A case report of the local treatment against hepatocellular carcinoma (HCC) in consideration of the prospective living donor liver transplantation (LDLT)

Various local cancer treatments became possible in the cure of hepatocellular carcinoma. Percutaneous ethanol injection (PEIT), a local ablation therapy such as microwave and radiofrequency were added to the transcatheter arterial chemoembolization (TACE) and hepatectomy. However, it is also a well-known fact to repeat hepatic carcinogenesis by the conditions of a background liver whereas to originate in the viral hepatitis. In this point of view, liver transplantation is one of the ultimate treatments to get rid of the carcinogenic factor. A 54-year-old man patient diagnosed as HCC strongly hoped for the prospective liver transplantation surgery from the beginning. Therefore, we had to treat a liver cancer in consideration of the prospective liver transplantation. A local ablation therapy and TACE treatment were carried out with being careful not to have an influence to the transplantation surgery. Because recurrence was repeated, a patient chose a transplantation medical treatment after one year and nine months. We reported the process of local treatments against HCC in consideration of the prospective liver transplantations.     

Radio-frequency ablation (RFA) assisted endoscopic hepatectomy for hepatocellular carcinoma

We introduced a new therapeutic approach for hepatocellular carcinoma (HCC); Radio-frequency ablation (RFA) assisted endoscopic hepatectomy (RFA-assisted EH). Seven patients with HCC, smaller than 3 cm and located on the surface of the liver, were entered into this study. RFA on the hepatic cutting line was achieved with a 2 cm Cool-tip needle at a 1-cm interval. RFA power was gradually increased to 100 W in a minute and ablation was stopped once an impedance-out state was attained of RFA power. Hepatic resection was achieved with various items in a coagulative hepatic parenchyma. If necessary, additional RFA could be performed during the hepatectomy. Patients' characteristics were described as follows; average age: 64 years, 5 males and 2 females, liver damage A: 5, B: 2, average tumor size: 27 mm, and average tumor number: 1.3 Two thoracoscopic and 5 laparoscopic approaches were selected. One application of RFA could make an elliptical coagulative area (2 cm x 1 cm). RFA was achieved eleven times on the hepatic cutting line and three times during the hepatectomy. The average operating time and blood loss was 256 minutes and 96 g, respectively. No blood product was needed. The average postoperative hospital stay was 11 days and no operative complication was encountered. All of the patients were well and without recurrence during the observation period (average: 6 months). We positively recommend RFA-assisted EH for HCC due to its perfect radicality and safety.     

Alcohol drinking frequency is more directly associated with alcohol use disorder than alcohol metabolizing enzymes among male Japanese

The development of alcohol use disorder (AUD) is related to various social, economic, cultural, environmental and hereditary factors. Several potential risk factors have been proposed for AUD in addition to alcohol consumption, including alcohol dehydrogenase2 (ADH2), acetaldehyde dehydrogenase2 (ALDH2), marital status, educational, occupational or past medical history (e.g. diabetes mellitus, hypertension, lung, digestive tract, or chronic liver disease) or smoking habits. The present study was performed to investigate the relationship between the aforementioned potential risk factors and AUD in Japan. A case-control study was performed on 153 male Japanese AUD patients and age-, gender-, or other confounder-matched controls to investigate the relation multivariately between ADH2, ALDH2 or alcohol drinking and AUD. Genomic DNA were extracted from nail clippings by the guanidium method, and genotyping of ADH2 and ALDH2 were performed using polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) methods. Univariate analyses by the conditional logistic regression model revealed statistically significant odds ratios due to ADH2*1/1 genotype, ALDH2*1/1 genotype, middle school as the final school attended, longest occupations as farmers, fishermen, craftsmen, miners, production process or construction workers, and past histories of chronic liver disease and AUD. However, multivariate analyses under a hierarchically well-formulated model strategy with interaction and confounding assessment indicated that (i) heavy alcohol intake was a significant risk factor (odds ratio per 1.0 g of daily ethanol intake; 1.096, 95% confidence interval; 1.026-1.171) for developing AUD after adjusting for other confounders; and (ii) ADH2*1/1 genotype and ALDH2*1/1 genotype were not risk factors after adjusting for daily ethanol intake and other confounders. The present study shows that AUD was more directly and strongly associated with alcohol drinking than with alcohol metabolizing enzymes among male Japanese.     

