Treatment of symptomatic hepatic cyst by injection of minocycline hydrochloride

We treated two patients with symptomatic hepatic cyst with minocycline hydrochloride (MINO) injections. Patient 1 was a 72-year-old woman who experienced upper abdominal discomfort brought on by a large hepatic cyst, 12 cm in diameter. MINO (200 mg) was injected daily for 8 days with a continuous drainage catheter. After the treatment, the size of the cyst decreased markedly and the symptoms disappeared. There has been no recurrence in a 55-month follow-up. Patient 2 was a 52-year-old man who experienced abdominal fullness and exhibited hepatomegaly. Investigations revealed many large hepatic cysts. Three continuous drainage catheters were inserted into the three largest cysts for the injection of MINO; a total of 5600 mg was injected over a period of 27 days. The cysts decreased in size and symptoms abated.     

Mycosis in the ear, nose and throat]

Recent trends of fungal infections of the ear, nose and throat were introduced from the viewpoint of otolaryngologic practice. Aspergillus terreus was the most common pathogen of otomycosis followed by A. niger and A. flavus. Lanoconazole showed the most effective antifungal function for these Aspergillus species by drug sensitivity test. Biological differences between clinical and soil-borne strains of A. terreus were evaluated. The clinical strains showed slower growth-rate on malt extract agar and different patterns of fingerprinting by Random Amplified Polymorphic DNA. Aspergillosis is the most common fungal disease in the paranasal sinuses. Unilateral opacity of the maxillary sinus which contains flecks of calcification was specifically found by CT-study. Surgical removal of the fungus ball and establishment of a drainage route to the nasal passage by endoscopic sinus surgery are effective to manage aspergillomas in paranasal sinuses. Although candidosis is a common and mild infection in the oral mucosa, underlying problems related to immunodeficiency syndrome must be evaluated.     

Involvement of matrix metalloproteinase-7 in invasion-metastasis through induction of cell dissociation in pancreatic cancer

Epidermal growth factor receptor (EGFR) mediated mitogen-activated protein kinase kinase (MEK)/extracellular signal-regulated kinase (ERK) signaling pathway was isolated as invasion-metastasis related factor in pancreatic cancer in our previous studies. Matrix metalloproteinase-7 (MMP-7) and tight junction (TJ) proteins are indicated to be involved in cancer invasion-metastasis. To clarify the underlying mechanism of involvement of MMP-7 in cancer invasion, western blotting, invasion assay and immunohistochemistry were performed in dissociated (PC-1.0 and AsPC-1) and non-dissociated (PC-1 and Capan-2) pancreatic cancer cells, as well as pancreatic cancer tissues. Intracellular MMP-7 protein presented as pre-proenzyme and its expression was decreased by AG1478 (EGFR inhibitor) or U0126 (MEK inhibitor) treatment in pancreatic cancer cells. Activated MMP-7 protein was only detected in the medium of PC-1.0 and AsPC-1 cells, but not detected in the medium of PC-1 and Capan-2 cells. Moreover, MMP-7 treatment significant induced the dissociation of cell colonies in PC-1 and Capan-2 cells. Synchronously, TJ structure was apparently disrupted and translocation of TJ proteins to cytoplasm or extracellular medium was induced in PC-1 and Capan-2 cells. Furthermore, MMP-7 treatment markedly increased the in vitro invasion of PC-1 and Capan-2 cells. In addition, MMP-7 expression at the invasive front was obviously stronger than that at the center of pancreatic cancer tissues. Activation of MMP-7 protein is closely involved in disruption of TJ structure and consequent induction of cell dissociation as well as invasion in pancreatic cancer. EGFR mediated MEK/ERK signaling pathway is implied to be involved in regulation of MMP-7 expression in pancreatic cancer cells.     

Life-span Studies on Spontaneous Tumor Development in the Medaka (Oryzias latipes)

A total of 961 medaka, separated chronologically from the first to the fifth year of life, were examined for spontaneous tumor development. While no liver tumors were found in either male or female medaka under the age of 1 year and the incidence in 2-year-old fish was relatively low (males 1.9% and females 1.7%), they became more common with advancing age. The incidence was higher in females than in males from 3 to 5 years of age, reaching 7.1% in 5-year-old female stock. These liver tumors included a total of 12 adenomas and 9 hepatocellular carcinomas. The hepatocellular carcinomas were histologically well differentiated and were all observed in female medaka. Spontaneous tumors occurring in organs other than the liver were rare and sporadic. Four squamous cell carcinomas, 5 melanomas and 4 lymphosarcomas were observed with no sexual or pronounced age bias being evident. The squamous cell carcinomas developed in the surface epithelium with local invasion into the dermis. Melanomas occurred in the abdominal cavity and demonstrated systemic invasion into various parts of the body. Three out of the 4 lymphosarcomas arose from the inner part of the operculum suggesting that these tumors were of thymic origin. They also showed extensive invasion. The data indicate a particular susceptibility of older female medaka to liver but not other tumor development.     

