Status of treatment for the overall population of patients with stage IVb endometrial cancer,and evaluation of the role of preoperative chemotherapy: A retrospective multi-institutional study of 426 patients in Japan

Objective

We previously reported on the role of cytoreduction in 248 patients with surgical stage IVb endometrial cancer (EMCA). This study aimed to evaluate the clinical characteristics, prognosis according to initial treatment, and impact of preoperative chemotherapy in the overall population of patients with clinical and surgical stage IVb EMCA.

Methods

A multi-institutional retrospective analysis was performed in 426 patients diagnosed with clinical and surgical stage IVb EMCA from 1996 to 2005. Factors associated with overall survival (OS) were identified using univariate and multivariate analyses.

Results

The median OS for all 426 patients was 14 months. Patients were divided into three groups according to their initial treatment: primary surgery group (n = 279), primary chemotherapy group (n = 125), and palliative care group (n = 22). The median OS times for these groups were 21, 12, and 1 month, respectively (p < 0.0001). Patients in the primary surgery group had better performance status (PS) and lower numbers of extra-abdominal metastases than those in the primary chemotherapy group. Multivariate analysis identified good PS, endometrioid histology, absence of clinical intra-abdominal stage IVb metastasis, hysterectomy, and chemotherapy as independent predictors of OS. In the primary chemotherapy group, 59 patients subsequently underwent surgery, and these patients had similar OS to those in the primary surgery group.

Conclusions

Hysterectomy and chemotherapy may prolong OS in selected patients with stage IVb EMCA. Our data suggest that primary chemotherapy followed by surgery may be a useful treatment choice in patients not suitable for primary surgery.     

Chromosomal stability of second polar bodies in mouse embryos

Purpose

Incorporation of a second polar body (PB2) into one of the blastomeres has been considered as a causal mechanism underlying diploid/triploid mixoploidy in humans. Using a mouse model, we examined whether PB2s can participate in the formation of mixoploidy.

Methods

Uptake of BrdU was examined to determine DNA synthesis in PB2s up to 28 h after fertilization. PB2s from embryos at 4–6 (1-cell), 24 (2-cell), 48 (4-cell), and 72 h (morula) were fused with MII oocytes to induce premature chromosome condensation. Caspase and TUNEL assays were used to detect apoptotic PB2s at 24, 48, and 72 h. PB2s were fused with one of the blastomeres of the 2-cell embryos to produce mixoploid embryos.

Results

DNA synthesis in the PB2s continued until 22 h after fertilization. At 4–6 h, nearly all of the PB2s showed G1-type chromosomes and there was no significant increase in chromosome damage. At 24, 48, and 72 h, S-type chromatin predominated. Few PB2s showed apoptotic response until 72 h. Regardless of the fusion with the PB2, more than 90 % of the embryos developed to 4-cell stage, and over 80 % of the resultant 4-cell embryos had daughter blastomeres with a morphologically normal nucleus. Some of the daughter blastomeres displayed triploidy.

Conclusions

The PB2 is viable for at least 72 h after fertilization, with slow progression through the cell cycle. Once the PB2 has been incorporated into a blastomere, the cell cycle of the PB2 might be synchronized with that of the host resulting in diploid/triploid mixoploidy.     

Validity of the Japanese Core Outcome Measures Index (COMI)-Back for thoracic and lumbar spine surgery: a prospective cohort study

European Spine Journal - To investigate the psychometric properties of the Japanese version of the Core Outcome Measures Index-Back (COMI-Back), only recently published according to the established...     

Early rebleeding of a foramen magnum dural arteriovenous fistula: A case report and review of the literature

Foramen magnum dural arteriovenous fistula (FM-DAVF) is a subset of craniocervical junction arteriovenous fistulas. We report a rare case of FM-DAVF with early rebleeding and review the literature. A 50-year-old man experienced 3 episodes of intracranial bleeding from a vessel malformation in the acute stage. We identified an FM-DAVF, supplied by multiple feeding arteries (eg, left ascending pharyngeal artery) that drained into the straight sinus and left superior petrosal sinus. The draining vein had venous varices. We performed transarterial feeder embolization and surgical disconnection of the DAVF. Early rebleeding of FM-DAVF is rare. High-risk patients require risk assessment and appropriate treatment as soon as possible in the acute stage.     