Identification of genes related to invasion and metastasis in pancreatic cancer by cDNA representational difference analysis

The difference in gene expression between the highly invasive and metastatic cell line PC-1.0 and the weakly invasive and metastatic cell line PC-1 both derived from a pancreatic ductal carcinoma induced by N-nitrosobis (2-oxopropyl) amine (BOP) in Syrian golden hamster was examined using the Representational Difference Analysis (RDA) method. Within 8 clones (cDNA fragments) successfully isolated after subtraction hybridization of PC-1 cDNA from PC-1.0, 5 clones were shown to be specific or highly expressed in PC-1.0 as confirmed by RT-PCR. Among these 5 clones, two known genes, MAP kinase kinase 2 (MKK2) and phosphatidylinositol 4-kinase (PI4K230) were detected by gene sequencing. The specific expressions of MKK2 and PI4K230 in the highly invasive and metastatic cell line PC-1.0 were confirmed by RT-PCR and Northern blotting. By adding the CM of PC1.0 which included the cancer cell dissociation factor (DF), PC-1 cells began to dissociate and migrate from the colonies, and in addition the expression of MKK2 was found to be induced. On the other hand, the expression of PI4K230 was not induced in PC-1 cells by adding the CM of PC-1.0. Interestingly, in PC-1.0 the expression of PI4K230 was completely abolished and apoptosis induced by the PI3K inhibitor wortmannin. These results suggest that both MKK2 and PI4K230 are factors of a signal transduction pathway that might play an important role related to invasion and metastasis through the induction of cell motility and/or the inhibition of apoptosis.     

Expression of proteinase-activated receptor-2 in human pancreatic cancer: a possible relation to cancer invasion and induction of fibrosis

The proteinase-activated receptor-2 (PAR-2) is a G protein-coupled receptor that is cleaved and activated by trypsin. To clarify the presence of PAR-2 in human pancreatic cancer, the expression of PAR-2 was analyzed by RT-PCR, immunoblotting and immunocytochemistry using 5 human pancreatic cancer cell lines. And to evaluate the biological significance, immunohistochemical expression of PAR-2 in malignant and non-malignant human pancreatic tissues was examined using paraffin-embedded sections. The presence of PAR-2 was confirmed in all 5 pancreatic cancer cell lines and all 21 paraffin-embedded specimens from human pancreatic cancer examined. The expression of PAR-2 was found to be higher in the tissues with infiltrative growth pattern than those with expansive growth pattern. Moreover, significantly higher expression of PAR-2 was observed in the tissues which were accompanied by severe fibrosis. Even in the same specimen, the intensity of immunoreactivity tended to be stronger in the part with severe fibrosis than that with mild fibrosis. Similarly, the higher expression of PAR-2 was observed in chronic pancreatitis with severe fibrosis than with mild fibrosis. Taken together, these results suggest that the activation of PAR-2 is involved in cancer invasion and the induction of fibrosis in human pancreatic cancer.     

