The Endoscopy-Guided Plan of Radiotherapy for Detecting Esophageal Cancer Using Lugol Staining

Abstract: The Lugol staining method has recently come to play an important role in the detection of superficial esophageal cancers which are extremely difficult to detect using only a barium double-contrasted esophagogram and/or a conventional esophagoscopy. We have therefore tested the endoscopy-guided treatment by radiotherapy using Lugol stainings as a technique for detecting 8 lesions of esophageal cancers in 5 patients. This method was found to be useful for the detection of small intraepithelial lesions, such as intramural metastasis or multiple origin cancers. It is also useful in projecting the lesions accurately on the surface of the body of the patient and planning the radiotherapeutic treatment of the lesions. Additionally, it has been found useful in determining the definite shape of superficial malignant lesions in the evaluation of biopsy specimens taken from the border of the non-stained regions.     

Contact Sensitivity to Polychloroparaxylene-Coated Cardiac Pacemaker

Poly-chloroparaxylene (parylene) is widely used as a material for cardiac pacemaker coating. Contact sensitivity to parylene was proven by patch test. Wrapping the pacemaker in a polytetrafluoroethylene sheet prior to implantation prevented further skin reactions.     

Development of an Imaging System Using Fluorescent Labeling Substances Excited by Infrared Rays

Abstract: An indocyanine green (ICG) derivative (ICG N-hydroxy sulfosuc-cinimide ester; ICG-sulfo-OSu) has been developed as an antibody labeling substance suitable for vital immunohistochemical staining. However, an appropriate fluorescence imaging system for ICG-sulfo-OSu using infrared rays has not as yet been reported. Therefore, we developed such a system. The absorption maxima of ICG and ICG-sulfo-OSu in buffer solution are both at 795 nm, the excitation maxima of their fluorescence spectra in buffer solution at 768 nm, and their emission maxima at 807 nm. An imaging system using an excitation filter with transmission at 710-790 nm and a barrier filter with transmission at 810-920 nm was constructed, and fluorescent images of ICG-sulfo-OSu labeled anti-epithelial membrane antigen (EMA) antibody were obtained with this system. Thus, vital immunohistochemical staining of microcancers under infrared ray excitation should now be possible, by exciting an ICG-sulfo-OSu labeled antibody specific to the tumor cells with infrared rays, using this imaging system.     

Obsessive-compulsive disorder comorbid with borderline personality disorder: A long-term case study

Abstract Three case reports of patients with borderline personality disorder (BPD) and obsessive-compulsive disorder (OCD) for more than 10 years are used to illustrate the relationship between OCD and borderline pathology. The recognizable features of the obsessive-compulsive symptoms in these reports are: (i) pervasiveness, the symptomatic overlap of obsessive-compulsive symptoms; (ii) poor insight and resistance; and (iii) obsessive control evident in personal relationships. These features are manifestations of OCD psychopathology as well as of a personality disorder. The symptoms with these features are located hypothetically towards the severe end of the symptomatic spectrum of OCD. The comorbidity is not a simple relationship, and the symptomatology of the comorbid patient is derived from OCD pathology linked with the personality disorder rather than from independent BPD pathology.     

The nocturnal secretion of cardiac natriuretic peptides during obstructive sleep apnoea and its response to therapy with nasal continuous positive airway pressure

