Radiation therapy for nasopharyngeal carcinoma. Retrospective review of 105 patients based on a survey of Kansai Cancer Therapist Group

One hundred five patients with nasopharyngeal carcinoma were treated with radiation therapy combined with or without chemotherapy at 16 of the participating institutes in Kansai Cancer Therapist Group, Japan, from January 1978 to December 1980. The study comprised 77 males and 28 females; their ages ranged from 15 to 80 years (mean, 53 years). Five-year survival rates according to stage were as follows: Stage I, 100%; Stage II, 67%; Stage III, 44%; and Stage IV, 34%. As far as Stage IV disease was concerned, the radiation therapy only group showed significantly poorer prognosis than the combined radiation and chemotherapy group (P less than 0.05). Concerning the N stage and treatment method, the radiation therapy only group showed a higher metastatic rate than the chemotherapy combined group (35% versus 14%, P less than 0.05).     

Two cases of vocal cord dysfunction and bronchial asthma indicated contrary course of bronchial responsiveness based on astography]

We encountered two cases of patients who showed vocal cord dysfunction and bronchial asthma. By using an ++astograph , we found that bronchial responsiveness of these ailments differed. In the case of vocal cord dysfunction, bronchial responsiveness to methacholine indicated a false high level by adduction of the vocal cord. Therefore other evaluations including pulmonary function and bronchoscopy were required to distinguish it from bronchial asthma. On the other hand, in the case of bronchial asthma, bronchial responsiveness to methacholine was mild, but life threatening asthmatic attack occurred after inhalation of methacholine. Psychological factors were not neglected in considering both of these cases. Therefore we must consider these results and psychological factors when evaluating bronchial responsiveness.     

QOL assessment after palliative surgery for malignant bowel obstruction caused by peritoneal dissemination of gastric cancer: a prospective multicenter observational study

Background

Patients with peritoneal dissemination of gastric cancer have poor oral intake caused by malignant bowel obstruction (MBO). Palliative surgery has often been undertaken to improve quality of life (QOL), but few prospective studies on palliative surgery in this patient population have been published.

Patients and methods

We prospectively investigated the significance of palliative surgery using patient-reported QOL measures. Patients underwent palliative surgery by small intestine/colon resection or small intestine/colon bypass or ileostomy/colostomy for MBO. The primary endpoint was change in QOL assessed at baseline, 14 days, 1 month, and 3 months following palliative surgery using the Euro QoL Five Dimensions (EQ-5D?) questionnaire and the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire gastric cancer module (QLQ-STO22). Secondary endpoints were postoperative improvement in oral intake and surgical complications.

Results

Between April 2013 and March 2018, 63 patients were enrolled from 14 institutions. The mean EQ-5D? utility index baseline score of 0.6 remained consistent. Gastric-specific symptoms mostly showed statistically significant improvement from baseline. Forty-two patients (67%) were able to eat solid food 2 weeks after palliative surgery and 36 patients (57%) tolerated it for 3 months. The rate of overall morbidity of?≥?grade III according to the Clavien–Dindo classification was 16% (10 patients) and the 30-day postoperative mortality rate was 3.2% (2 patients).

Conclusions

In patients with MBO caused by peritoneal dissemination of gastric cancer, palliative surgery did not improve QOL while improving solid food intake, with an acceptable postoperative morbidity and mortality rate.

     

Interleukin-11 promotes T cell polarization and prevents acute graft-versus-host disease after allogeneic bone marrow transplantation.

Administration of IL-11 prevented lethal graft-versus-host disease (GVHD) in a murine bone marrow transplant (BMT) model (B6 --> B6D2F1) across MHC and minor H antigen barriers (survival at day 50: 90 vs 20%, P < 0.001). Surpisingly, IL-11 administration polarized the donor T cell cytokine responses to host antigen after BMT with a 50% reduction in IFNgamma and IL-2 secretion and a 10-fold increase in IL-4. This polarization of T cell responses was associated with reduced IFNgamma serum levels and decreased IL-12 production in mixed lymphocyte cultures (MLC). In addition, IL-11 prevented small bowel damage and reduced serum endotoxin levels by 80%. Treatment with IL-11 also reduced TNFalpha serum levels and suppressed TNFalpha secretion by macrophages to LPS stimulation in vitro. IL-11 thus decreased GVHD morbidity and mortality by three mechanisms: (a) polarization of donor T cells; (b) protection of the small bowel; and (c) suppression of inflammatory cytokines such as TNFalpha. We conclude that brief treatment with IL-11 may represent a novel strategy to prevent T cell-mediated inflammatory processes such as GVHD.     

