Endosalpingiosis of nonmetastatic lymph nodes along the stomach in a patient with early gastric cancer: Report of a case

We report herein the case of a 32-year-old woman who underwent distal gastrectomy with D2 lymph node dissection for gastric cancer. Microscopic examination of the resected specimen revealed signet-ring cell carcinoma of the stomach with lymph node metastases, and endosalpingiosis in the normal lymph nodes. There was no evidence of malignancy in the peritoneal cavity. To our knowledge, no other case of endosalpingiosis in the lymph nodes along the stomach has ever been reported. The possible significance of endosalpingiosis is discussed following this case report.     

Trans-synaptically induced bursts in regular spiking non-pyramidal cells in deep layers of the cat motor cortex

In deep layers of the cat motor cortex, we have investigated the properties of neurons displaying trans-synaptically induced bursts. In in vivo experiments, extracellularly recorded burst neurons were separated into two subtypes based on their dependence on stimulation sites, the medullary pyramid or the ventrolateral (VL) thalamic nucleus, from which bursts of 10-20 spikes were triggered. The spike amplitude attenuation and frequency adaptation during a burst were more prominent in pyramid-dependent burst neurons than in VL-dependent burst neurons. Intracellular recordings in in vivo experiments revealed that pyramid-dependent bursts emerged from a long-lasting depolarization, while each spike during a VL-dependent burst was narrow in half-width and was followed by a fast AHP, similar to fast spiking neurons. In in vitro slice experiments, intracellular recordings were obtained from neurons that displayed a burst of attenuated spikes emerging from a long-lasting depolarization, and were also obtained from fast spiking neurons. They were morphologically recovered to be multipolar cells with sparsely spiny dendrites and local axonal networks, suggesting that they are inhibitory interneurons. The multipolar neurons displaying bursts of attenuated spikes may mediate the recurrent inhibition of pyramidal tract cells.     

Multiple chemical sensitivities: case definition, etiology and relations to allergy, poisoning, psychogenic illness etc]

Multiple Chemical Sensitivities (MCS) have been defined as an acquired disorder characterized by recurrent symptoms, referable to multiple organ systems, occurring in response to demonstrable exposure to many chemically unrelated compounds at doses far below those established in the general population to cause harmful effects; no single widely accepted test of physiologic function can be shown to correlate with symptoms (Cullen MR, 1987). The etiology of MCS is hypothesized as a toxicant-induced loss of tolerance to multiple chemicals with subsequent manifestation of multiple-organ symptoms triggered by low-level exposure to such chemicals. The involvement of multiple organs might be attributed to a neurogenic switching mechanism. The final diagnosis of MCS is to rely on provocation of symptoms in a exposure chamber by a double-blind method. Relations of MCS to allergy, poisoning, psychogenic illness, chemical sensitivity, idiopathic environmental intolerances etc. are discussed in terms of case definition and etiology of these disorders.     

The usefulness of FDG positron emission tomography for the detection of mediastinal lymph node metastases in patients with non-small cell lung cancer: a comparative study with X-ray computed tomography

We evaluated the usefulness of fluorine-18-fluoro-2-deoxy-d-glucose positron emission tomography (FDG PET) in the detection of mediastinal lymph node metastases in patients with non-small cell lung cancer and then compared the findings with the results of X-ray CT by region based on the histological diagnoses. We examined 29 patients with non-small cell lung cancer. One hundred and thirty-two mediastinal lymph nodes were surgically removed and the histological diagnoses were confirmed. FDG PET images, including 146 mediastinal regions, were visually analysed and the mediastinal lymph nodes were scored as positive when the FDG uptake was higher than that in the other mediastinal structures. On the X-ray CT scans, any mediastinal lymph nodes with a diameter of 10 mm or larger were scored as positive. All three examinations were successfully performed on 71 regions. For FDG PET, we found a sensitivity of 76%, a specificity of 98% and an accuracy of 93%. On the other hand, for X-ray CT a sensitivity of 65%, a specificity of 87% and an accuracy of 82% were observed. A significant difference was observed in respect of both specificity and accuracy (P<0.05). Based on the above findings, FDG PET is suggested to be superior to X-ray CT when used for the detection of mediastinal lymph node metastases in patients with non-small cell lung cancer.     

Recovery of slowed nerve conduction velocity in lead-exposed workers

Summary Maximum motor nerve conduction velocities in the median nerve (MCV) and blood lead (PbB) were repeatedly measured in 14 lead exposed workers with an initial PbB from 0.7 to 4.0 mol/kg (median 2.3 mol/kg) for a period from 3 months to 7 years: A certain dose of Calcium Disodium Ethylenediaminetetraacetic Acid (CaEDTA) was injected intravenously into most of the subjects during the period.In seven subjects, MCV improved by more than 4 m/s during the observation period which involved the first two successive measurements of MCV and PbB, but the remaining seven subjects showed the minimal alteration (within ± 4.0 m/s). The initial value of MCV was significantly slower (P < 0.01) and the decrease in PbB was significantly greater (P < 0.05) in the group of subjects having shown the improvement of MCV by more than 4 m/s.The initial value of MCV was significant in determining the alteration in MCV in multiple regression analysis and, together with the change in PbB, explained 31% of the alteration in MCV between the first two successive measurements. The initial level of PbB, dose of CaEDTA, time interval between the measurements and age played no essential part in the alteration in MCV.The alteration in MCV throughout the whole observation period in each subject significantly correlated with the concurrent change in PbB (r=–0.573, P < 0.001).     

