Intravenous cyclophosphamide pulse therapy is effective for refractory Graves' ophthalmopathy

Graves' ophthalmopathy is the most frequent extrathyroidal manifestation of Graves' disease. Although glucocorticoids and orbital radiotherapy have been used and are effective for the disease, we often experience cases refractory to either therapy. We report here a case that did not respond satisfactorily to either therapy and was later successfully treated by intravenous cyclophosphamide (IV-CY) pulse therapy. A 31 year old woman presented with typical Graves' disease and ophthalmopathy. After establishing a euthyroid state, she received intravenous glucocorticoid pulse therapy and orbital radiotherapy. Although this induced the resolution of the ophthalmopathy, it was temporary and thyroid-stimulating antibody (TSAb) increased to high titers, associated with relapse of ophthalmopathy 2 months after the treatment. Four courses of IV-CY pulse therapy were administered, which resulted in complete improvement of the symptoms and normalization of the TSAb titers. We suggest that IV-CY pulse therapy might be useful for Graves' ophthalmopathy, especially for patients refractory to glucocorticoid pulse therapy.     

Usefulness of a novel electrosurgical knife, the insulation-tipped diathermic knife-2, for endoscopic submucosal dissection of early gastric cancer

Background Although endoscopic submucosal dissection (ESD) of early gastric cancer using an insulation-tipped diathermic (IT) knife enables the removal of large and ulcerative lesions en bloc, expert endoscopic skill is required. We developed an improved IT knife (IT-2) and compared its efficacy and safety with that of the original IT knife (IT-OM). Methods We performed ESD of 602 gastric cancers. Of these, 314 previously untreated single lesions of initial onset were analyzed. Operating time, rate of en-bloc resection, and incidence of complications were compared in the IT-2 group (161 patients) and IT-OM group (153 patients). Lesions were further analyzed as to whether they met the Japanese Gastric Cancer Association indications for ESD or extended indications. Results Mean resection time was significantly shorter in the IT-2 than in the IT-OM group (48 vs 63 min). There were fewer surgeries lasting longer than 2 h in the IT-2 group than in the IT-OM group (3% vs 12%). En-bloc and margin-free resection rates in the IT-OM and IT-2 groups were 95% and 99%, respectively. Perforations occurred in 3.9% of patients in the IT-OM group and in 5% of patients in the IT-2 group (difference not significant [NS]). The incidence of postoperative hemorrhage was 7.8% in the IT-OM group and 8.7% in the IT-2 group (NS). In both groups, complications were treated endoscopically, and emergency surgery was unnecessary. Conclusion Resectability and complication rates were similar in the two groups. However, operating time was shorter with IT-2, irrespective of the indications for the performance of ESD. This study suggests benefits of the IT-2 over the IT-OM.     

A volumetric study of amygdala in cancer survivors with intrusive recollections.

BACKGROUND: Intrusive recollections, one of the re-experiencing symptoms of posttraumatic stress disorder (PTSD), frequently occur in cancer survivors rather than the full spectrum of the symptoms of PTSD. Functional neuroimaging studies of PTSD have revealed hyperresponsiveness to threat-related stimuli in the amygdala, but no volumetric studies have ever found alteration in the volume of the amygdala. The aim of the present study was to assess the possibility of structural alteration of the amygdala in cancer survivors with intrusive recollections. METHODS: Magnetic resonance imaging volumetric analysis of the amygdala was performed in 35 breast cancer survivors with a history of cancer-related intrusive recollections and 41 control breast cancer survivors who had no such history. The groups were similar in age, height, handedness, alcohol consumption, and medical characteristics except for past major depressive disorder. RESULTS: The total volume of the amygdala was significantly smaller in subjects with a history of intrusive recollections as compared with the control subjects. This finding continued to be significant after controlling for age, height, and major depressive disorder. CONCLUSIONS: These results suggest a difference in volume of the amygdala of cancer survivors according to whether they have had cancer-related intrusive recollections.     

A case of intestinal intussusception caused by multiple lipoma diagnosed preoperatively]

A 45-year-old man presented with intermittent abdominal pain for a month. Intestinal intussusception was diagnosed by the findings of abdominal ultrasonography and computed tomography. Intussusception was reduced by barium enema. Based on magnetic resonance imaging, we diagnosed intestinal intussusception due to multiple lipoma. At laparotomy, after successful reduction of the intussusception with Hutchinson's maneuver, an ileoceal resection was performed. Intussusception in adults is relatively rare and may be difficult to diagnose preoperatively. In the diagnosis of this disease, abdominal echo, CT, and MRI are useful.     

Functioning paraganglioma in the organ of Zuckerkandl associated with esophagus carcinoma: A case report

A case of extrameduflary pheochromocytoma in the organ of Zuckerkandl is reported. Moderately differentiated squamous cell carcinoma of the esophagus was found concomitantly. Despite the significant elevation of catecholamine levels in the plasma and urine, the value of vanillylmandelic acid was only slightly elevated.     

