Annexin 2 and hemorrhagic disorder in vascular intimal carcinomatosis

Vascular intimal carcinomatosis refers to a characteristic tumor proliferation on vascular intima that replaces normal endothelium. This pathological event of unknown cause is quite different from tumor thrombotic microangiopathy due to the absence of thrombi on the tumor cell surfaces. We analyzed renal transitional cell carcinoma cases with metastasis to the main pulmonary arteries and marked hyperfibrino(geno)lysis. The fibrinogen-derived products from patients' plasma were identified as D1A/gamma, D1/gamma, and D1/beta by immunoblotting with the NH2-terminus of the fragment D specific antibody JIF-23. In all cases, the neoplastic cells with vascular intimal carcinomatosis were stained positive for anti-human annexin 2, which is a unique cell surface co-receptor for plasminogen and tissue-type plasminogen activator. In contrast, normal renal pelvic mucosa or renal transitional cell carcinoma without vascular intimal carcinomatosis did not express any annexin 2. The isolated transitional cell carcinoma cells contained annexin 2 mRNA and expressed its protein. Anti-annexin 2 antibody and transfection of annexin 2 small interfering RNA into these carcinoma cells significantly inhibited tissue-type plasminogen activator dependent plasmin generation. These findings suggest that annexin 2 mediated fibrinolysis on the transitional cell carcinoma cells may play a role in inducing hemorrhagic disorder in vascular intimal carcinomatosis.     

Off-pump pericardiectomy using an ultrasonic scalpel and a heart positioner

The surgical treatment of constrictive pericarditis often requires extensive pericardial dissection under cardiopulmonary bypass. We performed a pericardiectomy in a patient with constrictive pericarditis without cardiopulmonary bypass, with assistance of a sternal retractor and a suction heart positioner. The severely calcified pericardium, which adhered tightly to the epicardium, was dissected with an ultrasonic scalpel. The operation was completed without blood transfusion. There was no malignant arrhythmia.     

The effect of bimodal distribution on the mechanical properties of hydroxyapatite particle filled poly(L-lactide) composites

The effects of a bimodal distribution of micro-HA and nano-HA particles on the mechanical properties such as bending strength, modulus and mode I fracture energy of HA/PLLA composites were investigated. The bending properties were effectively improved by a bimodal distribution compared to a monomodal distribution. It is considered that in the bimodal HA/PLLA, the PLLA molecular chains are constrained by the existence of well distributed nano-particles, resulting in the reduction of the deformation of molecular chains. The mode I fracture energy was also effectively improved by a bimodal distribution with additional energy dissipation mechanisms, that is, dense ductile deformation of the PLLA matrix and debonding of the particle/matrix interfaces in the crack-tip region.     

Two cases of curative resection for locally recurrent rectal cancer with high-level sacrectomy after preoperative chemoradiation therapy (CRT)

We herein report two cases of locally recurrent rectal cancer that were successfully treated by surgical resection of shrunken tumor by pre-operative CRT. Although one case had a relapse in 7 months after the operation, the prognostic difference between two cases was discussed. CASE 1: A 54-year-old male had a pre-sacral mass (54 mm) six months after an anterior resection for advanced rectal cancer. We planned a surgical resection after CRT (radiation 50 Gy, CPT-11, UFT and LV). The tumor had a good response (33 mm) allowing a dissection area between sacral bone and posterior margin. Low anterior resections with sacral bone resection (below S3) were done to prevent S1 nerve roots injury and spinal fluid leakage. Macroscopically, a surgical margin was well secured. The patient is alive for 84 months after the surgery without an evidence of recurrence. CASE 2: A 66-year-old man had an anal bleeding. He underwent Hartmann's maneuver for advanced rectal cancer. MRI revealed a recurrent tumor (66 mm) occupying up to the 1st sacral bone. CRT was carried out. After a tumor response was (35 mm) obtained, and total pelvic exenteration with sacral bone resection below S3 was carried out, achieving R0 operation. However, He had relapsed at 7 months after the operation.     

Development of a compact laparoscope manipulator (P-arm)

Background

Laparoscope manipulating robots are useful for maintaining a stable view during a laparoscopic operation and as a substitute for the surgeon who controls the laparoscope. However, there are several problems to be solved. A large apparatus sometimes interferes with the surgeon. The setting and repositioning is awkward. Furthermore, the initial and maintenance costs are expensive. This study was designed to develop a new laparoscope manipulating robot to overcome those problems.

Methods

We developed a compact robot applicable for various types of laparoscopic surgery with less expensive materials. The robot was evaluated by performing an in vitro laparoscopic cholecystectomy using extracted swine organs. Then, the availability of the robot to various operations was validated by performing a laparoscopic cholecystectomy, anterior resection of the rectum, and distal gastrectomy using a living swine. The reliability of the system was tested by long-time continuous running.

