Lactate, choline, and creatine levels measured by vitro 1H-MRS as prognostic parameters in patients with non-small-cell lung cancer

PURPOSE: To determine the biochemical characteristics of lung cancer tissue using in vitro (1)H-MRS, and investigate the correlation between survival probabilities and lactate (Lac), creatine (Cr), and choline (Cho) concentrations measured by in vitro (1)H-MRS. MATERIALS AND METHODS: A total of 21 patients with lung cancer were included in this retrospective study. (1)H-MRS spectra measurements were performed at 6.35T using a JNM-EX270, high-resolution FT-NMR spectrometer. RESULTS: When normal lung tissue was compared with lung cancer tissue, significant differences were noted most consistently in the levels of Lac and Cho, with lung cancer tissue showing higher values than normal lung tissue. Lac concentrations of lung cancer tissue were significantly higher in patients with recurrence compared to patients without recurrence (0.285 +/- 0.096 mumol/g). The mean overall survival of patients in the low-Lac group was 50.28 +/- 6.47 months, which is significantly higher compared to the high-Lac group, which had a mean survival time of only 30.49 +/- 5.41 months. CONCLUSION: Kaplan-Meier analysis of the data showed that the overall and disease-free survival probabilities were significantly higher in patients with low tumor Lac values than in those with high tumor Lac concentrations.     

Identification of homozygous deletions of tumor suppressor gene FAT in oral cancer using CGH-array

Homozygous deletions (HD) provide an important resource for identifying the location of candidate tumor suppressor genes. To identify the tumor suppressor gene in oral cancer, we employed high-resolution comparative genomic hybridization (CGH)-array analysis. We identified a homozygous loss of FAT (4q35), a new member of the human cadherin superfamily, from genome-wide screening of copy number alterations in one primary oral cancer. This result was evaluated by genomic polymerase chain reaction in 13 oral cancer cell lines and 20 primary oral cancers and Southern blot in the cell lines. We found frequent exonic HD of FAT in the cell lines (3/13, 23%) and in primary oral cancers (16/20, 80%). FAT expression was absent in these cell lines. Homozygous deletion hot spots were observed in exon 1 (9/20, 45%) and exon 4 (7/20, 35%). Moreover, loss of gene expression was identified in other types of squamous cell carcinoma. The methylation status of the FAT CpG island in squamous cell carcinomas correlated negatively with its expression. Our results identify mutations in FAT as an important factor in the development of oral cancer and indicate the importance of FATs function in some squamous cell carcinomas.     

Diagnostic mammography and ultrasonography for palpable and nonpalpable breast cancer in women aged 30 to 39 years

PURPOSE: To investigate the relationship between the tumor size of breast cancer by palpation and the sensitivity of mammography (MMG) and ultrasonography (US), and which modality can detect nonpalpable breast cancer in women aged 30 to 39 years. METHODS: We retrospectively evaluated the tumor size by palpation, breast density, and the sensitivity of MMG and US in 165 patients aged 30 to 39 years. Palpation, US, and MMG were performed with prior knowledge of the results of other modalities. The tumor size on palpation were classified into Tnp; nonpalpable, T1p; 2 cm or less, T2p; more than 2 cm, but not more than 5 cm, and T3p; more than 5 cm. RESULTS: Of 165 patients, 147 patients (89%) showed mammographically dense breasts. Of 165 cancers, 14 (8%) were Tnp, 40 (24%) were T1p, 82 (50%) were T2p, and 29 (18%) were T3p. The sensitivity of MMG was 57% (8 of 14) for Tnp, 78% (31 of 40) for T1p, 90% (74 of 82) for T2p, and 97% (28 of 29) for T3p. The sensitivity of US was 43% (6 of 14) for Tnp and 100% for palpable cancers. Of 14 nonpalpable cancers, 4 (29%), 4 (29%), and 2 (14%) could be detected by only MMG, bloody nipple discharge, and US. CONCLUSIONS: The sensitivity of MMG depends on the tumor size on palpation in this age range. MMG fails to detect relatively large palpable cancers. On the other hand, US can detect all palpable cancers. However, the sensitivity of US declines for nonpalpable cancers. For the detection of nonpalpable cancers, MMG, US, and nipple discharge are complementary modalities.     

