Survivin expression and its correlation with cell proliferation and prognosis in epithelial ovarian tumors

Survivin is a new member of the inhibitors of apoptosis proteins (IAP) family, selectively overexpressed in common human cancers but not in normal adult tissues, and associated with aggressiveness of the disease and unfavorable outcomes. Recent study also found that survivin expression is associated with cell proliferation. In order to gain insight into the role of survivin in ovarian tumors, we investigated the expression of survivin in a group of epithelial ovarian tumors, and examined the relationship of its expression with cell proliferation and clinical outcome. Immunohistochemical analysis was performed in 103 cases of epithelial ovarian tumors. Twenty-six of the 103 cases were evaluated by Western blot analysis. The results showed that survivin overexpression was detected in 21.2% (7 of 33) of benign tumors, 47.8% (11 of 23) of borderline tumors, and 51.1% (24 of 47) of ovarian carcinomas. The positive ratio was significantly higher in malignant or borderline tumors than in benign tumors, and the overexpression of survivin was significantly correlated with the size of residual disease. A positive correlation between survivin expression and proliferative activity of tumor cell measured by PCNA index was found. Kaplan-Meier analysis demonstrated that the patients with survivin overexpression have a short overall survival. These findings suggest that survivin overexpression may play a pivotal role in the progression of ovarian tumors and may provide an important prognostic implication for epithelial ovarian carcinomas.     

Role of endothelium in hyperemia during cortical spreading depression (CSD) in the rat

The purpose of this study was to examine whether endothelium-mediated dilation is responsible for the cortical hyperemia that occurs during cortical spreading depression (CSD) in rats using three different approaches. The first approach taken was the acute pharmacological inhibition of the predominant endothelium-centered dilator systems, using indomethacin, a cyclooxygenase inhibitor, Nomega-nitro-L-arginine methyl ester (L-NAME), a nitric oxide synthase (NOS) inhibitor, and miconazole, a cytochrome P-450 epoxygenase inhibitor. The second approach used was the acute general pharmacological impairment of endothelial function by the intravascular administration of phorbol 12, 13-dibutyrate (PDBu). The third approach taken was the chronic impairment of endothelium-dependent dilator responses by diet in insulin resistant (IR) rats. Cerebral blood flow (CBF) was measured using laser Doppler flowmetry. CSD was elicited by the topical application of potassium chloride. Pharmacological inhibition of endothelium-dependent dilator factors did not affect CSD. For example, with 20 mg/kg L-NAME, CBF peak of the first series of CSDs was 377 +/- 67% of baseline CBF. After drug administration, CBF peaks of the second and the third series of CSDs were 451 +/- 67% and 390 +/- 69% (n=5, P=n.s.), respectively. Control and IR animals and those treated with indomethacin, miconazole and PDBu showed similar results. We also calculated the area under the CBF curve to fully represent the extent of hyperemia during CSD. However, there were no significant differences in the CBF area with any treatment compared to control animals. Thus, our results provide strong evidence that endothelium-mediated mechanisms have minimal effects on the CSD-associated hyperemia.     

Cirrhosis: modified caudate-right lobe ratio

PURPOSE: To determine whether a modified caudate-right lobe ratio (C/RL) with use of the right portal vein to set the lateral boundary (C/RL-r) is more accurate for diagnosing cirrhosis and evaluating its clinical severity than is the previously described C/RL with use of the main portal vein to set the lateral boundary (C/RL-m). MATERIALS AND METHODS: Two hundred thirty-six patients (121 with pathologically proved cirrhosis and 115 without history of chronic hepatic diseases) underwent magnetic resonance (MR) imaging. Two independent observers measured C/RL-r and compared it with C/RL-m. Results were compared by using receiver operating characteristic (ROC) curves and accuracy measures at various thresholds. RESULTS: The area below the ROC curve was greater for C/RL-r (0.797) than for C/RL-m (0.731; P =.040). By using a C/RL-r greater than 0.90, the sensitivity, specificity, and accuracy for the MR imaging diagnosis of cirrhosis were 71.7%, 77.4%, and 74.2%, respectively. The highest accuracy of the C/RL-m was 65.7%, when the C/RL-m was greater than 0.55. Interobserver agreement was statistically confirmed for both measurements by using kappa analysis. Significant differences were found among the three Child-Pugh classes by using C/RL-r (P =.0105) but not by using C/RL-m. CONCLUSION: C/RL-r is more accurate for diagnosing cirrhosis and evaluating its clinical severity than is C/RL-m.     