Chronic Effect of Right Ventricular Pacing on Left Ventricular Rotational Synchrony in Patients with Complete Atrioventricular Block

Background: Chronic effect of right ventricular (RV) pacing on left ventricular (LV) rotational synchrony is unknown. The aim of this study is to assess chronic effect of RV pacing on LV rotational synchrony using two‐dimensional ultrasound speckle tracking imaging. Methods and Results: Thirty‐one patients who underwent dual‐chamber pacemaker implantation for complete atrioventricular block, and age‐ and sex‐matched 10 healthy controls were assessed. We divided our patients into RV apical (RVA, n = 16) and RV outflow tract (RVOT, n = 15) pacing groups. We compared echocardiographic parameters such as LV rotational synchrony between pacing groups and healthy control. We defined Q to peak rotation interval as the interval from the beginning of the Q‐wave to the peak apical counter‐clockwise or peak basal clockwise rotation. We calculated apical–basal rotation delay by subtracting basal Q to peak rotation interval from apical one as the representative of rotational synchronization. Apical–basal rotation delay of RVA pacing was significantly longer than that of healthy control (100 ± 110 vs. ?6 ± 15 ms, P = 0.002), while there was no statistically significant difference between RVOT pacing and healthy control (?3 ± 99 vs. ?6 ± 15 ms, P = 0.919). Conclusions: LV rotation during RVOT pacing is synchronous at 15 months after pacemaker implantation, while RVA pacing provokes LV rotational dyssynchrony by inducing delayed apical rotation at 7 years after pacemaker implantation in patients with complete atrioventricular block. (Echocardiography 2011;28:69‐75)     

Laparoscopic Treatment of Acute Ovarian Incarceration into the Pelvic Peritoneal Sac

Pelvic pain is a common symptom in women of reproductive age. Acute pelvic pain with rapid onset demands prompt diagnosis and treatment. We report the case of a patient with ovarian incarceration of acute onset. To our knowledge, this is the first report of ovarian incarceration into the pelvic peritoneal sac in a woman of reproductive age. In the present case, laparoscopy was useful in establishing the cause of pelvic pain. The patient reported severe lower right quadrant abdominal pain of sudden onset. At laparoscopic examination, the right fallopian tube was normal; however, the right ovary was not initially visible at the normal site. After the swollen right ovarian ligament was pulled aside using nontraumatic laparoscopic forceps, we were able to detect incarceration of the right ovary into the peritoneal sac in the medial to right uterosacral ligament. This case is unique because of ovarian incarceration into the peritoneal fenestration. We believe this condition was congenital because there was no other cause such as previous surgery, severe endometriosis, or pelvic inflammatory diseases.     

Questionnaire Survey of Treatment Choice for Breast Cancer Patients with Brain Metastasis in Japan: Results of a Nationwide Survey by the Task Force of the Japanese Breast Cancer Society

Objective: A nationwide survey was performed to investigate the currentpatterns of care for brain metastasis (BM) from breast cancerin Japan. Method: A total of 351 survey questionnaires were sent to communityor academic breast oncologists who were members of the JapaneseBreast Cancer Society as of December 2005. The questionnaireconsists of 40 multiple choice questions in eight categories. Results: Of 240 institutions sent survey questionnaires, 161 (67.1%)answered; 60% of institutions answered with ‘<5’patients with BM every year; almost half (83 of 161) screenedfor BM in asymptomatic patients; surgical resection was rarelyperformed, as ~75% of institutions (118 of 160 institutions)answered ‘none or one case of surgery per year’;27% (41 of 154) preferred stereotactic radiosurgery (SRS) overwhole-brain radiotherapy (WBRT) as the initial treatment inall cases, although ~70% (100 of 154) of them answered ‘dependon cases’. The preference for SRS over WBRT mainly dependson the impressions of breast oncologists about both safety (latenormal tissue damage and dementia in WBRT) and efficacy (betterlocal control by SRS). Eighty-one percent (117 of 144) of institutionsdid not limit the number of SRS sessions as far as technicallyapplicable. Conclusion: SRS is widely used as the first choice for BM from breast cancerin Japan. Considerable numbers of Japanese breast oncologistsprefer SRS over WBRT as the initial treatment for BM. A randomizedtrial comparing SRS and WBRT is warranted.     

