A case report of the laryngeal edema and peripheral cyanosis after extubation of the tracheal tube

A 65-year-old male in malnutrition due to advanced colon cancer underwent resection of transverse colon tumor and the invaded abdominal muscles with necrosis and abscess. After epidural catheter insertion between Th 10-11 for 9 cm cephalad, anesthesia was induced with thiopental 200 mg and fentanyl 50 micrograms. Tracheal intubation was done with vecuronium 5 mg, and anesthesia was maintained with sevoflurane with nitrous oxide in oxygen and epidural block. During surgery, systolic blood pressure often went up to 130 to 140 mmHg and down to 50 to 60 mmHg. Dopamine 3-5 micrograms.kg-1.min-1 was administered but occasional ephedrine bolus injection was still necessary. The intestine, including the intact part, was edematous. After the surgery, when systolic blood pressure was stable at about 130 mmHg and his consciousness was clear with regular spontaneous respiration, the tracheal tube was removed. However, soon after the extubation, expiratory stridor and cyanosis of the bilateral hands and feet were observed. Hydrocortisone 200 mg and nicardipine 0.5 mg were administered and room temperature was raised. About 30 minutes later, stridor and cyanosis subsided. In the ward after surgery, only hoarseness was observed. The stridor might have been due to the laryngeal edema, which could be attributed to stimulation by tracheal tube in the patient with malnutrition. The hemodynamic instability during surgery and cyanosis after extubation might have come from changes of the vascular resistance by sepsis.     

A case of post-radiation therapy patient with difficulty in intubation unexpected preoperatively

We experienced a post-radiation therapy patient who had a narrow trachea, and presented with unexpected difficulty for intubation. His trachea was narrowest at 2 cm below the glottis. The fiberscope barely could pass the narrowest part of the trachea. We speculate that the radiation therapy induced his tracheal constriction. Careful attention is necessary when examining the post-radiation therapy patients. Multiple cervical radiographs are necessary in such a case.     

hOGG1 Ser326Cys polymorphism and breast cancer risk among Asian women

To evaluate the potential association between breast cancer risk and Ser ³²⁶ Cys polymorphism of hOGG1 gene, encoding for an enzyme involved in the base excision repair of 8-hydroxyguanine, hospital based case-control studies were conducted in two Asian populations consisting of 475 breast cancer cases (271 Korean and 204 Japanese) and 500 controls (314 Korean and 186 Japanese). PCR-based methods were employed for the genotyping analyses and the statistical evaluations were performed by unconditional logistic regression model. The frequency of hOGG1 Ser/Ser, Ser/Cys, and Cys/Cys genotypes were 22.5, 48.7, and 28.8% in all cases, and 23.7, 52.1, and 24.1% in the controls. No statistically significant associations between the genotypes and breast cancer risk were observed, neither when the ethnic groups were examined separately nor when the total study population was included. Neither did stratification by menopausal status reveal any association between hOGG1 genotypes and breast cancer. Our novel findings therefore suggest that hOGG1 Ser ³²⁶ Cys polymorphism is unlikely to play a modifying role in individual susceptibility to breast cancer among Asian women.     

Malignant fibrous histiocytoma of the lung

Primary malignant fibrous histiocytoma (MFH) of the lung is very rare. To date, only 32 reports of 63 cases of primary MFH of the lung have appeared in English, excluding tumors arising from the pulmonary arteries and pleura. We describe a patient with primary MFH of the lung who developed brain metastasis and involvement of pulmonary great vessels. In addition, we reviewed previously reported cases to establish the clinical characteristics and most appropriate management of primary pulmonary MFH. When disease is sufficiently limited, complete resection remains the mainstay of treatment.     

Clinical evaluation using magnetic resonance imaging for patients with stage III cervical carcinoma treated by radiation alone in multicenter analysis: its usefulness and limitations in clinical practice

To evaluate the ability of magnetic resonance imaging (MRI) to predict the clinical outcome, we perform retrospective multicenter analysis of patients with stage III disease treated with radiation alone. From three institutions, 80 patients with stage III disease diagnosed with MRI were entered in the study. Seventy-eight patients received intracavitary brachytherapy with external beam radiotherapy. Univariate and multivariate analyses were performed to identify the prognostic factors for overall survival (OAS), disease-free survival (DFS), pelvic control (PC), and distant metastasis-free survival (DMFS). The 5-year OAS, DFS, PC, and DMFS rates were 59.5%, 48.7, 74.2%, and 62.5%, respectively. Bilateral pelvic fixation to the pelvis (p = 0.001) and patient age 50 years or less (p < 0.0001) were significant adverse factors for OAS. As a function of DFS, these were positive lymph nodes (p = 0.02), bilateral fixation to the pelvis (p = 0.03), and younger patient age (p < 0.0001), respectively. Patient age 50 years or less proved to be the only significantly unfavorable factor for PC (p < 0.0001). Larger size/volume (p < 0.05), positive lymph nodes (p = 0.03), bilateral pelvic disease (p = 0.02), and younger patient age (p = 0.004) were significantly adverse factors for DMFS. Using multivariate analysis, patient age 50 years or less, disease with bilateral fixation, and calculated volume more than 100 ml proved to be significantly adverse factors for OAS and DFS. In the analysis of PC, only patient age 50 years or less was a significantly adverse factor (p = 0.0014, relative risk [RR] = 14.93). Bilateral fixation to the pelvis (p = 0.0055, RR = 4.032), positive lymph nodes (p = 0.0494, RR = 2.637), and large calculated volume (>100 ml; p = 0.0057, RR = 4.831) proved to be significantly adverse factors for DMFS. For patients with stage III disease, size/volume and lymph node status derived from MRI showed a significant correlation with the development of distant metastasis, but failed to predict locoregional control. In addition, size/volume analysis showed no apparent relationship with disease-free survival. For patients with stage III disease, MRI may provide beneficial information predicting distant metastasis, but not for local control.     

