Triple isotope scintiphotography for differentiating between renal cysts and renal tumors

As a routine diagnostic approach to patients who present hematuria or abnormal findings in X-ray films such as intravenous pyelograms, the cases are submitted to serial scintiphotography every two minutes after the intravenous administration of 250 Ci of¹³¹I-Hippuran and to renography with PHO/GAMMA Scintillation Camera (Nuclear-Chicago).When scintiphotography with¹³¹I-Hippuran reveals filling defect in the kidney region, scintiphotography with 150 Ci of²⁰³Hg-chlormerodrin and renal blood flow scintiphotography after antecubital intravenous injection of 10 mCi of^99mTc are carried out. The present report concerns 8 cases of renal tumor and 5 cases of renal cyst confirmed by X-ray examinations and surgical operation.The scintiphotography revealed decreased uptake of¹³¹I-Hippuran and²⁰³Hg-chlormerodrin in both tumor and cyst sites, exhibiting round or band-shaped filling defects. On the other hand, renal blood flow scintiphotography with^99mTc demonstrated the cyst as a filling defect but failed to visualize most of tumors. Accordingly, these techniques are available for differential diagnosis of the two lesions.     

Unusual duplication of renal collecting system mimicking supernumerary kidney--a case report

Unusual mode of renal duplication may be confused with supernumerary kidney. The presented adult female complaining left flank pain had bilateral duplication of collecting system with ectopic opening in one of the left-sided ureter. Since the ureteral opening to the bladder neck resulted in giant hydronephrosis in the upper half segment responsible for her complaint, surgical resection was performed. The duplication of the left renal mass and collecting system was regarded as "unusual" in several points. First, the lower half segment of the left kidney looked a normal complete kidney, because it had upper, middle and lower calices. Second, the lower half segment was located rather superior to the upper one. Third, the parenchyma of the upper segment which was a rudimentary small mass of several grams was separated from the lower one. But the left renal artery was single, which supplied blood to not only the lower segment but also the upper one, and the two segments were connected tightly each other by loose areolar tissue. These facts prevented to categorize this case as supernumerary kidney. This case suggests that there may be many transitional cases between fused kidney and supernumerary kidney.     

Evolution of criteria for determination of brain death in Japan

Summary In 1974, the Japanese EEG Society's Ad Hoc Committee on Brain Death published criteria for determining brain death only in cases of acute gross primary brain lesions. In 1983, a new brain death study group was organized to re-evaluate these criteria. During a 6-month period from March 1, 1984, 217 neurosurgical and neurological clinics and emergency services throughout Japan reported 718 brain deaths caused not only by primary lesions but also by secondary brain lesions and diagnosed as such on the basis of the 1974 criteria excluding the condition of abrupt fall of blood pressure followed by persistent hypotension. The data derived from the 718 cases in this collaborative study were pooled and analyzed, and it became known that the 1974 criteria still are generally reliable. Some changes have been made, however, and new criteria for determination of brain death adopted.     

Pulmonary Tumor Thrombotic Microangiopathy Due to Gastric Cancer Diagnosed Antemortem by a Cytological Examination of Aspirated Pulmonary Artery Blood

A 66-year-old Japanese man receiving systemic chemotherapy for advanced gastric cancer presented with exertional dyspnea. D-dimer was elevated in the blood. Echocardiography revealed pulmonary hypertension, and a ventilation-perfusion scan indicated decreased perfusion in the bilateral lungs. Cardiac catheterization showed no evidence of pulmonary artery embolization and revealed cytologically confirmed adenocarcinoma. Thus, pulmonary tumor thrombotic microangiopathy (PTTM) was diagnosed. The patient died of respiratory failure on the 17th hospitalization day despite systemic chemotherapy. Retrospective serological testing revealed increased vascular endothelial growth factor in the pulmonary artery blood. This is a rare case with antemortem cytologically proven PTTM mediated by VEGF.     

Increased Akt and phosphorylated Akt expression are associated with malignant biological features of prostate cancer in Japanese men

OBJECTIVE: To investigate the relationship between the expression of Akt (a serine/threonine kinase that plays a central role in tumorigenesis), phosphorylated Akt (p-Akt), prostate cancer tumour grade, androgen receptor (AR)-staining score, and Ki67 labelling index (LI) in Japanese men. PATIENTS, MATERIALS AND METHODS: The expression and activation of the cell survival protein Akt was analysed by immunohistochemical staining of paraffin-embedded tissue microarray sections of prostate carcinoma taken from 52 Japanese men who under radical prostatectomy. The correlation between the expression of Akt and p-Akt, and their relationship to primary Gleason grade, AR expression and Ki-67 LI was investigated. RESULTS: The expression of Akt and p-Akt were positively related to primary Gleason grade (Fisher's exact test, P = 0.002 and P = 0.032, respectively). Both AR-staining score and Ki67 LI were were positively related to the expression of Akt (both P < 0.001) and p-Akt (P < 0.001 and P = 0.008, respectively). There was a significant positive correlation between the expression of Akt and p-Akt (Spearman's correlation, r = 0.644, P < 0.001). CONCLUSIONS: Increased expression of both Akt and p-Akt were associated with higher tumour grade as well as a higher AR-staining score and Ki67 LI. These data indicate that Akt and p-Akt might be molecular markers for detecting malignant biological features of prostate cancer in the Japanese population.     

