film

The interaction between the tear film and the ocular surface epithelium is crucial for the maintenance of ocular surface health; interference with this relationship may cause dry eye. Several diagnostic techniques have been developed to assess the tear film and diagnose dry eye but many of these tests are invasive and modify the parameter which they are designed to measure. Non-invasive or minimally invasive tests may overcome this problem and provide more reproducible and objective data. One test of this kind is meniscometry, which is particularly useful in assessing tear volume indirectly by measuring tear meniscus radius. The newly developed video-meniscometer, which enables calculation of the meniscus radius digitally, is useful for the diagnosis of tear-deficient dry eye. Video-meniscometry also has other applications, to the study of tear and eye drop turnover, determining the indication for punctal plugs and in demonstrating dysfunction of the tear meniscus. Interferometry of the tear film lipid layer is useful in screening and evaluating dry eye severity and in selecting dry eye candidates for punctal occlusion. It is also useful for analysing tear lipid layer pathophysiology more clearly, especially in combination with meniscometry. Meibometry is a minimally invasive technique to quantify the amount of meibomian lipid on the lid margin. Lipid is blotted onto a plastic tape and the change in optical density is used to calculate lipid uptake. Laser meibometry has increased the scope of this technique for the assessment of meibomian gland dysfunction; also, the delivery of lipids from the lid reservoir to the preocular tear film can be analysed using interferometry and laser meibometry. The present report reviews the application of these techniques to the study of tear film physiology and dry eye.     

New surgical methods for punctal occlusion of severe tear-deficient dry eye and its outcome

PURPOSE: Although several surgical methods for punctal occlusion have been reported, it is difficult to obtain complete punctal occlusion in all cases since recanalization of the punctum often occurs after the operation. In this report, new surgical procedures to obtain sufficient occlusion of punctum are introduced and the outcome of the present method is compared with that of previous methods. SUBJECTS AND METHODS: Subjects were 33 severe tear-deficient dry eye patients (4 males and 29 females; mean age: 54.3 yrs.) and they were considered as candidates for punctal occlusion of both upper and lower puncta. The previous surgical punctal occlusion method had been performed in 12 cases (group A: 10 females and 2 males) and the newly-developed method was applied to 21 cases (group B : 19 females and 2 males). Corneal epithelial damage(scored with AD classification; A : area, D : density, scored from 0 to 3) was compared before and after the treatment and the control-lability of dry eye with only an artificial tear preparation was compared between the previous and the new methods. The newly-developed surgical procedures include the following steps: (1) diathermy of the epithelium of the canaliculus using a newly-designed electric needle for diathermy, (2) full removal of the epithelium of the canaliculus using a hand motor drill, (3) cutting the punctum at two opposite points parallel to the lid margin, (4) suturing the punctum to close the cut punctum with 10-0 nylon or 8-0 absorbable sutures. RESULTS: In group A, corneal epithelial damage improved a little from A, D : 2.4, 2.1 to A, D: 1.8, 1.9 during an average of 7.2 months of alone follow-up, and only 2 of the 12 cases obtained control with eye drops. In group B, the corneal epithelial damage improved significantly from A, D : 2.1, 2.2 to A, D : 1.0, 1.3 during an average of 8.2 months of follow-up, and all cases obtained control with eye drops alone. CONCLUSION: The new surgical methods are regarded as a more complete way of performing surgical punctal occlusion compared to previous methods.     

A case of serum CEA disappearance curve after resection of breast carcinoma

Carcinoembryonic antigen (CEA) elimination kinetics after tumor resection were measured in a case of breast cancer. A 45-year-old woman with a left breast carcinoma underwent surgery after neoadjuvant chemotherapy. The serum CEA level before surgery was 34.3 ng/ml. After sequential monitoring of serum CEA levels, postoperative serum CEA elimination kinetics were calculated using non-linear least square analysis with the fitting equation C(t)=(C0-Cp)exp(-kt)+Cp, where C(t) was the postoperative CEA level, t was the number days after surgery, C0 was the CEA level at postoperative time zero, Cp was the CEA at plateau, and k was the rate constant of elimination. Cp was calculated as 6.9 ng/ml, which was above the cut-off level and indicated residual malignancy. After adjuvant chemotherapy, CEA normalized to 1.8 ng/ml. In breast cancer patients with high preoperative serum CEA levels, our analytical method for CEA elimination might be useful for the detection of residual malignancies.