Enhanced allostimulatory activity of host antigen-presenting cells in old mice intensifies acute graft-versus-host disease

Older bone marrow transplantation (BMT) recipients are at heightened risk for acute graft-versus-host disease (GVHD) after allogeneic BMT, but the causes of this association are poorly understood. Using well-characterized murine BMT models we have explored the mechanisms of increased GVHD in older mice. GVHD mortality, morbidity, and pathologic and biochemical indices were all worse in old recipients. Donor T cell responses were significantly increased in old recipients both in vivo and in vitro when stimulated by antigen-presenting cells (APCs) from old mice, which also secreted more TNF-alpha and IL-12 after LPS stimulation. In a B6 --> B6D2F1 model, CD4(+) donor T cells but not CD8(+) T cells mediated more severe GVHD in old mice. We confirmed the role of aged APCs in GVHD using B6D2F1 BM chimeras created with either old or young BM. Four months after chimera creation, allogeneic BMT from B6 donors caused significantly worse GVHD in old BM chimeras. APCs from these mice also stimulated greater responses from allogeneic cells in vitro. These data demonstrate a hitherto unsuspected mechanism of amplified donor T cell responses by aged allogeneic host APCs that increases acute GVHD in aged recipients in this BMT model.     

Overview of Human Salivary Glands: Highlights of Morphology and Developing Processes

Salivary glands are essential organs that produce and secrete saliva to the oral cavity. During gland morphogenesis, many developmental processes involve a series of coordinated movements and reciprocal interactions between the epithelium and mesenchyme that generate the ductal system and the secretory units. Recent studies have shown new findings about salivary gland development, particularly regarding lumen formation and expansion, with the involvement of apoptosis and cell polarization, respectively. Moreover, it has been observed that human minor salivary glands start forming earlier than previously published and that distinct apoptotic mediators can trigger duct lumen opening in humans. This review summarizes updated morphological and cellular features of human salivary glands and also explores new aspects of the human developmental process. Anat Rec, 300:1180–1188, 2017. © 2017 Wiley Periodicals, Inc.     

Clinical features of diffuse large B‐cell lymphoma with polyploidy

Polyploidy, defined as more than two sets of homologous chromosomes, is found in a variety of malignant tumors and is thought to be related to disease pathogenesis. However, there have been no studies that have investigated polyploidy in diffuse large B‐cell lymphoma (DLBCL). Here we reviewed clinicopathological features of 16 cases of DLBCL with polypoidy, which was defined as DLBCL with either near‐tetraploid or greater number of chromosomes as detected by the G‐band method. The frequency of polyploid DLBCL was 2.9 % (16/544), including 15 near‐tetraploid and one near‐pentaploid case. CD5, CD30 and EBER positive cases were 13 % (2/16), 13 % (2/16) and 6 % (1/16), respectively. Bcl2 positive cases were 75 % (12/16). The numbers of huge and multinucleated cells were higher in polyploid than in non‐polyploid DLBCL (P = 0.0029 and P < 0.0001, respectively). Clinical features of polyploid DLBCL included reduced infiltration of extranodal sites (2/15, 13 %) and major lymph node infiltration. Of seven cases that received chemotherapy, six responded to treatment and survived. Our results suggest that polyploid DLBCL represents a clinicopathologically characteristic group of DLBCL. This knowledge can be useful for informing more personalized and targeted management of DLBCL patients.     

Gum chewing enhances early recovery of bowel function following transperitoneal abdominal aortic surgery

Background and purpose

Postoperative bowel dysfunction is still a major unsolved problem following transperitoneal abdominal aortic surgery. We conducted this study to establish if gum chewing during the postoperative period promotes recovery of bowel function following abdominal aortic surgery.

Methods

The subjects were 44 patients who underwent elective abdominal aortic surgery. The patients were allocated to a control group (n?=?21), who received standard postoperative care, or a “gum group” (n?=?23), who received standard postoperative care and were also given gum to chew three times a day from postoperative day (POD) 0–5.

Results

The patient characteristics, intraoperative, and postoperative care were equivalent in both groups. Flatus was passed on POD 1.49 in the gum group and on POD 2.35 in the control group (P?=?.0004) and the time to oral intake was 3.09?days in the gum group and 3.86?days in the control group (P?=?.023). The number of days to full mobilization in the hospital room was 3.35 versus 5.59 for the gum and control groups, respectively (P?Conclusions Gum chewing enhances early recovery of bowel function following transperitoneal abdominal aortic surgery. Moreover, it is a physiologically sound, safe, and an inexpensive part of the postoperative care.     

Right atrial thrombus associated with combined valvular disease: case report

A 77-year-old man had a large right atrial (RA) thrombus associated with a combined mitral and tricuspid valve disease. Echocardiography showed a large, immobile, non-homogeneous, irregularly surfaced mass in the dilated RA, and prolapse of the anterior mitral leaflet resulting in massive mitral regurgitation. Computed tomography (CT) revealed a laminated structure with calcification and distinct margins, without invasion to the wall of the RA. On the basis of these echocardiographic and CT findings, a diagnosis of combined mitral and tricuspid valvular disease complicated with RA thrombus was made. Removal of the RA thrombus, mitral valve replacement and tricuspid annuloplasty were performed simultaneously, with successful outcome.