A case of primary small intestinal cancer diagnosed by laparoscopy

The patient was a 61-year-old female who developed ileus. Physical findings showed abdominal distension but peritoneal irritation signs were not observed. After the conservative treatment by the ileus tube, encircling stenosis was observed in the jejunum at about 50 cm on the anal side from the Treitz ligament on contrast radiography of the small intestine through the ileus tube. Tumor markers were normal except for mild elevation of IL2-R (609 U/ml). After confirming sufficient bowel decompression and the absence of other lesions, surgery was performed based on a preoperative diagnosis of small intestinal tumor including adhesive ileus, GIST, or malignant lymphoma. First, under the laparoscopic observation, the lesion was resected and definitive diagnosis was established as primary moderately to poorly differentiated adenocarcinoma of the small intestine by rapid intraoperative pathological diagnosis. Then, extensive jejunal resection involving sufficient lymph node dissection was performed as open surgery. Radical surgery was successfully performed.     

Fundamental study of coronary angiography using gadolinium contrast agent

To investigate the clinical usefulness of coronary arteriography using a gadolinium contrast medium (hereinafter referred to as Gd contrast medium) in patients with iodine allergy, images obtained using an iodinated contrast medium and a Gd contrast medium were compared using respective phantoms. Within the range of the effective energy (34.8 to 41.0 keV) in clinical use, the tube-voltage dependency of the Gd contrast medium was lower than that of the iodinated contrast medium. The contrast ratios were found to be comparable for the images obtained by a 4-fold-diluted iodinated contrast medium and the undiluted Gd contrast medium. Although the assessment of stenotic ratio was difficult to obtain by visual evaluation of the clinical images, due to unclear borders of the blood vessels, the presence or absence of significant stenosis was discriminative by arteriography using the Gd contrast medium. Based on these findings, it was considered necessary to make a confirmed diagnosis using a Gd contrast medium with concurrent diagnosis by intravascular echography. In conclusion, coronary arteriography and PCI using a Gd contrast medium are considered to offer benefit to the diagnosis and treatment of patients with iodine allergy.     

Effects of synthetic omega-conotoxin on the contractile responses of segments of rat ileum, stomach fundus and uterus and guinea pig taenia coli

The effect of synthetic omega-conotoxin (omega-CgTX) on the contractile responses of segments of rat ileum, stomach fundus and uterus and guinea pig taenia coli were investigated. Omega-CgTX (10(-9)-5 x 10(-6) M) did not inhibit the contractile responses of all smooth muscle segments to high KCl and/or ACh. However, unexpectedly, omega-CgTX (3 x 10(-7)-10(-5) M) alone caused dose-dependent contraction of segments of the stomach fundus and uterus. These contractile responses to omega-CgTX alone depended upon the presence and/or the influx of extracellular Ca2+; and they were inhibited by calcium antagonists such as diltiazem, nitrendipine and verapamil, with the exception that the segments of stomach fundus was not inhibited by verapamil. With the segments of uterus, but not those of other tissues, omega-CgTX (10(-7)-5 x 10(-6) M) significantly enhanced the contractile responses to various concentrations of ACh and high KCl. With rat ileum and guinea pig taenia coli segments, omega-CgTX (10(-9)-5 x 10(-6) M) did not induce a contractile response or have an enhancing effect. These findings suggest that omega-CgTX may have a calcium agonist-like effect on smooth muscles such as the stomach fundus and uterus of rats.     

Muscle training by means of combined electrical stimulation and volitional contraction

INTRODUCTION: A variety of techniques have been used with variable success in an attempt to reverse the loss of muscle strength, bulk, and endurance that occurs during spaceflight. This study was designed to evaluate a new "hybrid" approach that uses the resistance provided by an electrically stimulated antagonist muscle to resist the volitional contraction of its agonist. METHODS: There were 20 subjects who were randomized into 3 groups that received either the new hybrid program (HYB), isotonic weight training (WT), or isometric electrical stimulation (ES). Subjects trained 3 times per week for 8 wk with each session consisting of their non-dominant upper extremity performing 10 sets of 10 reciprocal 2-s elbow flexion and extension contractions separated by 1-min rest intervals. Elbow flexion\extension torques and biceps\triceps cross-sectional areas (CSA) were measured at the beginning, midpoint, and end of training as well as at follow-up 4 wk later. RESULTS: The HYB group demonstrated statistically significant increases in elbow flexion and extension torques (56% and 31%, respectively) at the end of training that were similar to or larger than the gains in the other groups with benefits that persisted at follow-up 4 wk later. Muscle CSA increases in the HYB group (10%) were comparable or larger than those in WT and ES subjects. CONCLUSIONS: These results suggest that HYB training may be an effective way to maintain and increase muscle bulk and strength for patients during bed rest, as well as astronauts in space.     

Blood flow analysis of the head and lower limbs by the laser Doppler blood flowmeter during LDL apheresis

The presence of peripheral arterial disease substantially increases the risk for both morbidity and mortality among end-stage renal disease patients. Low-density lipoprotein (LDL) apheresis has been also applied for the treatment of peripheral arterial disease to reduce LDL levels, resulting in the improvement of the blood flow to the ischemic limbs. In this study, we investigated the continuous changes of the tissue blood flows in the lower limbs and head during LDL-apheresis treatment by a non-invasive method (the non-invasive continuous monitoring method (NICOMM) system). In this study, the tissue blood flow in both the head and lower limbs showed a significantly enhancement from before to after treatment. The tissue blood flow in the lower limbs showed a significantly larger improvement than that in the head. The short-term effects of LDL apheresis were confirmed by using the NICOMM system; thus, this system will be useful for the determination of the appropriate schedule of LDL apheresis for long-term effectiveness.     

An evaluation of lymphovascular invasion in relation to biology and prognosis according to subtypes in invasive breast cancer

Lymphovascular invasion (LVI) is associated with a poor outcome in breast cancer. The purpose of the present study was to evaluate the clinical significance of LVI in primary breast cancer and to investigate disease-free survival as a prognostic marker according to the breast cancer subtypes. This study examined 4,652 consecutive cases of invasive breast cancer excluding the patients with non-invasive cancer, stage IV and those who underwent neo-adjuvant therapy from February 2002 to February 2021. The clinicopathological characteristics and prognosis of LVI-positive and -negative tumors were compared. LVI was evaluated in H&E staining specimens from surgically resected samples. The LVI expression rates were 29.2% (low, 19.7%; high, 9.5%) in all primary cases. The LVI-positive rate was significantly associated with specimens with the following characteristics: ER/PgR-negative, HER2-positive, p53 overexpression, higher Ki-67 index values, higher nuclear grade, positive nodes and larger tumors. Moreover, the subtypes were significantly associated with LVI positivity; 20% in Luminal A, 34.6% in Luminal B, 40.9% in Lumina/HER2, 38.1% in HER2-enriched and 29.8% in triple negative (TN). There were significant differences in disease-free survival between LVI status in Luminal A, Luminal B and TN subtypes, but there was no difference in the Luminal/HER2 and HER2-enriched subtypes. A multivariate analysis revealed that LVI was a significant factor in Luminal B and TN subtypes. Overall, LVI was significantly associated with the advanced and aggressive characteristics in breast cancer. Luminal A type had a lower LVI rate, and HER2 type had a higher LVI rate. Moreover, LVI was a significant prognostic factor in Luminal B and TN subtypes. These data suggested that the LVI status was useful in predicting the prognosis in HER2 negative breast cancer cases.