Species-specific metastasis of human tumor cells in the severe combined immunodeficiency mouse engrafted with human tissue.

We have attempted to model human metastatic disease by implanting human target organs into the immunodeficient C.B-17 scid/scid (severe combined immunodeficiency; SCID) mouse, creating SCID-hu mice. Preferential metastasis to implants of human fetal lung and human fetal bone marrow occurred after i.v. injection of human small cell lung cancer (SCLC) cells into SCID-hu mice; the homologous mouse organs were spared. Clinically more aggressive variant SCLC cells metastasized more efficiently to human fetal lung implants than did cells from classic SCLC. Metastasis of variant SCLC to human fetal bone marrow was enhanced in SCID-hu mice exposed to gamma-irradiation or to interleukin 1 alpha. These data indicate that the SCID-hu mice may provide a model in which to study species- and tissue-specific steps of the human metastatic process.     

Possible induction of multiple seizure foci due to parietal tumour and anti‐NMDAR antibody

“Formes frustes” of encephalopathy associated with anti‐NMDAR antibody have been recently described in cases of chronic epilepsy. We report a young woman with a parietal lesion and anti‐NMDAR antibody who acquired bilateral, secondary epileptogenesis in the temporal lobes within a period as short as six years. Removal of the primary epileptogenic lesion of oligoastrocytoma in the right parietal lobe resulted in seizure freedom, disappearance of secondary foci, and substantial decrease of the antibody titre. Chronic exposure to anti‐NMDAR antibody, albeit at a low titre, may have resulted in a smoldering chronic course and relatively early acquisition of “reversible” secondary foci without development of a high degree of epileptogenicity and structural changes.     

First case report of staghorn calculi successfully removed by mini‐endoscopic combined intrarenal surgery in a 2‐year‐old boy

Less‐invasive therapy for pediatric urolithiasis is available due to the miniaturization of equipment and improved optics; however, surgical treatment strategies, especially for large calculi, remain controversial. We describe here our experience of treating a 2‐year‐old boy with left renal staghorn calculi with a single session of mini‐endoscopic combined intrarenal surgery in the prone split‐leg position with pre‐ureteral stenting and the directional enhanced flow imaging ultrasound technique. This is the first report of successful pediatric mini‐endoscopic combined intrarenal surgery without any major complications. We believe this technique provides an important therapeutic option for large renal calculus in pediatric patients.     

Innovative marking method using novel endoscopic clip equipped with fluorescent resin to locate gastric cancer

An asymptomatic 76-year-old man presented to our department for the treatment of gastric cancer. Esophagogastroduodenoscopy revealed a superficial elevated lesion with an irregular central depression in the lower third of the stomach; this was confirmed to be adenocarcinoma by biopsy, while abdominal contrast-enhanced CT revealed no abnormal lesions. Based on the patient's clinical diagnosis of early gastric cancer, we planned laparoscopic gastrectomy with preoperative placement of four endoscopic marking clips equipped with indocyanine green-conjugated resin to determine the resection margin. During surgery, a dedicated laparoscopic system was used to detect indocyanine green fluorescence emitted by the clips and determine their precise position. The clips helped to identify an accurate resection line for the stomach, enabling accurate laparoscopic distal gastrectomy with regional lymphadenectomy. We successfully demonstrated the usefulness of clips with fluorescent resin for detecting gastric cancer in patients. We report the first case using the clips to accurately locate a site of interest.     

Cardiovascular Protective Effects of On‐Line Hemodiafiltration: Comparison With Conventional Hemodialysis

