General anesthesia for disabled patients undergoing dental treatment in a general hospital

BACKGROUND: General anesthesia for dental treatment in disabled patients may present particular problems, especially when it is done in a general hospital, compared with specialized dental hospitals. METHODS: We surveyed 24 patients who underwent dental treatment under general anesthesia in our institution during the last decade. RESULTS: Electrocardiography or chest x-ray photography was not obtained in 8 patients owing to lack of patients' cooperation. Slow induction with sevoflurane was selected in 5 patients, because intravenous cannulae could not be placed owing to their rejection. Nasotracheal intubation was performed in all patients, but no difficulty in intubation was documented. As postoperative complications, we observed convulsion in one patient and muscle rigidity in another, but no critical troubles related to circulatory or respiratory status. In patients who were treated for more than ten teeth, we observed differences in age, body weight, duration of anesthesia, maximum concentration of sevoflurane administered during anesthesia, and use of postoperative analgesics compared with the other patients. CONCLUSIONS: We found particular problems of anesthesia for disable patients undergoing dental treatment in a general hospital, and suggest that information on numbers of teeth to be treated is helpful.     

Impact of Adjuvant Immunochemotherapy Using Protein-bound Polysaccharide-K on Overall Survival of Patients with Gastric Cancer

Protein-bound polysaccharide K (PSK) is an anticancer agent used for adjuvant therapy against gastric cancer. The aim of this study was to evaluate the effect of PSK on the overall survival of patients with gastric cancer. A total of 254 patients who underwent surgical curative resection were included in this retrospective study. We identified 138 patients who received antimetabolites alone (control group) and 115 patients who received antimetabolites plus PSK (PSK group). In patients with early tumor recurrence, overall survival was significantly better in the PSK group (p=0.023). In patients with pN3 lymph node metastasis, median overall survival was better in the PSK group compared with the control group (p=0.032). Our results suggest that adjuvant immunochemotherapy with PSK increased the overall survival for patients with pN3 and early tumor recurrence. Thus, the combination of PSK with oral chemotherapeutic agents might be suitable for postoperative adjuvant therapy against gastric cancer in patients with lymph node metastases.     

ENDOSCOPIC MOLECULAR IMAGING: BEACON TO THE DESTINATION

Imaging technologies in gastrointestinal endoscopy have advanced greatly over the past few decades. Molecular imaging may be an additional innovation to conventional imaging methods and allow visualization of the localization, function, and characteristics of targets, especially in cancers. To realize endoscopic molecular imaging, there are three prerequisites: first, more target‐specific and highly sensitive biomarkers for clinical use; second, fluorochromes that have a high affinity to the markers and can produce a distinct signal; and third, equipment to visualize the indicator at high resolution in real time. This technique can be used for cancer screening and surveillance and can also provide important information for deciding treatment strategies and evaluating their effectiveness during therapy. Endoscopic molecular imaging will play a central role in gastrointestinal oncology in the near future.     

Lymphoepithelioma-like carcinoma of the esophagus: report of a case with non-progressive behavior

Lymphoepithelioma-like carcinoma (LELC) of the esophagus is extremely rare and the prognosis has been described to be favorable. Herein, the case is reported of esophageal LELC showing non-progressive course for 1 year. The patient was a 70-year-old Japanese man with a submucosal tumor in the lower esophagus. The tumor was endoscopically regarded as a benign leiomyoma. One year after the first endoscopic examination, the size of the lesion remained unchanged despite no treatment. Histologically, the tumor showed undifferentiated carcinoma associated with dense lymphocytic and plasma cell infiltration. Lymphoid follicles surrounded the tumor cell nests. Immunohistochemically, Ki-67 labeling index of the tumor cells were 76.0%, and there were few single-strand DNA-positive apoptotic cells. In situ hybridization using a digoxigen-labeled Epstein-Barr virus (EBV)-encoded small RNA (EBER)-1 riboprobe failed to detect the presence of EBV infection. Physicians should be aware that esophageal LELC endoscopically mimics benign submucosal tumor. This case may demonstrate that esophageal LELC is a slow-growing tumor and it is related to immune reaction.     

Priapism complicated by chronic myelogenous leukemia (CML); a case report

A-29-year-old man visited our hospital with the complaint of a continuous rigid and painful erection which began two days before. We diagnosed ischemic type of priapism by aspiration of penile cavernosal blood analysis; an acidotic and hypoxic blood. The leukocyte count was 263,000/p, and chronic myelogenous leukomia (CML) was suspected. After the failure of conservative treatment, glans-cavernosal shunt (Winter procedure) was performed. The postoperative course was uneventful and the intercourse was possible at five months after the operation. CML was treated by administration of imatinib mesylate and no evidence of recurrence was observed.     

Identification of HLA-A*2402-restricted epitope peptide derived from ERas oncogene expressed in human scirrhous gastric cancer

ERas is a recently identified oncogene involved in the tumorgenic growth of embryonic stem cells. We examined the significance of ERas expression in scirrhous gastric carcinoma, and the possibility of ERas as a tumor-associated antigen of gastric cancer for developing a cancer vaccine. ERas expression was determined in scirrhous gastric carcinoma specimens by immunohistochemical staining. To assess the possibility of the ERas protein as an anticancer vaccine target, we examined whether ERas for HLA-A-restricted epitope peptides were capable of eliciting cytotoxic T lymphocyte activity. Immunohistochemical analysis identified ERas protein in the nucleus and cytoplasm of cancer cells, yet ERas was not expressed in normal gastric epithelium. By western blotting, lysates of the scirrhous gastric cancer cell lines, OCUM-8, OCUM-2MD3 and OCUM-2M were shown to contain a 25-kDa band of ERas protein. ERas mRNA was detected in these cell lines by RT-PCR. To investigate cytotoxicity, we successfully established cytotoxic T lymphocyte clones stimulated by HLA-A*2402-restricted ERas peptides (FALDDPSSL). These peptides have specific cytotoxicity against corresponding HLA-A*2402-positive target cells pulsed with the candidate peptide. We found that the cytotoxic T lymphocyte clones demonstrated cytotoxic activity against OCUM-8 cells that endogenously express ERas. Our results suggest that ERas is a novel tumor-associated antigen with the potential application to be a vaccine against scirrhous gastric cancer.     

Prevention of posttransfusional non-A, non-B hepatitis by a screening test for hepatitis C virus antibody of donor bloods.

The preventive effect on posttransfusional non-A, non-B hepatitis (PTH) of screening out HCV-Ab positive blood and the prevalence of HCV-Ab-positive donor blood were examined. The incidence of HCV-Ab-positivity in donor blood A was 0.9% and that in donor blood B was 1.35%. The mean ALT and guanase levels were 11.5 +/- 5.8 and 0.58 +/- 0.24 IU/l in HCV-Ab negative blood and 17.3 +/- 7.9 and 0.84 +/- 0.23 IU/l in HCV-Ab-positive blood. Both levels were significantly higher in HCV-Ab-positive blood. These differences were considered to be nonspecific, but there may be some relationship between the levels of ALT and guanase in donor blood and the HCV carrier status. After adoption the screening test for HCV-Ab positive blood, there was no case of a definite diagnosis of PTH, although 4 patients (6.6%) suspected of developing PTH. So, the incidence of PTH was clearly lower than the lowest incidence before adoption of this test. Therefore, we conclude that screening for HCV-Ab in donor blood should be routinely used for prevention of PTH.