Secondary metabolites of Cinnamosma madagascariensis and their alpha-glucosidase inhibitory properties

Two new drimane-type sesquiterpenes, cinnamadin (1) and cinnamodial 11alpha,12beta-dimethyl acetal (2), together with pereniporin B (3), ugandensolide (4), polygodial (5), capsicodendrin, cinnamodial (6), sitosterol, stigmasterol, lignoceric acid, cinnamosmolide (7), D-mannitol, and delta-tocotrienol were isolated from Cinnamosma madagascariensis. The structures of the new compounds were determined by physical, chemical, and spectroscopic evidence. Compound 7 and D-mannitol were isolated in high yield (5% and 1.36%, respectively). Evaluation of the alpha-glucosidase inhibitory properties of the isolated metabolites demonstrated that compounds 1 and 4 show moderate effects, while cinnamodial (6) exhibited the most potent activity. The chemosystematics of Cinnamosma species are also discussed.     

Secondary resistance to imatinib mesylate 70 months after initiation of therapy in a patient with a metastatic gastric gastrointestinal stromal tumor

It is unknown how long the risk of developing secondary resistance to imatinib persists in patients with gastrointestinal stromal tumors (GISTs). Here we report a case of a patient with a metastatic gastric GIST who developed secondary resistance to imatinib 70 months after initiation of imatinib therapy. A 62-year-old woman with a gastric GIST underwent total gastrectomy with pancreaticosplenectomy. Immunohistochemistry revealed a KIT-positive GIST. The mitotic index of the tumor was 13/50 high-power fields, indicating a high-risk malignancy. After surgery, the patient developed a solitary liver metastasis and underwent right hepatic lobectomy. Four months later, a metastatic tumor was found at the left adrenal gland, and imatinib therapy was initiated in December 2004. Imatinib therapy led to marked tumor shrinkage and complete clinical remission in the patient. However, in October 2010, computed tomography scans revealed a peritoneal metastasis in the ileocecal area. The tumor progression was clinically determined to be due to the development of secondary resistance to imatinib, and the patient’s treatment was switched to sunitinib. This case illustrates secondary resistance to imatinib can develop even after a sustained and marked treatment response. Long-term therapy and close monitoring are recommended for the management of patients with metastatic GISTs.     

Distribution of orexin neurons in the adult rat brain

Orexin (ORX)-A and -B are recently identified neuropeptides, which are specifically localized in neurons within and around the lateral hypothalamic area (LHA) and dorsomedial hypothalamic nucleus (DMH), the regions classically implicated in feeding behavior. Here, we report a further study of the distribution of ORX-containing neurons in the adult rat brain to provide a general overview of the ORX neuronal system. Immunohistochemical study using anti-ORX antiserum showed ORX-immunoreactive (ir) neurons specifically localized within the hypothalamus, including the perifornical nucleus, LHA, DMH, and posterior hypothalamic area. ORX-ir axons and their varicose terminals showed a widespread distribution throughout the adult rat brain. ORX-ir nerve terminals were observed throughout the hypothalamus, including the arcuate nucleus and paraventricular hypothalamic nucleus, regions implicated in the regulation of feeding behavior. We also observed strong staining of ORX-ir varicose terminals in areas outside the hypothalamus, including the cerebral cortex, medial groups of the thalamus, circumventricular organs (subfornical organ and area postrema), limbic system (hippocampus, amygdala, and indusium griseum), and brain stem (locus coeruleus and raphe nuclei). These results indicate that the ORX system provides a link between the hypothalamus and other brain regions, and that ORX-containing LHA and DMH neurons play important roles in integrating the complex physiology underlying feeding behavior.     

