Small Depressed Cancer of the Large Bowel: Report of Three Cases

This report describes three patients in whom colonos-copy detected small depressed cancers (without an elevated component) that had invaded the submucosa. They represent 0.4% (3/884) of all patients with invasive cancers and 3% (3/101) of patients with submucosal cancers in the National Cancer Center Hospital between January 1990 and February 1994. This type of cancer may have been overlooked in the past because of its small, flat nature. A slight deformity of the lumen, a faint color change (slightly reddish), and a loss of a vascular network pattern were important colonoscopic findings. Small depressed cancers may follow a different pathway to advanced cancer than polypoid cancers, although both pathways are included in the adenoma-carcinoma sequence. We should be aware of these lesions in our efforts to detect colorectal cancers in the early stage.     

Effects of fasting on distribution and excretion of lead following long-term lead exposure in rats

Lead was given to rats through drinking water containing 100 ppm lead acetate for 20 days. Delta-aminolevulinic acid dehydratase (ALAD) activity in erythrocytes was significantly lower (p < 0.05) at 20 days after Pb treatment. Erythrocytic ALAD activity was significantly lower (p < 0.05) in fasted rats than in fed rats with or without Pb pretreatment. Serum glutamic pyruvic transaminase and glutamic oxaloacetic transaminase activities after 6 days of fasting were significantly higher (p < 0.05) in Pb pretreated rats than in other groups (Ph nontreated fed and fasted rats, and Pb pretreated fed rats). Long periods of fasting strongly enhanced these serum-enzymes elevations induced by lead. Maximum Pb concentrations and total amount in feces increased in rats fasted for 3 days regardless of Pb pretreatment. On the other hand, total amount of Pb in feces of rats fasted for 6 days were not significantly different from the other groups because their fecal volume decreased to about 1 % of fed rats. The Pb concentrations of liver, kidney, spleen, and femur increased significantly in Pb pretreated rats compared to in controls, but there were no significant differences between the fed and fasted rats.     

Left Ventricular Mass Regression After Implantation of St. Jude Medical Cardiac Valves in Small Aortic Roots

In this study, we analyzed the extent of regression of left ventricular hypertrophy in patients who received small St. Jude Medical (SJM) aortic valves and compared the results with those of another group receiving larger valves. Eighty-eight patients received either 19 or 21 mm valves (Group 1, 25 patients) or either 23 or 25 mm valves (Group 2, 53 patients). Echocardiographic studies were done before the operation and 5 years postoperatively. At follow-up a significant reduction in the left ventricular mass was found for both patient groups (p < 0.0001). Doppler echocardiography derived pressure gradients for both groups were obtained during the follow-up period. As expected, the patients in Group 1 had higher peak pressure gradients than did those in Group 2. However, there was no significant difference between the 2 groups or any significant correlations between peak pressure gradients and body surface area (BSA). Actuarial survival was 84.7% at 15 years for Group 1 and 85.9% at 17 years for Group 2. Actuarial freedom from valve related events was 91.4 % at 15 years for Group 1 and 82.7% at 17 years for Group 2. There was no significant difference in survival or valve related event free curves between the 2 groups. After implantations of SJM valves in small aortic roots, significant left ventricular mass regression was obtained, and the results were comparable to those for valves of other sizes. The long-term performance of aortic valve replacement with small valves was satisfactory as judged by improvement in the functional class of patients and survival statistics, the durability of the prosthesis, and valve related morbidity comparable to that of valves of other sizes.     

Inhibitory actions produced by local electrical stimulation in the caudal spinal trigeminal nucleus in rat

Inhibitory actions induced by local electrical stimulation (LES) on the tooth pulpal afferent activities were investigated in the caudal part of the rat spinal trigeminal nucleus. For the LES, ipsilateral Yin-Hsiang (intrasegmental point) or Ho-Ku (extrasegmental point) was used as a cathodal point which was stimulated electrically by a single pulse of 0.1 msec in duration or by 0.1 msec-pulse train at 45 Hz for 15 min. We found at least three types of inhibitions in the caudal trigeminal nucleus: Type I—this inhibition is the most forceful, caused by naloxone-reversible endogenous opiate system with a slow onset and prolonged aftereffect. This inhibition is presumably postsynaptic action. Type II—this is evoked by postsynaptical acting inhibition and begins within milliseconds after the stimulus is applied. Type III—this inhibition is elicited by presynaptic action and also begins within milliseconds after the onset of the stimulation. Type I and II inhibitions are evoked by stimulating either ultra- or extrasegmental LES points, however, Type III is produced by stimulation of intrasegmental and rarely provoked by extrasegmental point stimulation. Naloxone failed to reverse Type II and III inhibitions. During LES, Type I to III inhibitions co-work for producing the suppressive effect and after the cessation of its stimulation, only Type I inhibition produces the so-called aftereffect of the LES.     

Differences in Human Group Mean SEP between Sexes: with Reference to the Rohrer's Index*

Abstract: With 200 SEPs of normal subjects, the differences in the Group Mean SEP between sexes were defined eliminating the differences attributable to another peripheral factor relating to the nutritional condition represented by the Rohrer's index. The differences in the baseline amplitude of the Group Mean SEP between males vs. females in the sections between roughly 23–111 msec, around 330 msec, and behind 389 msec in latency were verified, subtracting the differences between the groups with a high vs. low value of the Rohrer's index, not attributable to the different nutritional condition, and might be the central origin. Applying the Amplitude Scaling, the differences in the sections 23–104 msec in latency were verified similarly, being more a significant indication of the sex difference per se.     