The nocturnal secretion profile of the newly identified natriuretic peptide (NP), brain natriuretic peptide (BNP), was studied in 14 patients with obstructive sleep apnoea syndrome (OSAS) (apnoea hypopnoea index: 60.5±3.4, mean±SE) during two separate nights before and during nasal continuous positive airway pressure (NCPAP) therapy. Plasma levels of NPs (atrial natriuretic peptides; ANP and BNP) were measured at 2-h intervals during sleep. Simultaneously, blood pressure was measured by a non-invasive method (Finapres^®, Ohmeda, Englewood, CO, USA) and urine was collected for determing volume and catecholamine levels. Urinary and serum sodium concentration were determined before and after the study. Eight non-snoring subjects were also studied for the investigation of normal nocturnal profiles of BNP levels. To understand the discrete secretion profiles of the two NPs during sleep, blood was sampled from an additional seven patients every 5 min over a 30-min period around 00.00 and 04.00 hours before NCPAP. In patients with OSAS, plasma BNP levels increased from the beginning of sleep (22:00 h) to the morning (06:00 h) before NCPAP therapy (P< 0.01, anova ). Baseline BNP levels were not significantly correlated with patient's clinical and poly- somnographic parameters. However, in the latter half of the sleep period (02:00–06:00 h), increases in BNP levels during the night before NCPAP therapy were significantly correlated with blood pressure elevations (systolic: r=0.784 P< 0.01, diastolic: r=0.587 P< 0.01) and with apnoea duration (r=0.582 P< 0.01). In normal subjects BP and BNP levels were not changed significantly during sleep. Plasma BNP levels were well correlated with concomitant ANP levels (P< 0.001). NCPAP therapy reduced ANP and BNP levels during sleep and in the morning (P< 0.01). Plasma levels of BNP at 5 min intervals before NCPAP therapy revealed few variations. On the other hand, ANP levels fluctuated over the 30-min period. Changes in BNP levels during sleep in the patients with OSAS may be related to blood pressure variations, but may be too small to play a significant physiological role in regulating diuresis in OSAS. Further work is required to determine the precise role of dual natriuretic system in cardiovascular load and natriuresis in OSAS.     

Gastrointestinal perforation in very low-birthweight infants

BACKGROUND: Spontaneous isolated gastrointestinal perforation (SIP) in very low-birthweight infants has been reported as a different disease entity from necrotizing enterocolitis (NEC). The objective of this study was to investigate the incidence and risk factors of NEC and SIP. METHODS: The authors reviewed the medical records of very low-birthweight infants who were admitted to Toho University Perinatal Center, Tokyo, Japan, between 1 January 1991 and 31 December 2002. The diagnosis of NEC was made with the finding of bloody gastric fluid or stool, abdominal distention, and abnormal abdominal X-ray findings such as pneumatosis intestinalis or fixed dilated intestinal loops. SIP was defined at laparotomy as the presence of an isolated gastrointestinal perforation surrounded by normal appearing bowel. RESULTS: A total of 556 very low-birthweight infants were included in this study. Of those, 15 infants were excluded because of major anomalies. Out of 541 infants, 14 were diagnosed to have NEC or gastrointestinal perforation. In total, 13 infants had gastrointestinal perforation and 10 were confirmed as SIP. Two SIP suggestive cases were included in SIP cases. There was only one case of NEC (0.2%) during 12 years in the authors' institute. Eight SIP cases had antenatal nonsteroidal anti-inflammatory drugs (NSAID). The treatment with antenatal NSAID was significantly associated with the incidence of SIP (p<0.001). CONCLUSION: The authors experienced only one proven case of NEC (0.2%), 12 cases of SIP (2.2%) among 556 very low-birthweight infants admitted during 12 years. Antenatal NSAID were strongly associated with SIP.     

Interstitial laser coagulation for management of benign prostatic hyperplasia: Long-term follow-up

AIM: We evaluated the long-term results of transurethral interstitial laser coagulation in the treatment of benign prostatic hyperplasia (BPH) with up to 9 years of follow up at the Kurashiki Central Hospital and determined the patient characteristics that predict a favorable outcome. METHODS: From December 1993 to May 1997, a total of 82 patients were enrolled in the present study. Subjective and objective voiding parameters were collected from medical records and a self-administered questionnaire was sent to the patients. Kaplan-Meier plots were constructed to assess the risk of retreatment. RESULTS: The mean follow-up period was 48.4 months (range, 3-108 months). A total of 59 patients (72%) did not need any additional treatment at 12 months and 30 patients (37%) did not require additional treatment during the entire follow-up period. A total of 29 patients (35%) were retreated during follow-up. Transurethral prostate resection (TURP) was performed in 18 patients (22%). The remaining 11 patients (13%) were offered additional pharmacotherapy. The minimum and median retreatment-free durations were 3 and 14 months, respectively. Seven patients died and 17 were lost to follow-up. Men aged 71 years or older had greater likelihood of requiring retreatment than those younger than 71 years (P = 0.0397). No significant differences were noted in the other baseline characteristics. Among postoperative parameters, a rate of decrease of the International Prostate Symptom Score of the patient of lower than 60% and a rate of decrease in patient quality of life of lower than 50% at 3 months were associated with greater likelihood of retreatment (P = 0.0083 and P = 0.0006, respectively). CONCLUSIONS: Interstitial laser coagulation is effective for the treatment of BPH. Good long-term results and an acceptably low retreatment rate render this modality an effective alternative to TURP, especially for younger patients. Short-term improvement of subjective symptoms was predictive of favorable long-term outcome.     