Primary leiomyoma of the pancreas

Summary We report the first documented case of a primary leiomyoma of the pancreas. A 72-yr-old female patient was admitted to our hospital for the follow-up of a pancreatic tumor detected 2 yr previously at a different hospital. Diagnostic images revealed the presence of a tumor located in the head of the pancreas. The tumor was characterized by a clear margin, hypervascularity, and was a homogenous mass. Moreover, the tumor had not changed in size or characteristics since a previous computed tomography (CT) scan performed 2 yr previously. The tumor was preoperatively diagnosed as a nonfunctional islet-cell tumor or papillary cystic tumor. During the operation, the tumor was found to be encapsulated and showed no signs of direct invasion to neighboring structure. Tumorous lesions of the liver or swellings of the neighboring lymph nodes suggesting metastasis were not found. Instead of a pancreatoduodenectomy, the tumor was enucleated. Microscopically, immunohistochemical studies of a resected specimen indicated a myogenic origin, and neither mitotic activity nor hemorrhagic and necrotic findings were recognized. No signs of recurrence have been seen since its excision. Accordingly, the tumor was diagnosed as a primary leiomyoma of the pancreas.     

HMMC-1: a humanized monoclonal antibody with therapeutic potential against Müllerian duct-related carcinomas.

PURPOSE: The purpose of this research was to generate a human monoclonal antibody specific to gynecological cancers and to evaluate such an antibody as therapy for gynecological cancers. EXPERIMENTAL DESIGN: Transchromosomal KM mice were immunized with the human uterine endometrial cancer cell line SNG-S. Hybridomas were constructed between spleen cells from KM mice and mouse myeloma cells. Reactivity of the antibody was evaluated by immunohistochemistry of pathological specimens of gynecological cancers. Cytotoxicity of HMMC-1 against SNG-S cells was tested by in vitro cytotoxicity assays. The epitope of HMMC-1 was determined by transfection with a panel of glycosyltransferase cDNAs and by inhibition assays with chemically synthesized oligosaccharides. RESULTS: HMMC-1 is a human IgM monoclonal antibody that reacts positively with mullerian duct-related carcinomas with positive rates of 54.6% against uterine endometrial adenocarcinoma, 76.9% against uterine cervical adenocarcinoma, and 75.0% against epithelial ovarian cancer. HMMC-1 does not react with normal endometrium at proliferative or secretory phases, normal uterine cervix, or normal and malignant tissue from other organs, whereas it reacts weakly with the epithelium of the gall bladder and the collecting duct of the kidney. HMMC-1 exhibits antigen-dependent and complement-mediated cytotoxicity. Upon cotransfection with cDNAs encoding two glycosyltransferases required for fucosylated extended core 1 O-glycan, mammalian cells express HMMC-1 antigen. Finally, binding of HMMC-1 to SNG-S cells is inhibited by synthetic Fucalpha1-->2Galbeta1-->4GlcNAcbeta1-->3Galbeta1-->3GalNAcalpha1-octyl. CONCLUSIONS: These results indicate that HMMC-1 specifically recognizes a novel O-glycan structure. The unique specificity and cytotoxicity of HMMC-1 strongly suggest a therapeutic potential of this antibody.     

Immunohistochemical Analysis of Distribution of RON Receptor Tyrosine Kinase in Human Digestive Organs

The immunohistochemical distribution of RON receptor tyrosine kinase in digestive organs of both human fetus and adult, including the esophagus, stomach, duodenum, small intestine, colon, rectum, liver, gallbladder, pancreas, and spleen, was investigated semiquantitively using an affinity-purified rabbit polyclonal antibody. RON was observed to be widely distributed throughout various digestive organs and cell types in humans. The immunoreactivity for RON was observed in the epithelium of the esophagus, small intestine, colon, hepatocytes, Kupffer cells, and splenic macrophages both in the adult and the fetus, suggesting that the MSP/RON signaling pathway possesses the proper biological properties to possibly be involved in morphogenesis or differentiation of cells in these organs and cell types. Several organs differed in immunoreactivity between adult and fetus. No immunoreactive cells were found in the pancreas of adults; however, immunoreactivity was observed in acinar cells and in some of the duct or ductular cells and endocrine cells of the islet of the fetus. Similarly, immunoreactivity was not observed in gastric mucosa except in the intestinal metaplastic cells in adults; however, immunoreactivity was found in the foveolar epithelium of the stomach of the fetus. Although the biological significance of RON in malignancy is unclear, the presence of RON immunoreactivity in the fetus and it lack in the adult may indicate that RON is a oncofetal substance in human pancreas and stomach.