Results

A compact and lightweight laparoscope manipulating robot by the name of P-arm was developed. The surgical time of an in vitro laparoscopic cholecystectomy with and without the P-arm was not different. The three types of operations were accomplished successfully. During the entire procedure, the P-arm worked without trouble and did not interfere with the surgeons. Continuous 8-h operating tests were performed three times and neither discontinuance nor trouble occurred with the system.

Conclusions

The P-arm worked steadily for various swine operations, without interfering with surgeon’s work.     

Validation study of the prediction system for clinical response of M-VAC neoadjuvant chemotherapy

To predict the efficacy of the M-VAC neoadjuvant chemotherapy for invasive bladder cancers, we previously established the method to calculate the prediction score on the basis of expression profiles of 14 predictive genes. This scoring system had clearly distinguished the responder group from the non-responder group. To further validate the clinical significance of the system, we applied it to 22 additional cases of bladder cancer patients and found that the scoring system correctly predicted clinical response for 19 of the 22 test cases. The group of patients with positive predictive scores had significantly longer survival than that with negative scores. When we compared our results with a previous report describing the prognosis of the patients with cystectomy alone, the results imply that patients with positive scores are likely to benefit from M-VAC neoadjuvant chemotherapy, but that the chemotherapy would shorten the lives of patients with negative scores. We are confident that our prediction system to M-VAC therapy should provide opportunities for achieving better prognosis and improving the quality of life of patients. Taken together, our data suggest that the goal of 'personalized medicine', prescribing the appropriate treatment regimen for each patient, may be achievable by selecting specific sets of genes for their predictive values according to the approach shown here.     

Variant autonomic regulation during active standing in Swedish and Japanese junior high school children

The present investigation is about cardiovascular responses and relevant autonomic function in Swedish and Japanese pubertal children on active standing using non-invasive continuous beat-to-beat finger arterial pressure (FAP) monitoring and power spectral analysis. Examined were 54 Swedish and 57 Japanese children (13-15 years). FAP and heart rate (HR) was continuously recorded in the supine position and during standing. Supine FAP was significantly higher in Swedish compared with Japanese children (121/62 versus 103/53 mmHg, P < 0.001). Swedish children showed a higher increase in arterial pressure and HR upon uprising, resulting in a higher vasoconstrictor index (5.04 +/- 0.22 versus 2.31 +/- 0.11 mmHg s(-1), P < 0.001, respectively). There were also higher increases in arterial pressure and HR in the following steady state period (1-7 min) between the two groups. These differences were also found after adjustment of body weight and height. Frequency domain analysis of HR and arterial pressure variability indicated significantly higher low/high frequency power of HR and low frequency power of arterial pressure. These results suggest that Swedish pubertal children have higher basal blood pressure and enhanced cardiovascular sympathetic responses. These differences in the two cohorts might be caused by genetic factors.     

Vascular pseudoinvasion in a solitary Peutz‐Jeghers polyp in the ileum

A Peutz‐Jeghers polyp (PJP) is a hamartomatous lesion characterized by arborescent smooth muscle bundles covered with mucosa native to the site of involvement. PJPs in the small intestine may represent misplacement of non‐neoplastic epithelium into the submucosa, muscularis propria and subserosa. Although epithelial misplacement in PJPs is a well‐documented phenomenon, pseudoinvasion even into the vascular space in PJPs has not previously been reported. We report a case of a 22‐year‐old Japanese woman with a solitary PJP in the ileum. The ileal PJP in this patient showed epithelial herniation even into the vascular space. All the herniated epithelium, including the epithelial components invaginated into the vascular space, demonstrated features of pseudoinvasion, that is, presence of normal small intestinal type mucosa accompanied by the lamina propria, absence of any stromal desmoplastic reaction, and retention of the basal‐luminal gradient. Pathologists must be aware of the possibility of vascular pseudoinvasion in small intestinal PJPs to avoid overdiagnosis of carcinoma and resulting unnecessary major surgery.     

Histological changes of the gallbladder and liver after extracorporeal shock wave lithotripsy for gallbladder

The histological changes of the gallbladder and liver following extracorporeal shock wave lithotripsy (ESWL) were investigated in a canine model. After performing ESWL on human cholesterol stones placed in the gallbladder of 8 dogs, the gallbladder and livers were removed for pathological study. The mucosa of the gallbladder showed erosion and ulceration in three of the eight dogs. Edema and bleeding were found in the stroma of the gallbladder beds. Hemorrhagic necrosis and vacuolar degeneration occured in liver parenchyma adjacent to the gallbladder bed, but the portal area was fairly well preserved. It can be said that ESWL caused damage to both the liver and the gallbladder, but its effects on the liver may be only slight because of the preservation of the portal area.