Ejaculatory disorder caused by alpha-1 adrenoceptor antagonists is not retrograde ejaculation but a loss of seminal emission

AIM: The etiology of the ejaculatory disorder induced by alpha-1 blockers is still controversial, although it has been suggested to be retrograde ejaculation. The aim of this study was to investigate the distribution of alpha-1 adrenoceptor subtype mRNA in human seminal vesicles, and to analyze the prevalence and etiology of the disorder in healthy men. METHODS: Experimental Study. Seminal vesicles from 10 surgical specimens (eight radical prostatectomy, two radical cystectomy) were dissected. Real-time PCR was conducted for quantification of mRNA expression of each alpha-1 adrenoceptor subtype. Clinical Study. Ejaculatory disorder was investigated using 17 healthy male volunteers. Tamsulosin (0.2 mg and 0.4 mg) and naftopidil (50 mg and 100 mg) were administered in a crossover manner for 3 days. The ejaculatory volume, sperm count in midstream urine after ejaculation, and fructose concentration in seminal plasma were investigated. RESULTS: Real-time PCR revealed that alpha-1a mRNA was significantly predominant in seminal vesicles (P < 0.001; 1a, 75.0%; 1b, 11.7%; 1d, 13.3%). Ejaculatory volume (baseline 2.72 +/- 0.28 mL) significantly decreased in the tamsulosin group (0.2 mg, 1.75 +/- 0.31 mL; 0.4 mg, 1.51 +/- 0.39 mL; P < 0.05), but not in the naftopidil group (50 mg, 2.70 +/- 0.24 mL; 100 mg, 2.48 +/- 0.26 mL; P = NS). There was no sperm in midstream urine after any ejaculation. CONCLUSIONS: The current study demonstrates that alpha-1a mRNA is predominant among the adrenoceptor subtypes in human seminal vesicles. Decreased capacity of contraction of the seminal vesicles is proposed as the cause of the ejaculatory disorder induced by alpha-1 blockers.     

CT examination of the head of the Baikal seal (Phoca sibirica)

We carried out a computerised tomographic (CT) examination to elucidate the modifications in the head related to orbital enlargement in the Baikal seal. Transverse CT images showed that (1) the external frontal contours and the frontal sinuses are compressed medially and ventrally by the orbital enlargement; (2) the caudal part of the nasal cavity and nasopharynx are compacted ventrally; and (3) the cranial cavity is displaced caudally. The neurocranium is obviously separated from the facial part in the transverse plane at the caudal region of the orbit. The disposition of the mandible, zygomatic arch, temporal bone, and the masseter, temporal, digastric and pterygoid muscles is changed by the enlarged orbit in the 3-dimensional reorganisation of the head in this species. It is suggested that adaptation for the Lake Baikal environment primarily resulted in orbital enlargement, and that the altered orbital design may subsequently have influenced the form and function of the masticatory and respiratory system.     

Enhanced phosphorylation of the epidermal growth factor receptor at the site of tyrosine 992 in esophageal carcinomas

This study aimed to determine whether epidermal growth factor receptor (EGFR), which has been reported to be frequently overexpressed in esophageal carcinoma cells, is actually activated in the cells. Paraffin‐embedded specimens of 39 cases of esophageal carcinoma were analyzed immunohistochemically with anti‐EGFR polyclonal antibody (α‐EGFR Ab) and also an anti‐phospho‐EGFR‐specific polyclonal antibody (α‐p‐EGFR^Tyr992 Ab) that specifically recognizes phosphorylated tyrosine 992 of EGFR. All of the 39 cases were found to express EGFR, but the expression levels were not significantly higher than those in basal cells of the normal esophageal epithelium. In 38 of the 39 cases, α‐p‐EGFR^Tyr992 immunoreactivity was evident. Interestingly, the positively stained carcinoma cells were not distributed diffusely, and strongly immunostained cells tended to be localized in areas of severe dysplasia and in microinvasive foci just adjacent to the main invasive carcinoma. However, the deeply invasive front never exhibited positive immunoreactivity. The present findings suggest that phosphorylation of EGFR ^Tyr992 may play some specific functional role in esophageal carcinomas besides promotion of cell proliferation.