A retrospective study on the patterns of sequential fluctuation of serum alpha-fetoprotein level during progression from liver cirrhosis to hepatocellular carcinoma

The patterns of sequential fluctuation of serum alpha-fetoprotein levels were analysed in 218 patients with liver cirrhosis in whom the serum alpha-fetoprotein levels were regularly and serially measured for more than 1 year. In the group of patients with persistently abnormal high values (greater than 50 ng/mL) over a follow-up period of more than 1 year, the incidence of the subsequent development of hepatocellular carcinoma was statistically and significantly higher (44%) compared to the other groups which showed normal (less than 20 ng/mL) or low abnormal levels (21-50 ng/mL) (16%), and transient abnormal high levels (greater than 50 ng/mL for a period of less than 1 year, mostly within 5 months) or fluctuated repeatedly between normal and transient abnormal high levels (23%). Hepatocellular carcinoma developed in 48 patients more than 2 years after the diagnosis of liver cirrhosis, and the fluctuating patterns of serum alpha-fetoprotein levels were analysed in these patients. The serum alpha-fetoprotein levels in 10 of these 48 patients stayed below 50 ng/mL until about 2.0-10.0 months before the detection of hepatocellular carcinoma and then increased steadily until the time of hepatocellular carcinoma detection. In these 10 patients, the monthly increasing ratios were approximately 1.6-4.8 times the previous values.     

Modified anatrophic partial nephrectomy with selective renal segmental artery clamping to preserve renal function: A preliminary report

Objectives: Partial nephrectomy is effective for preserving renal function, but temporary clamping of the renal artery for hemorrhagic control may impair renal function due to ischemia/reperfusion injury. Anatrophic partial nephrectomy (APNx) has been proposed to minimize renal ischemia/reperfusion injury by clamping only the feeding artery. We aimed to evaluate whether anatrophic partial nephrectomy (APNx) is useful in preserving renal function and to assess variations in renal artery anatomy to determine the feasibility of selective segmental artery clamping. Methods: We performed preoperative renal angiography to evaluate the utility of APNx. Perioperative changes in renal function were compared between the APNx group and a standard partial nephrectomy group. Results: APNx was successful in 18 patients. The mean lengths of the feeding artery on preoperative angiography were 20.5 and 6 mm for successful and unsuccessful cases, respectively. It was not difficult to clamp the feeding artery in 16 patients with lengths >10 mm or with multiple renal arteries. Evaluation of renovascular variations on 116 renal angiograms indicated that APNx was feasible for 60% and 40% on the right and left sides, respectively. The short‐term increase in the serum creatinine level was significantly smaller after APNx than it was after standard partial nephrectomy. Conclusions: APNx minimizes ischemic/reperfusion injury and preserves renal function while achieving hemorrhage control. As it can be performed safely in about 50% of cases, it may be the option for patients with renal impairment or a solitary kidney.     

Superficial small cell carcinoma of esophagus treated by endoscopic mucosal resection combined with chemoradiotherapy--a case report

The patient was a 70-year-old woman who was admitted to our hospital for positive fecal occult blood. Upper gastrointestinal endoscopy revealed a superficial plateau-type (0- I sep) submucosal cancer on the right wall of the esophagus 28 cm from the incisor. Biopsy revealed small cell carcinoma. CT scan detected neither lymph node metastasis, nor distant organ metastasis. Endoscopic mucosal resection (EMR) was performed. Post-EMR chemoradiotherapies were conducted. The patient has lived with no evidence of cancer recurrence for 40 months. This was the first case of esophageal small cell carcinoma treated by EMR combined with chemoradiotherapy.     

Significant changes in intestinal lymphatic system and immune response elicited by Peyer's patch excision in adult rats

Abstract The effect of deprivation of Peyer's patches (PP) on transport of lymphocytes through intestinal lymph and intestinal mucosal immune responses was investigated in rats. All visible PP in the rat small intestine were excised in order to examine the roles of PP in the intestinal lymphatic system and mucosal immune responses of the intestine. Two weeks after the experimental excision of PP, lymphocyte transport in intestinal lymph was significantly decreased in PP-excised rats without significant changes in lymphocyte subsets as compared with sham operated control rats. Lymphocyte subsets as determined morphometrically in the intestinal mucosa showed no significant alteration in PP-excised rats. There was a significant decrease in the number of immunoglobulin A (IgA) containing cells in the intestinal mucosa of PP-excised rats, while IgM and IgG containing cells showed no statistically significant changes in number. Conversely, the macrophages in the intestinal mucosa increased in number, suggesting the enhanced accessory functions of these macrophages. Antigen-specific immune response was further studied in PP-excised rats using intraduodenal priming and challenge with cholera toxin (CT). Both the determinations of cells producing antigen-specific antibody in the intestinal mucosa using anti-CT antibody and those of cells secreting anti-CT Ig in the intestinal lymph by enzyme-linked immunospot (ELISPOT) assay showed a significant reduction of CT-specific antibody production in PP-excised rats compared with controls. Peyer's patches appear to have an important role in lymphocyte transportation through intestinal lymph and also in mucosal immune responses.     