Recent changes of the incidence of complete and partial mole in Chiba prefecture

AIMS: To study the changes of the incidence of complete mole (CM) and partial mole (PM) by 10-year age groups in Chiba Prefecture. METHODS: All women registered as CM and PMs in Chiba Prefecture during these 18 years were included in this study. The diagnosis of CM and PM was based on the macroscopic and/or microscopic findings. The annual numbers of pregnancy were obtained from the Division of Statistics in Chiba Prefecture Government. RESULTS: The incidence of CM at the upper and lower extremes of maternal age is higher than that of PM. The incidence of CM has decreased constantly at all maternal ages and significantly decreased in women of middle reproductive age (20-39 years old) since 1991, while that of PM has stayed constant during these 18 years. CONCLUSIONS: The incidence of CM and PM in Chiba Prefecture has become as low as that in Europe or the USA. These recent changes suggest that Japanese women may have lost the increased risk to ovulate a nuclear or inactive oocytes, or the differential diagnosis between CM and PM may be obscured with the macroscopic and/or microscopic findings.     

A two-step laparoscopy-assisted curative resection for a patient with obstructive colitis accompanied by advanced sigmoid colon carcinoma: Report of a case

This report presents the case of a two-step laparoscopic resection and reconstruction for obstructive colitis accompanied by advanced sigmoid colon cancer. An 81-year-old woman was admitted with a diagnosis of ileus. Computed tomography revealed a circumferential tumor in the sigmoid colon and a diffuse dilated large intestine on the oral side of the tumor. On the 7th day after admission, her temperature was 38.8°C, she had increased white blood cell count (24 610 cells/mm(3)), and suffered persistent severe abdominal pain. An emergency laparoscopy-assisted Hartmann procedure was performed, based on a tentative diagnosis of obstructive colitis due to sigmoid colon cancer. The descending colon and residual rectum were anastomosed laparoscopically by double-stapling technique 6 months after the initial surgery. Her postoperative course was uneventful for both procedures and she was discharged after 10 and 18 postoperative days, respectively. This case demonstrates that an initial laparoscopic emergency excision followed by a later reconstruction might be a safe and simple surgical technique for patients with obstructive colitis accompanied by left-sided colon carcinoma.     

Surgical Outcomes for Hepatocellular Carcinoma in Nonalcoholic Fatty Liver Disease

Background  

The present study investigated outcomes following surgical resection of hepatocellular carcinoma (HCC) in nonalcoholic fatty liver disease (NAFLD).     

Radical Second Resection Provides Survival Benefit for Patients with T2 Gallbladder Carcinoma First Discovered after Laparoscopic Cholecystectomy

Port site recurrence or peritoneal seeding is a fatal complication following laparoscopic cholecystectomy for gallbladder carcinoma. The aims of this retrospective analysis were to determine the association of gallbladder perforation during laparoscopic cholecystectomy with port site/peritoneal recurrence and to determine the role of radical second resection in the management of gallbladder carcinoma first diagnosed after laparoscopic cholecystectomy. A total of 28 patients undergoing laparoscopic cholecystectomy for gallbladder carcinoma were analyzed, of whom 10 had a radical second resection. Five patients had recurrences; port site/peritoneum recurrence in 3 and distant metastasis in 2. The incidence of port site/peritoneal recurrence was higher in patients with gallbladder perforation (3/7, 43%) than in those without (0/21, 0%) (p = 0.011). The outcome after laparoscopic cholecystectomy was worse in 7 patients with gallbladder perforation (cumulative 5-year survival of 43%) than in those without (cumulative 5-year survival of 100%) (p <0.001). Among 13 patients with a pT2 tumor, the outcome after radical second resection (cumulative 5-year survival of 100%) was better than that after laparoscopic cholecystectomy alone (cumulative 5-year survival of 50%) (p = 0.039), although there was no survival benefit of radical second resection in the 15 patients with a pT1 tumor (p = 0.65). In conclusion, gallbladder perforation during laparoscopic cholecystectomy is associated with port site/peritoneal recurrence and worse patient survival. Radical second resection may be beneficial for patients with pT2 gallbladder carcinoma first discovered after laparoscopic cholecystectomy.