Apoptotic tumor-cell death in response to cell proliferation is influenced by p53 status in resected non-small cell lung cancer

To evaluate the influence of p53 status on postoperative survival and incidence of apoptosis (apoptotic index, AI) in non-small cell lung cancer (NSCLC), a total of 185 pathologic stage I patients were retrospectively analyzed. It was demonstrated by univariate and multivariate analyses that aberrant expression of p53 was a significant factor to predict a poor prognosis, which was caused by a significantly higher proliferative index (PI) in tumor with aberrant expression of p53 (52.7%) than that in tumor without aberrant expression of p53 (37.9%, P < 0.001). In addition, for tumor without aberrant expression of p53, mean AIs of the lowest-, the lower-, the higher-, and the highest-PI groups were 12.6, 12.9, 31.3, and 35.1, respectively, showing that incidence of apoptosis was markedly increased in response to cell proliferation (P = 0.002). In contrast, for tumor with aberrant expression of p53, no increase in incidence of apoptosis in response to cell proliferation was documented. These results clearly demonstrated that active cell proliferation and reduced apoptotic cell death in response to cell proliferation resulted in the poor postoperative prognosis in tumor with aberrant expression of p53.     

Primary lung carcinoma arising from emphysematous bullae

To clarify clinical characteristics and biological features of primary lung carcinoma arising from emphysematous bullae (EB), a total of 50 patients (49 males and one female) among all 1478 patients who underwent operation for primary lung carcinoma cases were reviewed; biological features were examined in 31 patients whose resected specimens were available for immunohistochemical staining (IHS). Thirty-one patients (62.0%) had pathologic stage I disease, and 30 cases (60.0%) had poorly differentiated tumor, demonstrating earlier pathologic stages and poorer cell differentiation of lung carcinoma with EB as compared with that without EB. The mean proliferative index (PI) for carcinoma with EB was 64.0%, which was significantly higher than that for carcinoma without EB (47.2%, P = 0.001); no significant difference in Apoptotic index (AI) was demonstrated. Aberrant p53 expression was less frequent in carcinoma with EB (29.0%) than in carcinoma without EB (47.9%, P = 0.043). Five-year survival rates for carcinoma with and that without EB were 50.3 and 46.9%, respectively, showing no significant difference. Multivariate analysis did not demonstrate that association of EB was a significant prognostic factor. In conclusion, although with the poorer cell differentiation and accelerated proliferative activity of lung carcinoma arising from EB, this does not have a significantly different prognosis than primary lung carcinoma not associated with bullae.     

Expression of cyclooxygenase-2 in primary and remnant gastric carcinoma: comparing it with p53 accumulation,Helicobacter pylori infection,and vascular endothelial growth factor expression

BACKGROUND AND OBJECTIVES: Cyclooxygenase-2 (COX-2) expression may contribute to the synthesis of prostanoids, which have been related to carcinogenesis and tumor progression. It is well known that the gastric remnant is at greater risk of the development of gastric cancer than is the whole stomach; incidence rates for gastric cardia adenocarcinoma are rising in the United States and Europe. Our objective was to determine the involvement of COX-2 in primary and remnant gastric cancer tissues as well as in adjacent noncancerous mucosa. METHODS: We investigated the expression of COX-2 in 91 human gastric cancer tissue and adjacent noncancerous mucosa samples (40 remnant gastric cancer, 37 gastric cardia cancer, and 14 gastric corpus and antrum cancer), using immunohistochemistry. In addition, p53 expression, Helicobacter pylori infection, and vascular endothelial growth factor in the tissues were evaluated by immunohistochemical staining and compared with COX-2 expression. RESULTS: There were no significant differences in clinicopathological data in the gastric cancer tissues. There was a significant relation between the expression of COX-2 and p53 in gastric cancer tissues (P = 0.0048). However, vascular endothelial growth factor expression and Helicobacter pylori infection showed no correlation with the expression of COX-2. In the case of adjacent noncancerous mucosa, the positive rate of COX-2 expression was significantly higher in the remnant gastric cancers (75.0%) than in the primary gastric cancers (25.5%) (P < 0.0001). CONCLUSIONS: This information may help in the analysis of the carcinogenesis of gastric cancer; there is also a possibility that the COX-2 selective inhibitor to the remnant gastric cancer has a chemopreventive effect.     

Predictive value of dihydropyrimidine dehydrogenase expression in tumor tissue,regarding the efficacy of postoperatively administered UFT (Tegafur + Uracil) in patients with p-stage I nonsmall-cell lung cancer

BACKGROUND AND OBJECTIVES: Dihydropyrimidine dehydrogenase (DPD) activity in tumor cells has been suggested to be one of the factors determining the effectiveness of 5-fluorouracil (5-FU). In the present study, we analyzed DPD expression in tumors and investigated retrospectively the relationship between the efficacy of UFT (Tegafur + Uracil) as adjuvant chemotherapy and DPD expression in nonsmall-cell lung cancer (NSCLC). METHODS: DPD expression of 166 resected p-stage I NSCLC was examined immunohistochemically. Patients who were administered UFT alone as adjuvant therapy comprised the UFT group (n = 54), and those who underwent only surgery comprised the control group (n = 112). DPD expression was categorized as either high or low, according to intensity of staining. RESULTS: DPD expression was high in 98 patients (59.0%) and low in 68 patients (41.0%). Patients with low-DPD tumors who were administered UFT had a significantly better prognosis than those who did not receive adjuvant treatment (P = 0.021). No significant difference was found between the two groups of patients with high-DPD tumors (P = 0.598). CONCLUSIONS: DPD expression may predict the efficacy of UFT after surgery for p-stage I NSCLC. A prospective study is needed to confirm the role of DPD expression as a predictor of UFT efficacy.