Ultrasonographic characteristics of small hepatocellular carcinoma

The ultrasonographic characteristics of hepatocellular carcinomas (HCC) were investigated. Four typical features of HCCs, "mosaic internal echo pattern", "halo", "lateral shadow" and "posterior echo enhancement", were not recognized in minute HCCs smaller than 2 cm in diameter. These characteristics developed as the tumors grew. Only hypoechoic space-occupying lesions can be considered as small HCCs. In differentiating small HCCs from hypoechoic non-malignant space-occupying lesions in the cirrhotic liver, the ratios of short to long dimensions of the lesions seemed to be important since the ratios of HCCs were significantly larger than those of non-malignant lesions. The fact that 3 hyperechoic small HCCs could not be diagnosed even by celiac arteriography has suggested to us that ultrasonically guided biopsies should be performed in order to differentiate from small hemangiomas. Serum alpha-fetoprotein (AFP) levels of 1/3 of the patients with HCCs were below 100 ng/ml, indicating that it is impossible to detect small HCCs only by measuring serum AFP.     

Clinical significant of semiquantificating DNA topoisomerase- I mRNA in colorectal cancer

PURPOSE: To examine the clinical significance of determining the expression levels of DNA topoisomerase- I (topo-I) mRNA of colorectal cancer. METHODS: The relative expression levels of topo-I mRNA in primary colorectal cancer and adjacent normal mucosa were semiquantificated by the RT-PCR method. The relative expression of thymidylate synthase (TS) mRNA of the primary lesions was also examined. RESULTS: The topo- I mRNA expression was higher in the tumorous tissue than in the normal mucosa (n=22, p<0.01). The topo- I mRNA expression did not significantly correlate with 9 clinicopathological variables examined (n=22). In patients who received irinotecan hydrochloride (CPT-11) following the failure of 5-fluorouracil-based treatment, the topoI mRNA expression did not differ nor correlate with the response to CPT-11 (PR, n=14; SD, n=11; PR; n=24) (p=0.91). In these patients, there was no relationship between the topo I mRNA expression and the TS mRNA expression (p=0.22, r=0.18). In addition, the efficacy of CPT-11 did not correlate with combinations subdivided according to the expression levels of topo- I mRNA and TS mRNA. CONCLUSIONS: Determination of topo- I mRNA levels of primary colorectal cancer may not be useful for predicting the efficacy of CPT-11 treatment alone or in combination with TS mRNA levels.     

A new, easy method for putting "U" stitches inside the chest wall

In this report, we describe a new, easy method for putting “U” stitches inside the chest wall. The method does not require extension of the skin incision nor subcutaneous dissection and it minimizes chest wall injury. This method may also be applied to other surgical fields where needles can penetrate the wall of the cavity when it is difficult to stitch from the inside of the cavity.     

Systematic node dissection by VATS is not inferior to that through an open thoracotomy: a comparative clinicopathologic retrospective study

BACKGROUND: Major pulmonary resection with systematic node dissection (SND) for early lung cancer by video-assisted thoracic surgery (VATS) is performed in many institutes, but the feasibility of SND for early lung cancer by VATS remains controversial. The aim of this study was to elucidate the feasibility and safety of SND by VATS. METHODS: Three hundred fifty patients with clinical stage I lung cancer who underwent pulmonary major resection with SND between 1998 and 2003 were enrolled in this study. Of these patients, 191 (VATS group) underwent pulmonary resection with SND by VATS; 159 patients (open thoracotomy [OT] group) did so through anterolateral thoracotomy. The clinical and pathologic data, including the number of dissected nodes in each nodal station, of the 2 groups were compared to evaluate the feasibility of SND by VATS. RESULTS: Pathologic data showed that, in the VATS group, more patients had adenocarcinoma (P = .0078) and fewer patients had advanced factors than the OT group. The greatest tumor diameter was 24.5 mm and 29.6 mm in the VATS group and OT group, respectively (P < .0001). The total number of mediastinal nodes dissected in right upper lobectomy plus right middle lobectomy (RUL+RML), right lower lobectomy (RLL), left upper lobectomy (LUL), and lower left lobectomy (LLL) also did not differ between the 2 groups. The total number of mediastinal nodes dissected in RUL+RML, RLL, LUL, and LLL was 19.7 in the VATS group versus 22.0 in the OT group (P = .122), 23.4 versus 21.0 (P = .241), 14.8 versus 17.5 (P = .123), and 18.8 versus 15.8 (P = .202), respectively. The number of dissected nodes in each nodal station in RUL+RML, RLL, LUL, and LLL was similar between the 2 groups. Operative mortality, morbidity, or recurrence did not differ between the 2 groups. CONCLUSIONS: With regard to the number of dissected nodes, SND by VATS was not inferior to that of OT. SND by VATS is technically feasible and safe, and seems acceptable for clinical stage I lung cancer.     