Sipple's syndrome: A case diagnosed preoperatively

A case of familial Sipple's syndrome diagnosed preoperatively is presented. Clinically, thyroid carcinoma and its metastasis to the cervical and upper mediastinal lymph nodes were first noticed. The diagnosis of medullary carcinoma was strongly suspected on the physical and roentgenologic evidences unique to this variety of thyroid cancer. Clinically pheochromocytomas were asymptomatic, but urinary catecholamine study revealed an increased epinephrine excretion. Furthermore this case had a parathyroid adenoma and preoperative serum parathormone (PTH) was high, though the serum calcium level remained normal. The patient was successfully treated by total adrenalectomy followed by thyroidectomy.     

Anti-Manic and Prophylactic Effects of Carbamazepine (Tegretol) on Manic Depressive Psychosis A Preliminary Report

• 1). The anti-manic, anti-depressive and prophylactic effects of carbamazepine (CAZP, Tegretol-Ciba Geigy) on the endogenous mani-depressive psychosis (MDP) were investigated on 50 MDP cases. The dosage of the drug ranged from 200 to 1,200 mg daily (usually 400 to 600 mg).
• 2). The effect of CAZP on 33 manic states was: “markedly effective” seven (23%), “effective” six (19%), “slightly effective” five (16%), “ineffective” 13 (42%), whereas the effect on six depressive states was: “markedly effective” one and “ineffective” five. No definite relationship was found between the kinds of drugs in combination use and the effect of CAZP. No significant difference of the CAZP effect was found in the four patient groups with different age of onset of the illness, nor among the “continuous,”“frequent” and “periodic” type cases.
• 3). The prophylactic effect of CAZP on 27 cases in which the assessment of the effect on the manic episode was possible was: “markedly effective” 13 (48%), “effective” seven (26%) and “ineffective” seven (26%), whereas that for depressive episode was: 12 (45%), two (7%) and 13 (48%), and the result of the general assessment on each patient was 14 (43%), 10 (30%) and nine (27%), respectively. The kinds of drugs in combination use, age of onset and type of course of the illness did not have any influence on the prophylactic effect of CAZP.
• 4). The prophylactic effect on MDP of CAZP did not parallel that of lithium salt, but CAZP may be effective on cases which did not respond to lithium and vice versa.
• 5). Side-effects such as ataxia, dizziness, exanthema, drowsiness and headache were observed in five of the cases, and the CAZP was discontinued in four of them.
• 6). The mechanism of effectiveness of the CAZP on MDP was discussed.

     

A case of HCC with inferior caval vein tumor thrombus and multiple pulmonary metastases that remarkably responded to combination therapy of TS-1 and interferon-alpha

A 56-year-old male was admitted to our hospital for hepatoma with portal vein thrombus and multiple intrahepatic metastases. He underwent an extended left lobectomy and a partial resection of the liver in May 2002. After two weeks from the surgery, he received intra arterial 5-FU infusion chemotherapy combined with subcutaneous interferon-alpha injection to treat the lesions in the residual liver. Four months after the surgery, hepatic vein tumor thrombus appeared in the remnant liver and it extended to the inferior caval vein. And another 4 months later, multiple pulmonary metastases were detected with computed tomography and they grew rapidly in the view of their sizes and numbers. Because the combined therapy of 5-FU/interferon-alpha was not effective to distant metastases, we started a new regimen of oral administration of TS-1 and a subcutaneous interferon-alpha injection. After 1 treatment cool, hepatic vein thrombus was markedly reduced the size and vascularity in the CT. Multiple pulmonary metastases also decreased in their sizes and numbers. No adverse effect was seen during this treatment. It was suggested that a combination therapy of TS-1 and interferon-alpha may be one of the most effective treatment modalities against advanced HCC with distant metastasis.     

Successful treatment of combined intraarterial (5-fluorouracil and adriamycin and cisplatin) infusion chemotherapy for advanced hepatocellular carcinoma with multiple intrahepatic metastases and/or portal vein thrombosis--two case reports

Hepatic arterial infusion chemotherapy has been often selected as a therapeutic option for advanced hepatocellular carcinoma with multiple intrahepatic metastases and/or portal vein thrombosis. We successfully treated and obtained CR in the 2 cases of far advanced hepatocellular carcinoma with intraarterial infusion chemotherapy (FAP). Case 1 was a 71-year-old male who had advanced hepatocellular carcinoma with intrahepatic metastasis (IM3) which was recurrent after two surgeries. He received hepatic arterial infusion chemotherapy (FAP: 5-fluorouracil 500 mg/day: continuous infusion, day 1-5, adriamycin 10 mg/day, day 1, CDDP 10 mg/day, day 1). After 10 courses, abdominal CT revealed that the viable lesions had completely disappeared (CR). This patient is still alive with no recurrence after 21 months from the beginning of this treatment. Case 2 was a 74-year-old male who had advanced hepatocellular carcinoma with portal vein thrombi (Vp4) and intrahepatic metastasis (IM3). He received FAP arterial infusion chemotherapy with the same protocol as case 1. After 8 courses of this therapy, CT revealed that these lesions had disappeared (CR). This patient is still alive with no recurrence after 9 months from the beginning of this treatment. For 15 patients with advanced hepatocellular carcinoma using a same protocol, the response rate of this therapy was 33.3% (CR & PR). These findings suggested that combined arterial infusion chemotherapy of FAP may be feasible and a promising modality for the advanced HCC with intrahepatic metastases and/or portal vein thrombosis.