Arterial occlusion following cerebral vasospasm (author's transl)]

1. The present study analysed the clinical course, the serial angiograms and the CT scans of the patients with angiographic arterial occlusion following vasospasm after subarachnoid hemorrhage. The occlusion was observed in 6 out of 84 patients with vasospasm. 2. The angiograms which showed this phenomenon were obtained between the 11th and the 30th day of the illness. The affected vessels were the branches of middle cerebral artery. 3. Thrombus formed on the intima which had been injured by vasospasm is suspected to be a genesis of this arterial occlusion. The pathological findings of a case in this series support this concept. 4. The surgical procedure during the direct aneurysmal operation performed in the period of "smooth narrowing" seems to be a contributing factor to the arterial occlusion. There was no correlation between antifibrinolytic therapy and this phenomenon except in one case. 5. Fibrinolytic therapy after clipping of aneurysm may be a treatment of choice for this arterial occlusion following vasospasm.     

Endoscopic surgery in obstetrics and gynecology

There are three types of endoscopic surgery in obstetrics and gynecology: laparoscopy; hysteroscopy; and salpingoscopy. The main indications for laparoscopic surgery are myoma uteri, ovarian tumors, ectopic pregnancy, infertility, and endometriosis. Currently the indications are limited to benign disease. The main indications for hysteroscopic surgery are submucous myoma uteri, uterine anormalies, and Asherman syndrome. During hysteroscopy the uterine cavity is dilated with liquid and then a resectoscope or hysterofiberscope is used. Salpingoscopy is useful in examining the tubal cavity and a potent tool for tubal recanalization. Endoscopic surgical techniques will develop rapidly in the near future to serve the various needs of female patients.     

Prediction of nodal metastasis by comparative genomic hybridization in biopsy specimens from patients with superficial esophageal squamous cell carcinoma.

PURPOSE: Selection of appropriate protocols for treatment of superficial esophageal squamous cell carcinoma (SESCC) is dependent on lymph node metastasis status. Therefore, it is important to know whether lymph node metastasis is present before treatment. EXPERIMENTAL DESIGN: In this study, we examined the relation between DNA sequence copy number aberrations detected by comparative genomic hybridization and lymph node metastasis in 26 surgically resected SESCCs (training samples). We then assessed whether the genetic information is predictive for nodal status in biopsy specimens from eight newly enrolled patients with SESCC (blinded samples). RESULTS: Pathological examination revealed that 17 of 26 training samples (65.4%) did not have associated lymph node metastasis. Gains of 8q24 and/or 20q12-qter were observed in 12, including all (nine of nine) with nodal metastasis. Fourteen training samples did not have gain of either 8q24 or 20q12-qter. Of the blinded samples, two showed no gain of 8q24 or 20q12-qter, and as anticipated the postoperative pathological examination revealed no nodal metastasis. The remaining six blinded samples had gains of 8q24 and/or 20q12-qter, and lymph node metastasis was detected by postoperative examination in four of these tumors. CONCLUSIONS: Absence of gains of 8q24 and/or 20q12-qter appears to be associated with absence of lymph node metastasis in patients with SESCC; therefore, less invasive surgery can be chosen.     

Mechanisms for the formation of glycoxidation products in end-stage renal disease

BACKGROUND: Advanced glycation end products (AGEs) accumulate on tissue and plasma proteins in patients with renal failure far in excess of normal aging or diabetes. The aim of these studies was to elucidate the nature of the precursors and the pathways that lead to an accelerated formation of two structurally identified AGEs [pentosidine and Nepsilon(carboxymethyl)lysine (CML)] in the uremic milieu. METHODS: Serum levels of the glycoxidation products, pentosidine and CML, were quantitated by high-performance liquid chromatography in uremic patients treated by dialysis. The formation of early glycation products (as furosine) and late glycoxidation products was modeled in uremic serum and in spent peritoneal dialysate. RESULTS: Clinical factors that affect circulating levels of AGEs included dialysis clearance and dialyzer membrane pore size, but not the presence or absence of diabetes. Both pentosidine and CML form at an accelerated rate in serum from uremic patients. Chelating agents most effectively slow the formation in vitro. In uremic fluids, the primary mechanism of formation of pentosidine is through the Amadori pathway. The primary mechanism of formation of CML is through metal-chelated autoxidation of reducing sugars generating reactive carbonyl precursors. In uremic serum, the presence of an unidentified reactive low molecular weight precursor accelerates the formation of pentosidine. CONCLUSIONS: The formation of the two glycoxidation products, pentosidine and CML, proceeds by different pathways and is enhanced by different precursors in the uremic milieu. The formation of both AGEs is markedly enhanced by metal-catalyzed reactions, evidence for the presence of increased metal-ion mediated oxidant stress in uremia.