Muscular Metastasis of Hepatocellular Carcinoma: Case Report and Literature Review

There are few case reports of hepatocellular carcinoma (HCC) metastasis to the skeletal muscle. A 78-year-old man developed a mass in the right shoulder. Washout of contrast medium during contrast-enhanced ultrasonography (CEUS) in both the primary HCC and the metastatic site was detected. Several nodules were scattered throughout the liver on an autopsy. In addition, the moderately differentiated HCC had metastasized to the right teres major muscle. Rare muscular metastasis should be considered if a hepatic tumor is moderately or poorly differentiated HCC. Early washout during CEUS is consistent with a pathological diagnosis of moderately or poorly differentiated HCC.     

Phylogenetic analysis of rotaviruses with predominant G3 and emerging G9 genotypes from adults and children in Wuhan,China

Prevalence and phylogenetic relatedness of rotaviruses causing diarrheal diseases in children and adults were analyzed in Wuhan, China. During a period between June 2006 and February 2008, group A rotavirus was identified in 24.9% (280/1126) and 7.6% (83/1088) of specimens taken from children and adults, respectively. G3P[8] was the most frequent genotype in both children (66.3%) and adults (62.7%), followed by G1P[8] (20.3% and 26.2%, respectively). G9 was detected in specimens from six children (2.0%) and seven adults (5.6%). The VP7 genes of G3P[8] rotaviruses from children and adults showed extremely high sequence identities to each other (98.9–100%) and also to those of G3 viruses isolated in Wuhan in 2003–2004. In the phylogenetic analysis of the VP7 gene, the G3P[8] rotaviruses in Wuhan were clustered into a single lineage with some G3 viruses, which had been referred to as “the new variant G3” rotaviruses, reported recently in East Asia and Southeast Asia. Similar to G3P[8] rotaviruses, extremely high sequence identities between children and adults were observed for VP7 genes of G1 and G9 rotaviruses. The G9 viruses were clustered in the lineage of globally spreading strains, while G1 viruses were genetically close to those reported previously in China and Japan. These findings indicated the persistence of the variant G3 rotaviruses and spread of G9 rotaviruses derived from the global G9 lineage in Wuhan, and suggested that the rotaviruses were circulating among children and adults, irrelevant to the G types. J. Med. Virol. 81:382–389, 2009. © 2008 Wiley‐Liss, Inc.     

Polymorphisms of six Y-chromosome STRs in a Chinese population

The polymorphic short tandem repeat (STR) loci of six Y-chromosome markers were investigated in 112 unrelated Chinese males using a multiplex polymerase chain reaction (PCR). Allele and haplotype frequencies for the Y-specific STR loci DYS19, DYS385, DYS389II, DYS390, DYS391 and DYS393 were analyzed by the Y-PLEX 6 Kit. The commonest allele for each locus was: DYS19, allele 15; DYS385, allele 12; DYS389II, allele 28; DYS390, allele 23; DYS391, 10; and DYS393, allele 12. Gene diversity value was calculated from the allelic frequency for each locus. The DYS385 locus proved to be highly polymorphic (0.890), DYS391 showed the lowest value (0.489), and the other loci showed values ranging from 0.646 to 0.897. A total of 99 haplotypes were observed in six Y-specific STR loci, the haplotype diversity was raised to 0.999. The results revealed that a set of six Y-specific STR loci were able to discriminate most of the male individuals in the Chinese population.     

Comparison of surgical outcomes between macro discectomy and micro discectomy for lumbar disc herniation: a prospective randomized study with surgery performed by the same spine surgeon

STUDY DESIGN: A prospective study was conducted on the surgical procedures for lumbar disc herniation. OBJECTIVE: The objective of this study is to investigate the surgical outcomes of different methods when performed by the same surgeon, using a prospective study. BACKGROUND: Macro discectomy is widely known as a common surgical procedure for lumbar disc herniation, while microdiscectomy in place of Caspar technique (the Caspar method) and microendoscopic discectomy by a posterior approach are reported as less invasive surgical methods for this condition. However, there have not been a significant number of prospective studies conducted to compare different surgical procedures for lumbar disc herniation. MATERIALS AND METHODS: The target of our study was a group of 62 patients (male: 43, female: 19) who underwent surgery by macro discectomy (A group) and 57 patients (male: 33, female: 24) who underwent surgery by microdiscectomy in place of Caspar technique (B group). The mean ages at surgery were 34 (14 to 62) years and 41 (18 to 65) years respectively, and the mean duration of follow-up was 2 years and 8 months (12 months to 4 years). For all patients, the surgery was performed by 1 of the authors. The items investigated were the operation time, amount of bleeding, duration of hospitalization, amount of analgesic agent used after surgery, pre- and postoperative scores based on judgment criteria for treatment of lumbar spine disorders established by the Japanese Orthopaedic Association score, visual analog scales (VAS, 0 to 10) for lumbago before surgery and at discharge, VAS for sciatica before surgery and at discharge, perioperative complications, and cases requiring further surgery. RESULTS: There were no significant differences between the 2 surgical procedures in the frequency of use of an analgesic agent after surgery, the pre- and postoperative Japanese Orthopaedic Association scores or postoperative VAS for sciatica. Statistically significant differences were observed in the operation time, amount of bleeding, duration of hospitalization, and postoperative VAS for lumbar pain, but the differences were not large, and may not have been clinically significant. CONCLUSIONS: For herniotomy for lumbar disc herniation, both macro discectomy and microdiscectomy are appropriate, as long as surgeons have mastery of the procedures.     