Atherosclerotic complications have a significant effect on mortality in patients undergoing hemodialysis (HD) therapy. However, anti‐atherosclerotic and cardioprotective effects of on‐line hemodiafiltration (HDF) remain to be elucidated. We prospectively compared the anti‐atherosclerotic and cardioprotective effects in two randomly divided groups, i.e. on‐line HDF group (n = 13) and conventional HD group (n = 9) for 1 year. Surrogate markers were brachial‐ankle pulse wave velocity (baPWV), intima‐media thickness (IMT) of carotid artery as an atherosclerosis marker, and cardiac functional surrogate markers included left ventricular mass index (LVMI), ejection fraction (EF), and LV diastolic capacity represented as E/A and deceleration time (DT). LVMI in on‐line HDF patients showed significant regression after 1 year of treatment (131.9 ± 25.8 to 116.5 ± 24.7 g/m², P = 0.03), while LVMI in HD patients did not show any significant change (148.0 ± 47.1 to 142.3 ± 35.5 g/m²). Levels of baPWV in HD patients showed a significant increase (11.4%) from basal levels, while on‐line HDF groups showed no significant increase. Furthermore, HD patients showed significant worsening of LV diastolic capacity (E/A: from 0.87 ± 0.12 to 0.79 ± 0.08, P = 0.03), while it was not shown in on‐line HDF patients. Ejection fraction and IMT did not show any significant change in both groups. Serum albumin, C‐reactive protein, β2 microglobulin, blood pressure, and anti‐hypertensive drug use did not change in both groups. On‐line HDF showed a significant improvement in LVMI and prevented a significant worsening of baPWV or LV diastolic capacity compared with patients on conventional HD therapy.     

The Pavlik harness in the treatment of developmentally dislocated hips: results of Japanese multicenter studies in 1994 and 2008

Background

It has already been more than 50 years since the Pavlik harness was introduced in Japan, and today the Pavlik harness is widely recognized as the standard initial treatment modality for developmental dysplasia of the hip. We performed a multicenter nationwide questionnaire study concerning the results of Pavlik harness treatment twice in 1994 and 2008.

Methods

In 1994 and in 2008, we sent questionnaires to 12 institutes in Japan specializing mainly in pediatric orthopedics. We compare the results of these two studies and discuss differences in reduction rates, incidence of avascular necrosis in the femoral epiphysis and the percentage of joints with acceptable morphology (Severin grade I + II/total) at skeletal maturity. We statistically assessed these results to see whether there were changes in the treatment outcomes over this 14-year period.

Results

Reduction of the dislocated hips was obtained by the Pavlik harness in 80.2 % (1990/2481 hips; 1994) and 81.9 % (1248/1523 hips; 2008). The incidences of avascular necrosis of the proximal femoral epiphysis in the dysplastic hips were 14.3 % (119/835 hips; 1994) and 11.5 % (76/663 hips; 2008). The type of avascular necrosis in hips from the 2008 study was determined according to the classification of Kalamchi and MacEwen: 24/69 hips (34.8 %) were classified as group I; 20/69 hips (29.0 %) as group II; 11/69 hips (15.9 %) as group Ill; 14/69 hips (20.3 %) as group IV. The percentages of hips with acceptable outcomes at skeletal maturity discerned from Severin X-ray changes (grade I + II/total) were 72.3 % (604/835 hips; 1994) and 77.7 % (488/628 hips; 2008).

Conclusion

Reduction rates and the incidence of avascular necrosis in 2008 were statistically similar to the results in 1994. The rate of acceptable outcome (Severin grade I + II/total) in 2008 was statistically higher than that of 1994.     

Predictive Factors for Change of Diabetes Mellitus Status After Pancreatectomy in Preoperative Diabetic and Nondiabetic Patients

Introduction

This study aimed to determine risk factors for exacerbation of diabetes mellitus (DM) after pancreatectomy.

Methods

Medical records of 167 patients with benign and malignant pancreaticobiliary diseases who underwent pancreaticoduodenectomy or distal pancreatectomy were retrospectively analyzed. DM was diagnosed by diabetic history or American Diabetes Association criteria. Worsened and improved DM after pancreatectomy was defined when treatment intensity or insulin/oral antidiabetic drug dosage increased or decreased, respectively, postoperatively. Long-standing DM was defined as a duration of >2 years.

Results

In 76 preoperative diabetic patients, worsened and improved DM was observed postoperatively in 46 (60.5 %) and 9 (11.8 %) patients, respectively. In 91 preoperative nondiabetic patients, 22 (24.2 %) developed new-onset DM after pancreatectomy. Multivariate logistic analysis of the preoperative diabetic patients demonstrated long-standing DM and malignancy as independent predictors for postoperative worsened DM. No patients with long-standing DM or insulin treatment experienced improved DM after pancreatectomy. Multivariate logistic analysis of the preoperative nondiabetic patients showed body mass index of ≥25 and hard pancreatic texture as independent risk factors for new-onset postoperative DM.

Conclusions

These results may enable preoperative evaluation of risk factors for worsened or new-onset DM after pancreatectomy and may help plan intensive care for patients at a high risk of postoperative worsened DM.