Early experience with robotically assisted internal thoracic artery harvest

We sought to determine the efficacy of using robotic assistance to facilitate endoscopic harvesting of internal thoracic arteries (ITAs). A total of 104 patients had ITAs harvested endoscopically with use of both the AESOP 3000 system (Computer Motion, Goleta, CA, U.S.A.) and Zeus robotic telesurgical system (Computer Motion). All ITAs were harvested with a harmonic scalpel (Ethicon Endosurgery, Cincinnati, OH, U.S.A.). With the left lung collapsed, ITAs were harvested with CO2 insufflation through three 5-mm ports in the left chest. All patients tolerated insufflation without hemodynamic compromise. Average ITA harvest time was 61.3 +/- 20.9 minutes. Intraoperative graft flows averaged 36.3 +/- 22.4 mL/min. There were three distal ITA injuries; all other vessels were patent after harvesting and demonstrated no angiographic evidence of injury. This article demonstrates a technique by which ITA can be safely harvested totally endoscopically with use of computer-enhanced robotic systems and a harmonic scalpel, allowing complete pedicle dissection through 5-mm ports with minimal ITA manipulation.     

Early experience in the use of Levovist ultrasound contrast in the evaluation of liver masses

The aim of the present paper was to assess the utility of Levovist in defining the pathology of liver masses. Levovist is a new ultrasound contrast agent consisting of galactose microparticles, air bubbles and palmitic acid. Prospective studies were performed in patients referred for further evaluation of known liver masses. Levovist was peripherally injected and colour Doppler ultrasound studies were performed. Findings were correlated with clinicopathology and three other imaging modalities: biphasic spiral CT, CT arterial portography and contrast MRI. Twenty-five patients were studied (15 male and 10 female) in the age range 25-74 years. Liver masses ranged from 0.5 to 7 cm in maximum diameter. Thirteen lesions were benign and 12 were malignant (four hepatomas (HCC) and eight metastases). Levovist enhancement occurred in 18 lesions. Of these, six were benign (four focal nodular hyperplasias (FNH) and two haemangiomas). All 12 malignant lesions demonstrated enhancement. The HCC showed a mosaic pattern of central and peripheral enhancement, and the FNH demonstrated a spoke-wheel pattern. It was not possible to distinguish between haemangiomas and malignant lesions. Non-enhancing lesions may well be benign, with all malignancies showing some enhancement. Characteristic enhancement patterns were found for HCC (mosaic) and FNH (spoke-wheel). It was not possible to distinguish between metastases and benign lesions (haemangiomas) when the pattern of enhancement was peripheral.     

Development of a digital image database for chest radiographs with and without a lung nodule: receiver operating characteristic analysis of radiologists' detection of pulmonary nodules

OBJECTIVE: We developed a digital image database (www.macnet.or.jp/jsrt2/cdrom_nodules.html ) of 247 chest radiographs with and without a lung nodule. The aim of this study was to investigate the characteristics of image databases for potential use in various digital image research projects. Radiologists' detection of solitary pulmonary nodules included in the database was evaluated using a receiver operating characteristic (ROC) analysis. MATERIALS AND METHODS: One hundred and fifty-four conventional chest radiographs with a lung nodule and 93 radiographs without a nodule were selected from 14 medical centers and were digitized by a laser digitizer with a 2048 x 2048 matrix size (0.175-mm pixels) and a 12-bit gray scale. Lung nodule images were classified into five groups according to the degrees of subtlety shown. The observations of 20 participating radiologists were subjected to ROC analysis for detecting solitary pulmonary nodules. Experimental results (areas under the curve, Az) obtained from observer studies were used for characterization of five groups of lung nodules with different degrees of subtlety. RESULTS: ROC analysis showed that the database included a wide range of various nodules yielding Az values from 0.574 to 0.991 for the five categories of cases for different degrees of subtlety. CONCLUSION: This database can be useful for many purposes, including research, education, quality assurance, and other demonstrations.     

Detection of Tumor DNA in Serum of Colorectal Cancer Patients

We previously found p16 promoter methylation in DNA in the sera of 13 colorectal cancer patients out of 44 (30%) whose tumor DNA exhibited the methylation, using methylation-specific PCR (MSP). To examine whether the cancer detection rate could be improved by using a different tumor marker, we examined the K- ras status in 90 colorectal cancer patients using a mismatch ligation assay. Among the 31 patients showing K- ras gene mutations in their tumors, the same mutations were observed in serum DNA of 11 patients (35%). Among the 90 patients, 63 showed tumors positive for K- ras mutation or p16 promoter methylation, or both, and 22 had serum DNA positive for one or both. K- ras mutation was found even in serum DNA of patients with Dukes A cancer, suggesting that colorectal cancer might be detected even in patients without symptoms by using this ligation assay.     

