Cervical Lymph Node Dissection for Clinically Submucosal Carcinoma of the Thoracic Esophagus

Background

The purposes of this study were to clarify the risk factors for supraclavicular lymph node (SCLN) metastasis and the survival benefit from cervical lymph node (LN) dissections in patients with clinically submucosal (cT1b) carcinoma of the thoracic esophagus.

Methods

A total of 86 patients with this disease who underwent esophagectomy with 3-field lymph node dissection were retrospectively reviewed. Multivariate logistic regression and Cox proportional hazard model were used to identify the independent risk factors for SCLN metastasis and prognostic factors, respectively. An index calculated by multiplying the frequency of metastasis at nodal basin and the 5-year overall survival rate of patients with metastasis at that basin were used to assess the therapeutic outcomes.

Results

A total of 40 patients (47 %) were found to have pathological LN metastasis. Also, 13 patients (15 %) had cervical LN metastasis: 6 and 7 with carcinoma of the upper and mid-thoracic esophagus, respectively. SCLN metastasis was found in 6 patients (7 %); however, there was no independent risk factor for SCLN metastasis. The 5-year overall survival rate was 72.5 %. Cervical LN metastasis was an independent prognostic factor (p = .04; odds ratio 2.55; 95 % confidence interval 1.03–6.31); however, there was no significant difference in survival between patients with SCLN metastasis and those without (p = .06). The calculated index of estimated benefit from cervical LN dissections was 6.9, following upper mediastinal LN of 15.6 and perigastric LN of 8.3.

Conclusions

We could not identify risk factors to predict SCLN metastasis. Cervical LN dissection should not be omitted in patients with cT1b carcinoma, especially of the upper and mid-thoracic esophagus.     

Effect of the Volume of Fluid Ingested on Urine Concentrating Ability During Prolonged Heavy Exercise in a Hot Environment

This study examined the effect of the volume of fluid ingested on urine concentrating ability during prolonged heavy exercise in a hot environment at low levels of dehydration. Seven healthy males performed 105 min of intermittent cycle exercise at 70% maximum oxygen uptake (32°C, 60% relative humidity) while receiving no fluid ingestion (NF), voluntary fluid ingestion (VF), partial fluid ingestion equivalent to one-half of body mass loss (PF), and full fluid ingestion equivalent to body mass loss (FF). Fluid (5°C, 3.4% carbohydrate, 10.5 mmol·L^-1 sodium) was ingested just before commencing exercise and at 15, 33, 51, 69, and 87 min of exercise, and the total amount of fluid ingested in PF and FF was divided into six equal volumes. During exercise, body mass loss was 2.2 ± 0.2, 1.1 ± 0.5, 1.1 ± 0.2, and 0.1 ± 0.2% in NF, VF, PF, and FF, respectively, whereas total sweat loss was about 2% of body mass in each trial. Subjects in VF ingested 719 ± 240 ml of fluid during exercise; the volume of fluid ingested was 1.1 ± 0.4% of body mass. Creatinine clearance was significantly higher and free water clearance was significantly lower in FF than in NF during exercise. Urine flow rate during exercise decreased significantly in NF. There were significant decreases in creatinine and osmolar clearance and was a significant increase in free water clearance during exercise in NF and VF. Creatinine clearance decreased significantly and free water clearance increased significantly during exercise in PF. There was no statistical change in urinary indices of renal function during exercise in FF. The findings suggest that full fluid ingestion equivalent to body mass loss has attenuated the decline in urine concentrating ability during prolonged heavy exercise in a hot environment at low levels of dehydration.

Key points

• During prolonged heavy exercise in a hot environment at low levels of dehydration, fluid ingestion equivalent to body mass loss results in no changes in urinary indices of renal function.
• Fluid ingestion equivalent to body mass loss can attenuate the decline in urine concentrating ability during exercise.
• Ad libitum or voluntary fluid ingestion is ineffective in reducing the decline in urine concentrating ability during exercise.

Key words: Body fluid, dehydration, heat stress, rehydration, renal function     

Maxillary sensory nerve responses induced by different types of dentures

PurposeThe purpose of this study was to investigate whether different types of dentures induced different responses to stimulations in sensory nerve underlying the denture-supporting mucosa using current perception threshold (CPT).Materials and methodsThe study population comprised 45 complete denture wearers with a mean age of 69.7 years (CD), 30 partial denture wearers (PD) with a mean age of 67.1 years, and 40 dentulous participants with a mean age of 69.0 years (Dent). Current perception threshold (CPT) on the greater palatine nerve at 2000 Hz, 250 Hz, and 5 Hz, corresponding to A-beta, A-delta, and C fibers respectively, were measured by the Neurometer^® NS3000 device. The differences CPTs among CD, PD, and Dent groups were analyzed by Kruskal–Wallis test and Mann–Whitney U test with adjusting the multiple comparisons’ inflation of type 1 error rate by a Bonferroni correction.ResultsCPTs of CD, PD, and Dent group at 2000 Hz were 61.5 ± 45.8, 53.5 ± 25.3, 33.0 ± 11.4 (10^?2 mA) respectively. CPTs of CD, PD, and Dent group at 250 Hz were 29.2 ± 28.2, 20.1 ± 13.2, 14.3 ± 5.9 (10^?2 mA) respectively. CPTs of CD, PD, and Dent group at 5 Hz were 28.9 ± 23.4, 17.8 ± 12.2, 12.2 ± 5.6 (10^?2 mA) respectively. The CPTs at all frequencies increased in the following order: Dent < PD < CD wearer. The statistical analyses showed that the different types of dentures significantly affected CPTs at 2000 Hz (p < 0.0001), 250 Hz (p < 0.0001), and 5 Hz (p < 0.0001).ConclusionThe different types of dentures induce different responses to stimulations in the sensory nerve underlying the denture-supporting mucosa.     