The efficacy and safety of docetaxel for elderly advanced breast cancer patients

We studied the efficacy and safety of docetaxel (DOC) for elderly breast cancer patients. Between September 1997 and June 2003, five consecutive women with advanced breast cancers who were 75 years of age or older received DOC at a dose of 60 mg/m(2) every three weeks. No premedications to prevent hypersensitive reactions and fluid retention by DOC were given. The number of DOC dosages per case was 5-16 times (12 times the median) and the relative dose intensity (RDI) was 80-100% (95% of medians). Objective partial responses were observed in all patients. The median time to partial response was 21 days (range: 21-50 days). The median time to treatment failure was 12 months (range: 5-22 months). The grade and the frequency of major side effects were the following: leukocytopenia of grade 3 (80%), edema of grade 2-3 (40%), and alopecia of grade 2 (100%). It was concluded from these findings that DOC could be safely and effectively administered to elderly advanced breast cancer patients.     

S-1 chemotherapy for cancer of the gastric tube used for esophageal reconstruction following surgery for esophageal cancer

We used S-1 chemotherapy to treat 5 patients with cancer of the gastric tube used for esophageal reconstruction through the posterior mediastinal route following surgery for esophageal cancer. The response rate was 40%, the median survival 15 months, and 3 patients still survive. In those 3 patients, the gastric tube cancer was at a resectable stage, but the patients elected to have chemotherapy instead. One patient has survived 21 months after responding completely to 2 cycles of combined chemotherapy with S-1 and cisplatin. Another has survived 15 months after partially respondingto S-1 chemotherapy. And the third has survived 46 months after endoscopic treatment, radiation therapy and S-1 chemotherapy. S-1 chemotherapy thus appears to be an effective treatment for cancer of the gastric tube after surgery for esophageal cancer.     

A short-term outcome of endoscopic submucosal dissection (ESD) for early gastric cancer

In this study, we investigated a short-term outcome of 56 cases of ESD for early gastric cancer performed in our department concerning the tumor diameter within or over 20 mm. Seventeen lesions were larger than 21 mm (large group), and 39 lesions were within 20 mm (indication group). There was no significant difference in the background factors between the two groups. The mean operating time and median of post operative hospital stay of the large group were longer than those of the indication group, and those differences were statistically significant. On the other hand, no significant difference was seen in the rate of one-piece resection, the incidence of complications and curability. With a further improvement of our skills, an ESD application in a case where the tumor diameter is larger than 21 mm may be extended.     

A case of deep venous thrombosis associated with pegylated interferon α2b plus ribavirin treatment of chronic hepatitis C

We present a case of deep venous thrombosis (DVT) during pegylated interferon (peg-IFN)-α2b plus ribavirin treatment of chronic hepatitis C (CHC). A 67-year-old man, who had been under treatment for hypertension and diabetes mellitus, was admitted to our hospital for peg-IFN-α2b plus ribavirin treatment for CHC. His serum hepatitis C virus (HCV) RNA level became undetectable 1 week after the initiation of peg-IFN-α2b plus ribavirin treatment. He suffered from severe pain, flare, and edema in both of his lower legs 6 weeks after the initiation of peg-IFN-α2b plus ribavirin treatment. He was diagnosed as having DVT because of the presence of a thrombus in the right soleus vein by ultrasonography. Peg-IFN-α2b plus ribavirin treatment was discontinued because a causal relationship between DVT and peg-IFN-α2b plus ribavirin treatment was suspected. DVT was not observed and the symptoms in both of his legs were improved after the administration of warfarin potassium. Subsequently, DVT has not recurred, and he has remained HCV-RNA negative.     

Acute pancreatitis associated with peroral double-balloon enteroscopy： A case report

A 58-year-old Japanese man had tarry stool and severe anemia. Neither upper nor lower gastrointestinal (GI) endoscopy showed any localized lesions. Thus, the source of his GI bleeding was suspected to be in the small intestine, and he underwent peroral double-balloon enteroscopy (DBE) using EN-450T5 (Fujinon-Toshiba ES System Co., Tokyo, Japan). There were no lesions considered to be the source of GI bleeding. After the procedure, the patient began to experience abdominal pain. Laboratory tests revealed hyperamylasemia and abdominal computed tomography revealed an inflammation of the pancreas and the peripancreas. He was thus diagnosed to have acute pancreatitis. Conservative treatments resulted in both clinical and laboratory amelioration. He had no history of alcohol ingestion, gallstone disease or pancreatitis. Magnetic resonance cholangio-pancreatography demonstrated no structural alterations and no stones in the pancreatobiliary ductal system. As his abdominal pain started after the procedure, his acute pancreatitis was thus thought to have been related to the peroral DBE. This is the first reported case of acute pancreatitis probably associated with peroral DBE.