Lateral radiography of the knee with single-leg standing

The purpose of this investigation was to accomplish reproducible radiography of single-leg standing lateral radiography of the knee by adjusting lateral rotation using a ruler to measure foot position. After preliminary assessment of three-dimensional CT of the knees of normal volunteers, the best adjustment of external rotation was estimated. A ruler was made for use in adjusting the angle of knee rotation by measuring foot rotation. Based on the foot rotation measured by this ruler, the positioning of radiography was adjusted to correct rotation. Rotation was estimated by the distance between the posterior edges of the lateral and medial femoral condyles. Fifteen-degree and 17.5-degree rotations were used for correction. Correction of rotation was 17 degrees on average. This helped not only to correct external rotation in the initial radiography but also to correct rotation for repeat radiography. Our method is quantitative and highly reproducible, and it increases the success rate of lateral knee radiography.     

Key factors influencing bowel function after ileal W-pouch anal anastomosis: A spectral analysis of W-pouch motor activity

Restorative proctocolectomy with ileal pouch anal anastomosis (IPAA) has become the standard surgical procedure for ulcerative colitis (UC). The purpose of this study was to determine which factors are important to achieve good anal continence after IPAA in terms of the motor activity and pressure–volume relationship. A total of 17 patients with UC who underwent IPAA were evaluated. The internal ileal pouch pressure was transanally measured with and without volume-loading of the pouch which induces the urge to evacuate. The maximum tolerable volume (MTV), first urge volume (FUV), and ileal pouch compliance were calculated and the internal ileal pouch pressure records were subjected to spectral analysis for intensive evaluation of the intraluminal pressure waves. The FUV, correlation of the compliance of the FUV with MTV, and the remaining volume up to the MTV (RVMTV) were analyzed. Compliance of the FUV was significantly correlated with the RVMTV (r = 0.736, P < 0.01). The frequency of the phasic waves in the pouch decreased with length of follow up, reflecting improved function (r = −0.588, P < 0.05). The findings of this intensive analysis of manometric measurement indicate that the key factors in postoperative pouch function are RVMTV and the frequency of phasic waves in the W-pouch. Received: May 6, 1999 / Accepted: May 30, 2000     

Nonoperative Treatment of Reperforated Duodenal Ulcer: Report of Three Cases

During the period between 1983 and 1998, a total of 58 patients were admitted to the surgical department of Akita Red Cross Hospital with acute duodenal perforation. Of these 58 patients, 16 were treated operatively and 42 were treated nonoperatively. Among the 38 men and 4 women who received nonoperative treatment, 3 developed reperforation. The incidence of reperforation was 7.1% and the mean average interval from the initial treatment until reperforation was 3.5 years. Endoscopic biopsy and/or serum anti-H. pylori IgG measurement revealed Helicobacter pylori infection in all three patients. No serious complications developed during the nonoperative treatment of reperforation in these three patients, and their recovery was uneventful. The hospital stay ranged from 10 to 18 days, with a mean stay of 12 days after the first perforation and from 14 to 18 days, with a mean stay of 15.6 days after the reperforation. Nonoperative treatment proved successful as a life-saving procedure for reperforation of a duodenal ulcer in all three patients. Received: September 7, 1999 / Accepted: May 30, 2000     

Thoracic Esophagectomy Combined with Pylorus-Preserving Pancreatoduodenectomy in a One-Stage Procedure: Report of a Case

(Received for publication on Oct. 12, 1998; accepted on July 13, 1999)     

Composite Tumor with Papillary Adenocarcinoma and Squamous Cell Carcinoma of the Esophagus: Report of a Case

(Received for publication on Mar. 2, 1999; accepted on Nov. 11, 1999)     

A Case of Tardive Tourette-Like Syndrome

Abstract: We have had experience in treating tardive Tourette-like syndrome on a chronic schizophrenic patient. The patient was a 38-year-old woman. A diagnosis of schizophrenia was made in 1971 and she received repeated medications for 17 years. In 1989, she began to show vocal tic with coprolalia and motor tic. The medications were haloperidol 18 mg, zotepine 200 mg, levomepromseine 100 mg, biperiden 3 mg and nitrazepam 10 mg at the beginning of Tourette-like syndrome. We have tried to change the medications but this tardive Tourette-like syndrome continued to hang on. However, the symptoms gradually improved after a change in drugs; cessation of biperiden 3 mg and the administration of clonazepam 3 mg. The present case suggested that tardive Tourette-like syndrome might be a subtype of neuroleptic-associated tardive syndromes which might be treated with clonazepam.