Is D2 lymph node dissection necessary for early gastric cancer?

Background The objective of this study was to clarify a survival benefit of D2 lymphadenectomy in patients with early gastric carcinoma (GC). Methods A retrospective study was conducted to examine the incidence of metastasis to level 2 lymph nodes, the causes of postoperative death, and the mode of recurrence in 1041 patients who head early GC and underwent D2 lymphadenectomy with curative intent. Results Postoperative mortality occurred in 129 (12,4%) of 1041 patients, 6 patients (.6%) died of surgical complications 108 (10.2%) died of diseases other than cancer, and 16 (1.5%) died of recurrence. Hematogenous metastasis was the major mode of recurrence (56.3% of recurrences). The incidence of metastasis to level 2 nodes was 2.5% (26 of 1041 patients, 18 of whom were alive). Thus, the estimated survival benefit of radical lymphadenectomy for patients with early GC was calculated to be 1.7% (18 of 1041 patients). Conclusions D2 lymphadenectomy in patients with early GC had little survival benefit because (1) metastasis to level 2 nodes was rare, (2) most causes of death were not related to the tumor, and (3) more than half the recurrences were hematogenous. Use of radical lymphadenectomy for early GC should be limited.     

Cost performance and efficacy of off-pump coronary artery bypass grafting

Off-pump coronary artery bypass grafting (Off-Pump CABG) may provide an alternative form of surgical revascularization by avoiding the unwanted complications of cardiopulmonary bypass, particularly in high-risk patients. To clarify the efficacy and cost performance of Off-Pump CABG, we studied the postoperative course of Off-Pump CABG and compared it to On-pump coronary artery bypass grafting (On-Pump CABG). From Aug. 1998 to Feb. 2002, twenty-eight patients who had preoperative complications such as cerebral vascular disease (11), chronic renal failure (4), atheromatous aorta (4), one lung (1), severely impaired left ventricular function (6), re-do CABG (1), and cancer (1) underwent Off-Pump CABG. Another thirty-six patients who underwent On-Pump CABG served as a control. The Off-Pump CABG patients were almost the same age as the On-Pump CABG patients (68 +/- 8 vs 64 +/- 8 years, ns). The Number of grafts was similar in both groups (2.6 +/- 1.0 vs 2.9 +/- 1.0, ns). Peak CK, peak CKMB, peak LDH, and peak GOT release were significantly lower in the Off-Pump CABG group compared with the On-Pump CABG group. Graft patency rates were similar in both groups (98% in Off-Pump CABG vs 98% in On-Pump CABG). The total cost for surgery and patient care was significantly lower (p < 0.0001) in the Off-Pump CABG group (dollar 21000 +/- 7000) compared with the On-Pump CABG group (dollar 33000 +/- 4200). Off-Pump CABG is less invasive to the myocardium, is less expensive, and has a similar efficacy in comparison with On-Pump CABG.     

Gene mutation in hereditary progressive dystonia with marked diurnal fluctuation (HPD), strictly defined dopa-responsive dystonia

Mutations of the guanosine triphosphate (GTP)-cyclohydrolase I (GCH-I) gene, which catalyzes the first step in the tetrahydrobiopterin (the natural cofactor for tyrosine hydroxylase) biosynthesis, are demonstrated to cause HPD, i.e. strictly defined dopa-responsive dystonia. We analyzed the GCH-I gene of patients who fulfilled clinical criteria for typical hereditary progressive dystonia (HPD) to finalize the diagnosis. Two novel point mutations in two independent families and one novel de novo point mutation in one sporadic patient were identified. In a Japanese family, a T-to-C transition was found at exon 2, which resulted in a substitution of Cys 141 to Arg. In another Japanese family, a C-to-T mutation in exon 4 caused a nonsense codon Gln180Stop. In a clinically sporadic Japanese patient, T-to-G transition in exon 1 brought Met 102 Arg missense mutation, which was not observed in its biological parents. These three mutations were not observed in previously reported 57 pedigrees/patients and no polymorphisms in the coding region of the GCH-I gene were identified. None of the mutations of GCH-I gene in HPD reported to date or in this study have been detected more than once in any ethnicity suggesting a relatively high spontaneous mutation rate in this gene.     