Hypnotic effects of total aqueous extracts of Vervain hastata (Verbenaceae) in rats

The in vivo sedative property of the total aqueous extract of the aerial portion of Vervain hastata (Verbenaceae) (TAEV) was studied in male rats to establish its scientific basis in herbal medicine. The investigation was conducted using electroencephalogram (EEG) analysis, and the barbituric-hypnosis test. The results showed that TAEV potentiated the pentobarbital-induced hypnosis significantly by reducing sleep latency and increased sleeping time in a dose-dependent manner that was reversed by flumazenil. The EEG data demonstrated that extract administration augmented total sleep time, rapid eye movement (REM) sleep and non-REM sleep at the expense of wakefulness. The study's results clearly showed the scientific validity for the use of this plant as a sedative and possibly as a nerve tonic substance.     

Early gastric cancer located just above Dieulafoy's ulcer, with massive bleeding

In 2003, a 69-year-old man visited our emergency department because of hematemesis and anemia. Emergency gastroscopy revealed massive bleeding from Dieulafoy's ulcer in the upper body of the stomach. The arterial bleeding was successfully controlled by endoscopic clipping. Blood transfusion and a proton-pump inhibitor were administered and his condition recovered smoothly. Two weeks after the treatment, type IIa early gastric cancer was detected at the previous bleeding point by follow-up endoscopy. He underwent distal gastrectomy with systematic lymph node dissection (D2), and he had no sign of recurrence until 2005. Histopathological examination revealed an early gastric cancer with submucosal invasion located just above the Dieulafoy's disease. The characteristic finding of Dieulafoy's disease was an enlarged and tortuous artery arising from the subserosa, penetrating the muscle layer, and spreading in the submucosa. Abnormal Dieulafoy's artery coexisting with gastric cancer has been reported in only 17 cases until now. Our clinical and pathological findings led us to the following speculation on the pathogenesis in our patient. Repeated regeneration of the mucosal membrane would have been caused by circulatory disturbance in Dieulafoy's vessels. This regeneration and mucosal dysplasia may have been a factor in promoting the gastric cancer. In the previously reported cases of the coexistence of abnormal Dieulafoy's artery and gastric cancer, the initial gastroscopic examination rarely diagnosed the gastric cancer. Thus, follow-up gastroscopy is essential, so as not to miss such coexisting diseases.     

Multiple hepatocellular carcinomas successfully treated by combined therapies

We report a case of advanced multiple hepatocellular carcinomas (HCC), successfully treated by combination therapies of transarterial chemoembolization (TAE), operation and radiofrequency ablation therapy (RFA). A 59 year-old man was detected with an increased serum alpha-fetoprotein (AFP) level and an ultrasonography (US) revealed three nodules of HCC at the right lobe in August 1998. He was successfully treated with a combination therapy of TAE and percutaneous ethanol injection therapy (PEIT) at the beginning. However, HCC had recurred quite often. TAE had been repeated for twelve times before right trisegmentectomy was performed in November 2002. Thirteen months after the operation, CT revealed a new lesion at subsegment 3, which was treated by RFA. Furthermore, a metastatic single lesion had appeared at the left lung, which was resected. He has still been well for 82 months since the first detection of HCC.     

Effects of nocturnal bright light on saliva melatonin, core body temperature and sleep propensity rhythms in human subjects

Nine healthy male volunteers (mean age of 24) participated in two experimental sessions of random crossover design: a bright light (5000 lux for 5 h from 00:00 to 05:00 h) session and a dim light (10 lux for 5 h from 00:00 to 05:00 h) session. Subsequently participants entered an ultra-short sleep-wake schedule for 26 h, in which a sleep-wake cycle consisting of 10-min sleep EEG recording on a bed and 20-min resting awake on a semi-upright chair were repeated. Saliva melatonin level and core body temperature was measured throughout the experiment. Bright light significantly delayed rhythms of melatonin secretion (01:58 h), core body temperature (01:12 h) and sleep propensity (02:00 h), compared as dim light session. Significant positive correlation was found between bright light-induced phase change in core body temperature and that in sleep propensity rhythm. Light-induced melatonin suppression significantly positively correlated with the phase change in core body temperature and that in sleep propensity rhythm. Assuming that light-induced melatonin suppression represents an acute impact of light on the circadian pacemaker, our results suggest that such an impact may be directly reflected in phase changes of sleep propensity and core body temperature rhythms rather than in melatonin rhythm.     

Lessons Learned: Medical and Health Care Management for Emergency Workers at the TEPCO Fukushima Daiichi APP Accident

During the emergency work at the Fukushima Daiichi Atomic Power Plant (APP), the Tokyo Electric Power Company (TEPCO) and the Japanese government experienced various problems in medical and health care management issues, including special medical examinations, on-site triage and initial treatment, patient transportation, lodging and food, and long-term health care for emergency workers. To resolve these problems, the Ministry of Health, Labor and Welfare (MHLW) issued a series of compulsory directives and provided administrative guidance to TEPCO. Based on the experiences and lessons learned, the MHLW recognized that the proper management and implementation of medical and health care management in response to a similar accident would require sufficient measures and systematic preparation, including the following:

1. In case of large-scale nuclear accidents, the government needs to assist in dispatching medical staff to the affected plants.

2. Nuclear facility operators, medical facilities and fire departments should make an agreement to clarify the division of the roles played prior to the accident and should conduct emergency drills periodically with the full attendance of related personnel to identify and resolve the problems.

3. Operators need to develop a support base at a safe distance from the plant and to prepare to develop makeshift lodgings in case of emergency.

4. Operators need to come to an agreement to share food stocks among closely located nuclear plants and prepare cooking equipment that can be used in case of blackout to provide warm foods and drinks to as many workers as possible.

5. It is necessary to conduct long-term follow-up for emergency workers, including health care system, medical examinations and mental health consultations.