The role of surgery in the current treatment of gastric carcinoma

Surgery currently is the only curative option in the treatment of gastric cancer. For early gastric cancer, an endoscopic mucosal resection (EMR) is adequate for intramucosal cancer less than 2?cm in diameter without ulcer. For early cancers ineligible for EMR, limited surgical operation (proximal gastrectomy, segmental resection, and pylorus-preserving distal gastrectomy) can be recommended to reduce surgical risk and achieve improvements in quality of life without decreasing survival. Subtotal/total gastrectomy plus D2 lymph node dissection is the standard surgery for advanced gastric cancer in Japan. Pancreas-preserving total gastrectomy is recommended due to the reduced risk of pancreatic fistula and postoperative diabetes. Regarding extended surgery, results of a phase III study to evaluate the role of paraaortic node dissection will be analyzed in a few years' time after the accrual of more than 500 patients in a Japan Clinical Oncology Group (JCOG) study. For scirrhous gastric cancer, left upper abdominal exenteration appears to be associated with improved survival and should be tested in another controlled trial.     

Feasibility study of weekly paclitaxel as second-line chemotherapy against 5-FU-refractory gastric carcinoma

The present study investigated the efficacy and feasibility of weekly paclitaxel for advanced/recurrent gastric cancer. Subjects comprised 23 patients with advanced/recurrent gastric cancer who had been treated using a 5-FU-containing regimen. Paclitaxel was administered at a dose of 80 mg/m(2), 3 times every 4 weeks. Dexamethasone, diphenhydramine and ranitidine chloride were given 30 min before paclitaxel as premedication. The mean number of treatment cycles was 6.4 (range, 1-28). Response rate was 40.0% (4/10) with measurable lesions. Among 13 patients without measurable lesions, 3 cases revealed improvements on colonography, 1 case displayed decreased ascites on abdominal computed tomography, and 1 case recovered from disseminated intravascular coagulopathy due to bone metastases. Median survival time was 258 days, and median time to progression was 140 days. Grade 3 leukocytopenia and neutropenia occurred in 13.0% of patients. All non-hematological toxicity was low-grade, including that involving the gastrointestinal system. Weekly paclitaxel appears effective and safe for 5-FU-refractory gastric cancer.     

Development of a food-frequency questionnaire to measure the dietary calcium intake of adult Japanese women

Assessing calcium intake is necessary for epidemiological studies on osteoporosis. This study was aimed at developing a valid food frequency questionnaire (FFQ) to estimate the dietary calcium intake of Japanese people. The FFQ contains 26 items, representing common sources of calcium. The respondents, 74 women aged 15 - 79 years living in Fukui city, whose dietary calcium intake was estimated at 638 +/- 306 (S.D.) mg based on a one-day weighted food record kept during the National Nutrition Survey of 1996, were asked to indicate their consumption frequency and usual portion size (large, medium, small) for each food item. Trained dieticians interviewed the subjects to confirm their answers to the FFQs. The mean calcium intake per day according to the FFQ (655 +/- 222 mg) did not differ significantly from that according to the one-day food record. The coefficient of correlation between these methods was 0.512, a statistically significant value. The calcium intake from dairy products showed a good correlation, r = 0.717. The coefficient of correlation between the values estimated based on two FFQ filled out three days apart was 0.900, showing good test-retest reliability. Therefore, this FFQ is valid and reliable in estimating dietary calcium intake for epidemiological studies.     

Temporal bone histopathology in a patient suspected of inner ear extension of otitis media

We report the histopathological findings in the temporal bone of a 30-year-old female who died of cervical esophageal carcinoma. The temporal bone sections revealed severe bilateral suppurative labyrinthitis and otitis media that presumably occurred immediately before her death. Many inflammatory cells were present in the middle ear, particularly around the stapes and the round window niche. They had also infiltrated the inner ear via the annular ligament of the stapes and the round window membrane. Inflammatory cell accumulation was also observed in the peri- and endolymphatic spaces, and it was most severe in the basal turn. Most of the inner and outer hair cells were preserved, but some had degenerated or were missing. Numerous round cells were observed in the modiolus, and some of the spiral ganglion cells had degenerated. On the basis of these findings, we concluded that bacterial otitis media had extended in to the inner ear via the oval window and round window membrane and had resulted in suppurative labyrinthitis. These findings are consistent with those of stage II suppurative labyrinthitis according to the classification of Schuknecht.