Impact of different methods of estimating renal function on determining eligibility for cisplatin (CDDP)-based chemotherapy in patients with invasive urothelial carcinoma

Assessment of renal function is important to determine the appropriate dose for cisplatin (CDDP)-based chemotherapy. Many previous CDDP-based chemotherapy trials for bladder cancer have required a creatinine-clearance (Ccr) ≧60 ml/min for entry. However, there is little evidence on renal function assessed by estimated glomerular filtration rate (eGFR) using the 4-variable Modification of Diet in Renal Disease Study Equation (MDRD), which has recently been introduced, to determine the eligibility for CDDP-based chemotherapy. To evaluate the proportion of patients with invasive urothelial carcinoma(UC) who would be ineligible ("unfit") to receive CDDP-based chemotherapy based on eGFR criteria (eGFR ＜60 ml/min/1.73 m2), and to determine the side effects of chemotherapy in these "unfit" patients, we conducted a retrospective clinical study. Our study population consisted of 61 consecutive patients who underwent 100% dose CDDP-based chemotherapy for invasive UC with 24 h-Ccr≧50 ml/min between June 2001 and July 2009. We assessed renal function using 3 equations (eGFR, Ccr according to Cockcroft-Gault formula (C-G Ccr), and Ccr examined by 24-hour urine collection (24 h-Ccr)) as well. Mean values of eGFR, C-G Ccr, and 24 h-Ccr were 58.6, 68.9, and 82.8 ml/min, respectively (P＜ 0.001). In total, 29/61(48%) patients were ineligible ("unfit") to receive chemotherapy based on eGFR criteria. However, there was no difference in the frequency of side effects between eGFR ≧60 ml/min/ 1.73 m2 and eGFR ＜60 ml/min/1.73 m2 groups. Our observations suggest that 24 h-Ccr≧50 ml/min would be a reasonable cutoff for CDDP-based chemotherapy even when eGFR ＜60 ml/min/1.73 m2.     

Implication of Extracapsular Invasion of Sentinel Lymph Nodes in Breast Cancer: Prediction of Nonsentinel Lymph Node Metastasis

Background  

Accurate intraoperative diagnosis of sentinel lymph node (SLN) metastases enables the selection of patients who require axillary lymph node dissection (ALND). However, many patients with positive SLN do not show metastasis to other axillary lymph nodes. In this study, we investigated the factors that may determine the likelihood of additional positive nodes in the axilla when metastasis is found in the SLN.     

Three‐dimensional ultrastructural analysis of development at the supraspinatus insertion by using focused ion beam/scanning electron microscope tomography in rats

To obtain a successful outcome after rotator cuff repair, the repaired tendon must be biologically anchored to the bone. However, the histological structure at the repaired tendon‐bone interface differs from that of the site of normal tendon insertion. Therefore, analyzing postnatal development in detail will contribute to understanding the repaired tendon‐bone interface after rotator cuff repair. In this study, we analyzed postnatal development at the tendon‐bone insertion in terms of temporal changes in SOX9/SCX expression and three‐dimensional (3D) ultrastructure with FIB/SEM tomography, a new scanning electron microscopic method. Sixteen postnatal Sprague–Dawley rats were used for the study. One‐, two‐, three‐, and four‐week‐old rats were sacrificed and both right and left shoulders were removed; eight normal supraspinatus tendon insertions were isolated for each time point. At each time point, four specimens were evaluated with fluorescent immunostaining for SOX9/SCX expression, and the remaining four specimens were evaluated with FIB/SEM tomography. Even in postnatal development, SOX9⁺/SCX⁺ expression was observed at the tendon insertion; expression gradually decreased with postnatal development at the normal tendon insertion. In 3D ultrastructure, the morphology of the cells and the number/orientation of the cell processes drastically changed by postnatal week 4. The pattern of SOX9/SCX expression and 3D ultrastructural changes obtained in this study contribute to an understanding of the complicated development of normal tendon‐bone insertion. Therefore, this study helps elucidate the pathophysiology of tendon‐bone insertion, especially in cases of rotator cuff tear and repair. © 2015 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 34:969–976, 2016.