Comparison of prognostic value of MRI and FIGO stage among patients with cervical carcinoma treated with radiotherapy

PURPOSE: To compare the efficacy of MRI and FIGO stage, we performed retrospective multicenter analysis of patients with Stage II-III disease treated with radiation alone. METHODS AND MATERIALS: From three institutions, 164 patients diagnosed with cervical carcinoma were entered into the study. The majority of this cohort received intracavitary brachytherapy combined with external beam radiotherapy (n = 161). Uni- and multivariate analyses were performed to identify the prognostic factors for overall survival (OAS), disease-free survival (DFS), pelvic control (PC), and distant metastasis-free survival (DMFS). RESULTS: The 5-year OAS, DFS, PC, and DMFS rates were 68.8%, 60.4%, 77.4%, and 71.7%, respectively. Using uni- and multivariate analyses, both large tumor size/volume and positive lymph node enlargement (LN) showed a significantly unfavorable influence on survival and local and/or distant failure (p < 0.05). Using these two prognostic factors, patients were divided into three subgroups; the 5-year DFS rates of patients with risk 0 (volume 50 cc or positive LN), and 2 (volume >50 cc and positive LN) were 72.9%, 53.3%, and 26.1%, respectively (p < 0.0001). Among patients with volume 0.05). CONCLUSION: MRI will provide more useful and practical information than will FIGO stage classification for patients with bulky disease, although this will remain a prognostic factor for patients with nonbulky disease (volume 相似文献   

Augmentation of the antitumor activity of capecitabine by a tumor selective dihydropyrimidine dehydrogenase inhibitor,RO0094889

Capecitabine is an orally available fluoropyrimidine and is finally converted to 5-FU selectively in tumor tissues. In our study, we examined whether the antitumor activity of capecitabine is directly affected by a modulation of dihydropyrimidine dehydrogenase (DPD). The modulations were carried out by the overexpression of DPD in tumor cells and by tumor selective DPD inhibition. The DPD-overexpressing cells were obtained by transfection of human DPD cDNA into HCT116 human colorectal cancer cells. The HCT116 cells bearing DPD cDNA expressed about 13 times higher DPD activities than the parental HCT116 cells, and they became significantly less susceptible to capecitabine than the parental cells when transplanted into nude mice. Administration of RO0094889 that is converted to a DPD inhibitor 5-vinyluracil selectively in tumor tissues restored the antitumor activity of capecitabine against the tumor of the HCT116 cells carrying DPD cDNA and various tumors expressing DPD. As compared to 5-ethynyluracil or 5-vinyluracil, which inhibited DPD not only in tumor tissues but also in other non-cancerous tissues, the effective dose range of RO0094889 in augmenting the efficacy of capecitabine was much broader. These results indicate that the antitumor activity of capecitabine is directly affected by DPD activities in tumor tissues and therefore, the combination of capecitabine and a tumor selective DPD inhibitor, RO0094889, will be beneficial to patients who have tumors with high levels of DPD.     

Application of laser capture microdissection to cytologic specimens for the detection of immunoglobulin heavy chain gene rearrangement in patients with malignant lymphoma

BACKGROUND: The demonstration of the monoclonality of immunoglobulin heavy chain (IgH) gene rearrangement is an indispensable method for the diagnosis of B-cell lymphoma as well as histocytochemical analysis. For the detection of IgH gene rearrangement, the extraction of DNA from a homogenous cell population is necessary. Recently, the laser capture microdissection (LCM) technique was shown to isolate specific cells from histopathologic specimens for molecular analysis. However, to the authors' knowledge the applicability of LCM to cytologic specimens has not yet been well established. METHODS: Using LCM, a homogenous population of B-cell lymphoma cells as both histologic sections and cytologic specimens was captured, and genomic DNA was extracted from the captured cells. IgH gene rearrangement was analyzed by the polymerase chain reaction (PCR)-based single-strand conformational polymorphism (SSCP) method. RESULTS: Genomic DNAs were extracted successfully from ethanol-fixed cytologic specimens, but cells were not captured from air-dried specimens. Using PCR-SSCP analysis, the monoclonality of the IgH gene rearrangement was detected in five cases of tissue sections among nine analyzed cases of malignant lymphoma diagnosed immunohistochemically. However, analysis of the cytologic specimens with LCM demonstrated the monoclonality of the IgH gene rearrangement in seven cases of lymphoma. CONCLUSIONS: The results of the current study suggest that the novel application of LCM to cytologic specimens occasionally exhibits high sensitivity for the detection of IgH gene rearrangement monoclonality compared with the use of histologic sections.     

Dammarane-type triterpenes from the Brazilian medicinal plant Cordia multispicata

From the Brazilian medicinal plant Carucaá (Cordia multispicata), oleanane- and ursane-type triterpenoids were previously reported as anti-androgenic constituents of the plant. In this study, purification of the polar elements of the EtOAc-soluble fraction of the plant revealed nine novel dammarane-type triterpenes, named cordianols A-I (1-9) along with the known compound cordialin A (10). The structures of these new compounds were elucidated by means of spectral methods including HRFABMS, (1)H NMR, (13)C NMR, and 2D NMR (HMQC, HMBC, NOESY). Absolute configuration at C-23 of compound 7 was determined by an excitone chirality method. Some of these new compounds revealed a hemiketal structure on the A ring and a hydroxylated or epoxidated 20(22)-(E)-ene side chain and showed weak anti-androgenic activity.