Severe Henoch-Schönlein Purpura with Intestinal Hemorrhagic Ulcers: Treated by Steroid Pulse Therapy

Abstract: Henoch-Schönlein purpura, associated with severe duodenal hemorrhage and gastrointestinal dysfunction, was dramatically suppressed by steroid pulse therapy. A 22-year-old male was admitted with abdominal pain, purpuric rash, and neutrophilic leukocytosis. C-reactive protein was increased and coagulation Factor XIII was markedly decreased. Upper gastrointestinal endoscopy disclosed multiple ulcers and erythema with petechiae in the postbulbar duodenum. Based on laboratory findings including examination of a skin biopsy specimen, this patient was diagnosed as having Henoch-Schönlein purpura. Despite aggressive administration of prednisolone, intravenous hyperalimentation, and Factor XIII concentrate, symptoms worsened. Steroid pulse therapy was then given for three days, resulting in amelioration of all clinical findings. The duodenal ulcers showed scarring on endoscopy. Gastrointestinal complications of Henoch-Schönlein purpura. Factor XIII concentrate therapy, and pulse steroid therapy are discussed herein.     

Measurement-specific bioavailable testosterone using concanavalin A precipitation: Comparison of calculated and assayed bioavailable testosterone

Objective:   To assess the value of calculated bioavailable testosterone (cBT) and assayed BT (aBT) for the diagnosis of late-onset hypogonadism (LOH) in middle-aged and elderly subjects.
Methods:   In order to assay serum BT, sex hormone-binding globulin was precipitated with concanavalin-A and then testosterone was measured using liquid chromatography-tandem mass spectrometry. To validate the non-sex-hormone-binding-globulin-bound testosterone, gel filtration chromatography and concanavalin-A sepharose were used. Following this validation, the usefulness between aBT and cBT was evaluated in clinical samples.
Results:   Eighty-eight healthy male volunteers (mean age 65.6 years, range: 50–86) were recruited for this study. A significant correlation was found between cBT and aBT (R² = 0.53, P  < 0.01). Mean value ratio (cBT/aBT) was 2.48. Both cBT (R² = 0.122) and aBT (R² = 0.251) decreased with age. Variations in aBT were less marked than those for cBT, suggesting that aBT can be used to determine age-related reduced testosterone levels.
Conclusion:   aBT levels are more reliable than cBT levels for the diagnosis of LOH in middle-aged and elderly subjects.     

A Case of Choledochocele Associated with Carcinoma of the Pancreas

A-59-year old woman was admitted with lumbago and back pain. An abdominal ultrasonography and abdominal computed tomography demonstrated a tumor of the body of the pancreas and multiple space occupying lesions in the liver. Endoscopic retrograde chorangiopancreatography revealed a 11 mm cystic dilatation of the terminal portion of the common bile duct protruding into the duodenal lumen and an obstruction of the pancreatic duct in the body portion. Celiac artery angiography showed an irregularity in the wall of the splenic artery. In line with these findings, the patient was diagnosed as suffering from choledochocele associated with carcinoma of the pancreas. As she already had multiple metastatic liver tumors, her treatment was limited to amelioration of her symptoms. Increasing stenosis of the common bile duct, however, required endoscopic sphinctomy and endoscopic retrograde biliary drainage. Type 3 Choledochocele of Alonso-Lej's classification is very rare, and only a few cases have been reported in association with malignant bile duct tumors. We believe this case to be the first one in our country linked with carcinoma of the pancreas.     

The expressions of p21 and pRB may be good indicators for the sensitivity of esophageal squamous cell cancers to CPT-11: Cell proliferation activity correlates with the effect of CPT-11

Previously, we demonstrated that CPT-11 is an effective agent against esophageal squamous cell cancers (ESCC), and that the protein level of DNA topoisomerase I can be a predictor for sensitivity to CPT-11 (Jpn J Cancer Res 2001; 92: 1335-41). Here, we describe our search for additional predictors of sensitivity to CPT-11, mainly among cell cycle-regulating proteins, because the cytotoxicity of CPT-11 is significantly correlated with the percentage of ESCC cells in S-phase. To this end, we selected and examined the expressions of 5 proteins involved in G1-S transition, i.e., p53, cyclin D1, p21, p27, and pRB, in 14 ESCC cell lines by western blot analysis. Among these proteins, the expression levels of p21 and pRB showed significant differences that were associated with the IC50 values for CPT-11 (P = 0.0339 and P = 0.0109, respectively). Namely, the expression of p21 or pRB independently could be a good indicator of CPT-11 efficacy in ESCC. In addition, the cell proliferation activities examined by enzyme-linked immunosorbent assay (ELISA) using 5-bromo-2'-deoxyuridine (BrdU) showed a significant correlation with the percentage of total S-phase cells (correlation coefficient = 0.568, P = 0.0324), and an inverse correlation with the IC50 values for CPT-11 (correlation coefficient =-0.601, P = 0.0213). Because, as in the case of DNA topoisomerase I, the cell proliferation activity determined using BrdU shows a close relationship with the MIB-1 labeling index, immunohistochemical studies of p21, pRB, and MIB-1 in resected ESCC specimens and/or biopsy samples could make it possible to predict more precisely the sensitivity of ESCC patients to CPT-11 prior to treatment.