Successful Resection of a Duodenal Fistula Complicated with Recurrent Crohn's Disease at the Site of Previous Ileocolonic Anastomosis: Report of a Case

A duodenal fistula complicated with Crohn's disease may present a difficult management problem. We herein report the case of a 22-year-old woman who developed a colo-ileo-duodenocutaneous fistula with recurrent disease at the ileotransverse anastomosis. The patient had previously undergone an ileoascending colectomy for Crohn's disease. Preoperative colonoscopy did not reveal any evidence of intrinsic duodenal Crohn's disease. Symptomatology was obstructive and a consequence of associated ileocolic lesions. The patient underwent a resection of the diseased bowel including the duodenal component of the fistula. Surgery included a simple closure of the duodenal defect with both omental pedicle graft wrapping and decompression of the duodenum via a gastrostomy tube. The patient had an uneventful postoperative course. The duodenal fistula was successfully cured. Our experience demonstrates that duodenal fistulas may be successfully treated when the duodenum is not involved with intrinsic Crohn's disease. Such treatment consists of a resection of the diseased bowel segment and a primary simple closure of the duodenal defect. Received: January 6, 2002 / Accepted: November 19, 2002 RID="*" ID="*" Reprint requests to: T. Nakagoe     

Long-term results of a prospective study of anterior decompression with fusion and posterior decompression with laminoplasty for treatment of cervical spondylotic myelopathy

Background

There have been no prospective studies comparing anterior surgery and posterior method in terms of long-term outcomes. The purposes of this study is to clarify whether there is any difference in long-term clinical and radiologic outcomes of anterior decompression with fusion (ADF) and laminoplasty (LAMP) for the treatment of cervical spondylotic myelopathy (CSM).

Effect of resuscitative endovascular balloon occlusion of the aorta in hemodynamically unstable patients with multiple severe torso trauma: a retrospective study

Background

Although resuscitative endovascular balloon occlusion of the aorta (REBOA) may be effective in trauma management, its effect in patients with severe multiple torso trauma remains unclear.

Methods

We performed a retrospective study to evaluate trauma management with REBOA in hemodynamically unstable patients with severe multiple trauma. Of 5899 severe trauma patients admitted to our hospital between January 2011 and January 2018, we selected 107 patients with severe torso trauma (Injury Severity Score >?16) who displayed persistent hypotension [≥?2 systolic blood pressure (SBP) values ≤?90 mmHg] regardless of primary resuscitation. Patients were divided into two groups: trauma management with REBOA (n?=?15) and without REBOA (n?=?92). The primary endpoint was the effectiveness of trauma management with REBOA with respect to in-hospital mortality. Secondary endpoints included time from arrival to the start of hemostasis. Multivariable logistic regression analysis, adjusted for clinically important variables, was performed to evaluate clinical outcomes.

Results

Trauma management with REBOA was significantly associated with decreased mortality (adjusted odds ratio of survival, 7.430; 95% confidence interval, 1.081–51.062; p?=?0.041). The median time (interquartile range) from admission to initiation of hemostasis was not significantly different between the two groups [with REBOA 53.0 (40.0–80.3) min vs. without REBOA 57.0 (35.0–100.0) min ]. The time from arrival to the start of balloon occlusion was 55.7?±?34.2 min. SBP before insertion of REBOA was 48.2?±?10.5 mmHg. Total balloon occlusion time was 32.5?±?18.2 min.

Conclusions

The use of REBOA without a delay in initiating resuscitative hemostasis may improve the outcomes in patients with multiple severe torso trauma. However, optimal use may be essential for success.

     

Propofol reduces liver dysfunction caused by tumor necrosis factor-α production in Kupffer cells

Purpose

The present study, conducted in rats, investigated whether propofol attenuates lipopolysaccharide (LPS)-triggered liver dysfunction via regulation of tumor necrosis factor (TNF)-α production in activated Kupffer cells.

Methods

Rats received LPS (500 μg/kg) under Urethane? sedation (1 g/kg) in combination with propofol (5 mg/kg/h) or Intralipid? from 1 h before to 6 h after LPS administration. Some rats were treated with 10 mg/kg gadolinium chloride (GdCl₃) to induce Kupffer cell depletion. The serum levels of alanine aminotransferase (ALT) and aspartate aminotransferase (AST), TNF-α mRNA and protein expression, caspase-3 activation and apoptosis were evaluated in hepatocytes. Immunofluorescence staining revealed expression of the pan-macrophage marker CD68 as well as TNF-α in Kupffer cells.

Results

ALT and AST serum levels increased approximately four-fold in LPS-exposed rats compared with Intralipid?-treated rats at 6 h after LPS administration, whereas propofol and GdCl₃ reduced the LPS-induced increases. LPS simultaneously augmented TNF-α expression in Kupffer cells, followed by increased caspase-3 activity and apoptosis in hepatocytes. Immunofluorescence staining and immunoblotting assay showed that TNF-α expression in Kupffer cells was inhibited by propofol and GdCl₃, resulting in a reduction of caspase-3 activity and apoptosis in LPS-treated rat hepatocytes.

Conclusions

Propofol (5 mg/kg/h) attenuated LPS-triggered liver dysfunction via inhibition of TNF-α production in activated Kupffer cells. These results suggest that propofol is capable of inhibiting inflammation-induced liver dysfunction in vivo.