Inter-observer agreement and validity of photographic dietary assessment

PURPOSE: Estimation of nutritional intake from photographs of served meals has been proposed. We examined the inter-observer agreement and validity of this method for assessment of the daily diet. METHODS: Twenty-five family members (13 men and 12 women, mean age +/- SD: 47.3 +/- 5.6 years) of students in a dietetic course performed both meal photography and traditional weighed dietary records for four days. For the photo method, two observers independently identified foods and estimated their portion sizes from the photographs, converting them into energy and nutrient intake with a food composition table. The inter-observer agreement with the photo method was assessed in terms of inter-observer ratios, correlations, and coefficients of variation (CV), and the method was validated using the weighed dietary records as the reference. Its running cost was also calculated. RESULTS: The inter-observer ratios for estimation of mean daily nutritional intake ranged from 0.89 (magnesium) to 1.14 (retinol) with a median of 1.03. The correlation coefficients between observers varied from 0.65 (saturated fatty acids [SFA]) to 0.92 (vitamin C) on a daily basis (median, 0.79), and from 0.65 (SFA) to 0.96 (vitamin C) on an individual basis (median, 0.78). The CVs ranged from 7.9% (energy) to 23.8% (carotenc) (median, 13.3%), and from 5.2% (energy and magnesium) to 17.8% (carotene) (median, 8.8%) for daily and individual intake, respectively. Regarding validity, the ratios between methods (the photo method/weighed dietary records) ranged from 0.96 (potassium and SFA) to 1.11 (retinal and salt) with a median of 1.00. Correlations between the two methods were distributed from 0.40 (salt) to 0.82 (vitamin C and retinol) on a daily basis (median, 0.67), and from 0.47 (salt) to 0.90 (vitamin C) on an individual basis (median, 0.74). The CVs ranged from 10.5% (energy) to 39.6% (carotene) (median, 16.9%), and from 6.1% (protein) to 20.6% (carotene) (median, 11.2%), respectively. It was calculated to cost 105 Japanese yen per meal when using a lens-attached film for 25 shots. CONCLUSIONS: Inter-observer agreement and validity of the photo method, though varying with the nutrient, were generally acceptable. Although some modifications are needed for diners-out, the method appears to be useful as a dietary recording tool.     

A simple food frequency questionnaire for Japanese diet--Part I. Development of the questionnaire, and reproducibility and validity for food groups.

We developed a simple food frequency questionnaire (FFQ) based on one-day dietary records (DRs) among 1001 subjects in Nagoya, Japan. A total of 97 foods and dishes were selected through a two-step procedure; first by ranking food items according to the contribution to the population intake of nutrient variables, and second by stepwise multiple regression analyses of individual food items as the independent variables and of total nutrient intake as the dependent variables. For simplicity, questions on portion sizes were not included except for a few selected food items, which resulted in short time (about 20 minutes) to complete the questionnaire. This FFQ was validated for food groups by referring to four 4-day DRs among 88 men and women in central Japan, from 1996 to 1997. The energy-, sex- and age-adjusted test-retest correlation coefficients between the two FFQs administered at an one year interval ranged from 0.34 to 0.78. The de-attenuated, energy-, sex- and age-adjusted correlation coefficients between the second FFQ and the DRs were larger than 0.40 for most food groups, indicating the usefulness of this simple FFQ with its sufficient validity in epidemiological surveys.     

A simple food frequency questionnaire for Japanese diet--Part II. Reproducibility and validity for nutrient intakes.

A self-administered 97-item simple food frequency questionnaire (FFQ), without portion size questions for most items, was completed twice at an one-year interval by 88 men and women in central Japan to evaluate its reproducibility. This FFQ was further validated by referring to four 4-day weighed dietary records (DRs) which were performed at 3-month intervals. Mean energy and 18 nutrient intakes measured by the first and the second FFQs were quite similar to those measured by the DRs. In our reproducibility study, Pearson and intraclass correlation coefficients, adjusted for energy intake, sex and age, ranged from 0.48 to 0.82 (median = 0.67). In the validation study, adjusted and de-attenuated correlation coefficients between the second FFQ and the DRs ranged from 0.42 for iron to 0.83 for calcium (median = 0.61). The proportion of subjects classified by the FFQ into the same or adjacent quintiles defined by the DRs was between 65.9% and 83.0% (median = 69.9%). These findings essentially suggested that our FFQ is well reproducible and sufficiently valid, and therefore, reasonably useful for nutritional epidemiological studies for Japanese diets, particularly for those of Tokai Area.     

Aortobronchial fistula late after transverse arch replacement

We report an unusual case of aortobronchial fistula late after transverse arch replacement caused by the remnant of a temporary bypass near the ascending aorta. In reconstructive surgery of the ascending aorta, antegrade perfusion is preferably performed through a side branch after completion of the distal anastomosis by some surgeons. This report suggests possible risk of a serious late complication unless the side branch is placed and tailored properly.