Genetic analysis of ring finger protein 213 (RNF213) c.14576G>A polymorphism in patients with vertebral artery dissection: a comparative study with moyamoya disease

ABSTRACT

Background: Intracranial vertebral artery dissection (VAD) and moyamoya disease (MMD) are rare cerebrovascular diseases, both of which have an ethnic predominance in the East Asian population. Disruption of the internal elastic lamina and subsequent rupture of the medial layer result in intracranial VAD. MMD is a chronic occlusive cerebrovascular disease of unknown etiology, in which the medial layer and internal elastic lamina of the intracranial arteries are significantly compromised. Recent genetic studies found ring finger protein 213 (RNF213) to be an important susceptibility gene for MMD in East Asian patients, but the association between VAD and RNF213 has not been investigated. .

Methods: We investigated polymorphism of the RNF213 gene (c.14576G>A) in genomic DNA of 24 patients with intracranial VAD in comparison with 58 patients with definitive MMD and 48 healthy controls.

Results: Although RNF213 gene polymorphism (c.14576G>A) was evident in 69% of the MMD patients (40/58), none of the patients with intracranial VAD had this characteristic polymorphism (0/24, p < 0.001). The incidence of RNF213 c.14576G>A polymorphism was 4.2% in healthy controls (2/48). After adjustment by age and sex, the incidence of RNF213 c.14576G>A was significantly lower in intracranial VAD patients (p = 0.021) than that in MMD patients.

Conclusions: In contrast to MMD patients, the prevalence of RNF213 c.14576G>A polymorphism was significantly lower in patients with intracranial VAD. The RNF213 gene polymorphism may preferentially affect the cerebrovascular lesion in the anterior circulation, which is originated from the primitive internal carotid arteries. The genetic background underlying intracranial VAD should be elucidated in future studies.

Abbreviations: VAD: vertebral artery dissection; MMD: moyamoya disease; RNF213: ring finger protein 213; CAD: carotid artery dissection     

Importance of independent evaluation of initial anatomic results after endovascular coiling for ruptured cerebral aneurysms

Initial incomplete occlusion is been an important predictor of aneurysm recurrence, rebleeding or retreatment after endovascular coiling. In 129 patients in the Prospective Registry of Subarachnoid Aneurysms Treatment (PRESAT) cohort, ruptured aneurysms were coiled within 14 days of onset, and initial post-coiling and 1-year follow-up aneurysm-occlusion status were evaluated by both local investigators and independent reviewers. The aim of this study was to investigate whether self-reported evaluations of initial aneurysm occlusion by treating physicians predicted incomplete aneurysm occlusion at 1 year after coiling for ruptured cerebral aneurysms as well as that done by independent evaluations. The relationships between self-reported or independent evaluations of initial anatomic results and 1-year incomplete aneurysm occlusion (retreatment within 1 year, or residual aneurysms at 1 year) were determined. Both initial and 1-year aneurysm-occlusion status were judged significantly worse by independent reviewers than by local investigators (p < 0.001). One-year incomplete aneurysm occlusion was identified in 59 patients: 10 patients, including two patients with re-ruptured aneurysms, were retreated and 49 other patients were judged to have residual aneurysms by independent reviewers. On immediate post-coiling angiograms, both residual neck or aneurysm judged by local investigators, and residual aneurysm judged by independent reviewers, were predictive for 1-year incomplete aneurysm occlusion on univariate analyses. However, multivariate analyses found that the initial aneurysm occlusion status judged by independent reviewers (p = 0.02, odds ratio = 2.83, 95% confidence interval = 1.15–6.95), but not by local investigators, was a significant predictor for 1-year incomplete aneurysm occlusion. This study demonstrates the importance of independent evaluations of aneurysm occlusion status for management of coiled aneurysms.     

Can an enhanced thin-slice computed tomography delineate the right adrenal vein and improve the success rate?

Purpose

To evaluate the usefulness of enhanced thin-slice computed tomography (TSCT) for delineating the right adrenal vein (RAV) anatomy before adrenal vein sampling (AVS).

Materials and methods

A total of 151 consecutive AVSs with CT during angiography (interventional CT) were included. Of them, TSCT was performed before AVS for 72 patients. Successful RAV cannulation was confirmed using cortisol measurement. The RAV on TSCT was classified as certain, probable, or unidentified, and cases with certain or probable RAV identification were classified as useful. In the cases where AVS was successful, the anatomical features of the presumed RAV from the useful TSCT, including the position along the inferior vena cava, vertebral level, and distance from the upper pole of the right kidney, were compared with the RAV features identified on interventional CT. Estimated successful cannulation rates before interventional CT were compared between patients with and without useful TSCT.

Results

In total, 66 TSCTs were classified as useful. The anatomical features identified on TSCT were significantly correlated with those on interventional CT. The estimated successful cannulation rates for cases with and without useful TSCT were 92.4 and 82.4 %, respectively.

Conclusions

TSCT clearly shows the anatomical features of the RAV, facilitating accurate sampling and increasing the success rate.