A Case of Neurogenic Sarcoma of the Stomach

A very rare case of neurogenic sarcoma of the stomach is reported.It is the only case (0.03%) among 3,643 patients with malignanttumors of the stomach operated on at the National Cancer CenterHospital during the past 18 years. The patient was a 60-year-oldhousewife complaining of a palpable mass in the upper abdomen.After X-ray and endoscopical examination, partial gastrectomywas performed on the basis of the clinical diagnosis as a submucosaltumor of the stomach. The resected tumor was well demarcatedand showed extragastric growth with a continuity to the serosaof the stomach. Histologically the tumor consisted of spindle-shapedcells with moderately hyperchromatic and irregular-shaped nucleiwithout any nuclear palisading. It was very hard to differentiatethis tumor from leiomyosarcoma, fibrosarcoma and other mesenchymalmalignant tumors by routine histological methods. However, thistumor was immunohistochemically demonstrated to contain nervoustissue-specific S100 protein, which is present in both the peripheraland central nervous systems among a wide variety of vertebrates.Our results indicate that the diagnosis of neurogenic sarcomaof the stomach was appropriate for this tumor and suggest thatS100 protein would be a useful diagnostic indicator for tumorsof Schwann cell origin.     

Outcomes and Complications following Posterior Long Lumbar Fusions Exceeding Three Levels

The outcomes and complications of posterior-only lumbar instrumented long fusions exceeding three segments with selective segmental transforaminal lumbar interbody fusion for the treatment of degenerative lumbar scoliosis, kyphosis, or both combined with spondylolisthesis were analyzed to investigate risk factors associated with surgical instrumentation failure. Fifteen consecutive patients with degenerative lumbar scoliosis, kyphosis, or both combined with spondylolisthesis were studied retrospectively. There were 5 male and 10 female patients, with a mean age of 71.8 years. All the patients were followed for a mean duration of 19.4 months postoperatively. Radiographic evaluation included coronal Cobb angle, lumbar lordosis (LL) angle, pelvic incidence (PI), and pelvic tilt (PT). The clinical outcomes were assessed by means of Japanese Orthopedic Association (JOA) score. Patients were divided into two groups: group 1—7 patients with surgical complications; group 2—8 patients without complications. The preoperative and postoperative coronal Cobb''s angle were not significantly different between groups 1 and 2. The LL highly correlated with developing surgical complications. There were statistically significant differences in preoperative and postoperative LL and the mean difference between PI and the LL (PI–LL) between groups 1 and 2. Linear correlation and regression analysis showed that there was no correlation between JOA score and the coronal Cobb angle in degenerative scoliosis patients. However, we found a positive correlation between JOA and LL. Our series of long lumbar fusions had a high complication and instrumentation failure. Creating adequate LL angle in harmony with PI was a key to prevent surgical complications and attain neurological improvement.     

Clinical investigation of the ICD-10 subcategories for obsessive-compulsive disorder

Abstract  To examine the validity of ICD-10 subcategories for obsessive-compulsive disorder (OCD), the Yale-Brown Obsessive-Compulsive Scale (Y-BOCS) was applied to 53 OCD patients. The ratios of Y-BOCS compulsions subscore to obsessions subscore were calculated. The group with ratios around one consisted of patients diagnosed in three subcategories (F42.0, F42.1 and F42.2). This suggests that subjective subcategorization such as ICD-10 may be inadequate to differentiate between predominantly obsessive and compulsive patients compared with differentiation by quantitative assessment such as the Y-BOCS ratio. Thus, in selecting the appropriate therapeutic methods, we emphasize the usefulness of quantitative assessment in clinical settings.     

Synthesis and disulfide structure determination of porcine endothelin: an endothelium-derived vasoconstricting peptide

All disulfide analogs (types A, B and C) of porcine or human endothelin, a 21-amino acid peptide having two intramolecular disulfide bonds, were synthesized and their retention times on HPLC were compared with that of natural endothelin. One of the analogs (type A) having disulfide bonds between positions 1 and 15 and between 3 and 11 was found to be identical with natural endothelin. Random oxidation of fully reduced endothelin formed a mixture of type A and B in a ratio of 3:1, with almost none of type C, which has disulfide bonds between positions 1 and 3 and between 11 and 15. Type A endothelin was also synthesized by the segment condensation procedure in solution applying our maximum protection strategy. This product was found to have full vasoconstricting activity in rat pulmonary artery ring preparations; the potency was as high as that of the natural product.