Henoch-Schönlein purpura with hypocomplementemia in children

BACKGROUND: The clinical course and prognosis of Henoch-Schonlein purpura (HSP) associated with hypocomplementemia are not clear. METHODS: The clinical findings of 10 children with HSP and hypocomplementemia were studied. RESULTS: Purpuric rash in all patients, abdominal pain in five, and arthralgia in nine were noted. The findings in HSP were not different from others with HSP. In eight patients, infection preceded hypocomplementemia. Serum levels of CH50, C3 or C4 were depressed variously. Complement levels returned to normal within 5 weeks in all patients. Antistreptolysin-O (ASO) titer was elevated in all patients and nephritis occurred in eight patients. Six patients had generalized edema and hypertension. Macroscopic hematuria occurred in two patients and heavy proteinuria in five patients. One patient was diagnosed as having poststreptococcal acute glomerulonephritis (PSAGN) combined with HSP nephritis according to renal biopsy findings. In three of eight patients with nephritis, abnormal urinary findings continued for more than 1 year. CONCLUSIONS: Hypocomplementemia in children with HSP was transient and was not related to severity of HSP. Incidences of elevated ASO titer and nephritis were high. The nephritis resembled PSAGN during the acute stage and long-term clinical courses varied. These findings suggest PSAGN may be associated with HSP nephritis.     

Familial cases of Henoch-Schönlein purpura in eight families

Abstract Background : Familial cases of Henoch‐Schönlein purpura (HSP) have rarely been reported. Methods : Familial cases of HSP were reviewed by medical records of 418 children with HSP. Results : Two members developed HSP in eight families. HSP occurred in a mother and her daughter in one family and in siblings, including one pair of twin sisters, in seven other families. Four pairs of patients developed HSP at the same age. Three pairs presented HSP within 1 month of each other and the other pairs presented HSP between 9 months and 5 years. Seven patients had a history of allergic diseases. The clinical courses of 12 patients were reviewed. Upper respiratory tract infection preceded HSP in 10 patients, two of whom had elevated antistreptolysin‐O titers. No pairs of patients in a family received the same drugs before the onset of HSP. Abdominal pain was noted in eight patients, arthralgia in six and nephritis in four. Severity of skin lesions, presence of abdominal pain and nephritis, and serum IgA levels at the acute stage varied among family members of HSP. Conclusions : The incidence of HSP in family members of children with HSP seems to be high. Onset at the same age and onset of HSP within 1 month in siblings have not previously been reported. There were no characteristic or similar findings between two patients of the same family. No trigger or genetic factor causing HSP was identified.     

Importance of the CT/MRI fusion method as a learning tool for CT-based postimplant dosimetry in prostate brachytherapy.

BACKGROUND AND PURPOSE: To compare the CT-based and CT/MRI fusion-based postimplant dosimetry after permanent prostate brachytherapy and to evaluate the improvement in CT-based dosimetry by physicians with or without experience in using the CT/MRI fusion method. PATIENTS AND METHODS: Thirty-eight consecutive patients agreed to participate in a prospective study. The prostate contours from CT/MRI fusion are the gold standard for determining the prostate volume and dose volume histogram (DVH). CT-based postimplant dosimetries were performed by two physicians. Observer 1 was a radiologist who had never used CT/MRI fusion method for postimplant dosimetric analysis. Observer 2 was a radiation oncologist experienced in postimplant analysis using the CT/MRI fusion method. The prostate dosimetry was evaluated by prostate D90 and V100. RESULTS: No significant difference was observed in the mean prostate volumes between the two observers and the CT/MRI fusion data. However, the correlation coefficient value for observer 2 (R(2)=0.932) was greater than that for observer 1 (R(2)=0.793). The D90 and V100 values as evaluated by the two observers were significantly underestimated in comparison to those evaluated using the CT/MRI fusion methods. The DVH related parameters were underestimated more frequently by observer 1 than by observer 2: (prostate D90: 99.56% for observer 1, 102.97% for observer 2, 109.37% for CT/MRI fusion. Prostate V100: 88.12% for observer 1, 90.14% for observer 2, 91.91% for CT/MRI fusion). CONCLUSIONS: The difference in the mean value in D90 and V100 by observer 1 was significantly greater than that for observer 2. These findings suggest that the CT/MRI fusion method provides accurate feedback which thereby improves CT-based postimplant dosimetry for prostate brachytherapy.     

Cell cycle regulation by the Wee1 Inhibitor PD0166285, Pyrido [2,3-d] pyimidine, in the B16 mouse melanoma cell line

Background  

Wee1 kinase plays a critical role in maintaining G2 arrest through its inhibitory phosphorylation of cdc2. In previous reports, a pyridopyrimidine molecule PD0166285 was identified to inhibit Wee1 activity at nanomolar concentrations. This G2 checkpoint abrogation by PD0166285 was demonstrated to kill cancer cells, there at a toxic highest dose of 0.5 μM in some cell lines for exposure periods of no longer than 6 hours. The deregulated cell cycle progression may have ultimately damaged the cancer cells. We herein report one of the mechanism by which PD0166285 leads to cell death in the B16 mouse melanoma cell line.