Diagnostic accuracy of glycohemoglobin A1c (HbA1c) for postprandial hyperglycemia was equivalent to that of fasting blood glucose

OBJECTIVES: To compare the sensitivity, specificity, and total accuracy of an HbA1c of > or =6.5% in the detection of hyperglycemia (PPHG) relative to those of a fasting blood glucose (FBG) of > or =7.0 mmol/L. METHODS: A total of 6,010 subjects (2,987 men and 3,023 women) living or working in Kasugai, Japan, underwent a medical checkup at Kasugai City Medical Care Center between April 2001 and March 2002. For the 91 subjects who had either a FBG of > or =7.0 mmol/L or an HbA1c of > or =6.5%, a 75-g oral glucose tolerance test was performed to confirm or exclude PPHG. We calculated the true- and false-positive odds ratios to evaluate the sensitivity and specificity of HbA1c relative to FBG, and compared the overall accuracy by calculating the conditional relative odds ratio (CROR). RESULTS: Among the 91 subjects, the true- and false-positive odds ratios were 0.43 (95% CI 0.26-0.69) and 0.40 (0.13-1.27) (Fisher's exact test, P < .090), respectively; the CROR was 1.07 (95% CI 0.30-3.75). CONCLUSIONS: Although the HbA1c test was marginally more specific but less sensitive than the FBG test, at the given cutoff points the accuracies of two tests were equivalent.     

The effect of heating on the dissolution of alkaline earth silicate fibers in a simple amino acid solution and water

In order to evaluate the effect of pre-heating on biosolubility and water-resistance of alkaline earth silicate (AES) fibers in MgO-SrO-SiO2 and MgO-CaO-SrO-SiO2 compositions, dissolution experiments of the heat-treated (from 110 degrees C to 1,260 degrees C) AES fibers have been carried out in a glycine solution and in distilled water at 40 degrees C for 50 h. The dissolution experiments show that the heat-treatment around 700 degrees C has made the AES fibers more soluble in the glycine solution. This is due to the phase separation of the AES fibers resulting from the heat-treatment. Probably, alkaline earth-rich glassy phases formed by the phase separation facilitate the dissolution of the heat-treated AES fibers in the glycine solution. The heat-treatment around 700 degrees C is possible to decrease the toxicity of the AES fibers further. Meanwhile, this heat-treatment around 700 degrees C has given little effect on the dissolution of the AES fibers in the distilled water. This indicates that the resistance of the AES fibers to water or humidity remains unaffected by the heat-treatment. The water-resistance is a very useful property for MMVFs. This study suggests that the heat-treatment around 700 degrees C is probably an useful treatment in order to enhance the total performance, biosolubility and water-resistance, of AES fibers.     

Evaluation of clinical efficacy of a cephem antibiotic, cefmetazole, in inflammatory infections of the upper respiratory tract

We had reported the fundamental study on the utility of a new cephem antibiotic, cefmetazole (CMZ). On the basis of the results we administered CMZ to patients to investigate its clinical utility in this study. 1. CMZ was administered to 53 patients including 4 infants. They consisted of 30 cases of acute tonsillitis, 10 of peritonsillar abscess, 10 of laryngitis or pharyngitis, and 3 of sinusitis. 2. One of 2 g CMZ was administered to an adult patient except for l case and 0.5 g to an infant patient once or twice daily for at least 3 days. The method of administration was one shot intravenous injection, intravenous drip infusion or intramuscular injection. 3. The strict criteria for evaluating the efficacy of a drug were made and used for judging the efficacy of CMZ. 4. CMZ was clinically effective in 100% of patients with acute tonsillitis, 100% of those with peritonsillar abscess, 90% of those with laryngitis or pharyngitis, and 67% of those with sinusitis. 5. Bacteriologically, a single sort of bacterium was isolated in most cases of acute tonsillitis, laryngitis and pharyngitis and in the half of cases of peritonsillar abscess. Two and more sorts of bacteria were isolated in the other cases. The main bacteria isolated were beta-Streptococcus, S. pneumoniae and H. influenzae. Anaerobic bacteria, mostly Peptococcus spp. and Peptostreptococcus spp., were detected in peritonsillar abscess. 6. The clinical results agreed with the clinicobacteriological results. All the bacteria detected before treatment of CMZ disappeared. CMZ also acted effectively in cases in which H. influenzae was suspected to be a causative organism. 7. The present results of CMZ treatment were similar to those of cefazolin (CEZ) treatment published so far. 8. Thus, CMZ was confirmed fundamentally and clinically to be a very useful drug for infection of the upper respiratory tract.