Endoscopic Criteria for Invasive Depth of Superficial Esophageal Cancer

Abstract: The therapeutic strategy for superficial esophageal cancer should be determined by the depth of invasion. Therefore, we endeavored to develop reliable criteria for endoscopic evaluation of the invasive depth of superficial esophageal cancer. Two hundred and fifty nine superficial squamous cell carcinoma cases were enrolled in this study, designed to investigate the relationship between endoscopic classification and the depth of invasion, and also between lesion size and depth of invasion. Almost all 0-1, 0-1+0-llc, O-llc+0-lla and 0-111 lesions invaded the submucosal layer, although 0-lla and O-llb lesions were limited to the mucosal layer. The 0-llc type of lesion showed a wide range of invasive depths from M1 to SM3; in M1 cases with minimal depression the surface appears entirely smooth; in M2 cases the depressed surface is uniformly granular; and M3 cases have slightly larger granules. With submucosal cancer, the depressed surface showed some irregularity and variability in granule size. In the 0-llc type, 100% of lesions under 10 mm and 80% of those under 30 mm in greatest dimension were mucosal cancer. The accuracy of our criteria for endo-scopically evaluating the depth of invasion was 80.2%. The accuracy rate, in terms of assignment to group Ml and M2, M3 and SM1, or SM2 and SM3, was 90.6%.     

Unexpected racemization of proline or hydroxy-proline phenacyl ester during coupling reactions with Boc-amino acids

When L-proline or O-benzyl-trans-4–hydroxy-L-proline phenacyl ester was coupled with Boc-amino acids in dimethylformamide using water-soluble carbodiimide (WSCI) in the presence of anhydrous 1-hydroxybenzotriazole (HOBt) as coupling reagents, extensive racemization was observed at the Cα of the proline or hydroxy-proline residue. The extent of racemization was measured by HPLC after the coupling with Boc-L-Leu-OH in the presence or absence of HOBt. The extent of racemization increased when HOBt was added to the reaction mixture, but greatly decreased when it was not, indicating that HOBt was needed for inducing racemization. Almost no racemization was observed when the coupling reaction was carried out by the mixed anhydride procedure in tetrahydrofuran or by the carbodiimide method in dichloromethane without using HOBt. In the case of coupling reactions with ordinary L-amino acid phenacyl esters, no racemization was observed. Examination of some model systems yielded sufficient evidence to prove that HOBt is an efficient catalyst for racemizing proline or hydroxy-proline phenacyl ester not only in the stage of cyclic intermediate formation but also in the opening of the ring structure. Thus, the racemization reaction was found to be closely related to the formation of the cyclic carbinol-amine derivative.     

Studies on Vascular Endothelial Cell Damage by Polidocanol in Relation to Concentration,Ethylene-oxide Chain Length and Exposure Time

Abstract: In sclerotherapy for esophageal varices, the mechanism of intravariceal thrombus formation produced by a sclerosant (polidocanol, ethanolamine oleate, etc) is thought to be endothelial cell damage. Polidocanol (polyoxethylene monododecyl ether) has an average ethylene oxide chain length of 9 (ñ= 9) and is a non-ionic surfactant. The extent of vascular endothelial cell damage is thought to be dependent on (1) the concentration (%) of polidocanol, (2) the length of ethylene oxide chains(n), and (3) the duration of exposure of endothelial cells to the sclerosant. Using these parameters, we evaluated the efficacy of sclerotherapy in two experimental systems employing cultured human endothelial cells and canine mesenteric veins. As the sclerosant concentration was increased, the extent of cell damage became greater, suggesting that thrombus formation can be more effectively induced with a higher concentration of sclerosant. As for the length of the ethylene oxide chains, a sclerosant with ñ=12 showed markedly reduced cytotoxicity as compared to those with ñ= 6 and ñ= 8. Cytotoxicity increased in proportion to the duration of exposure to the sclerosant, suggesting that exposure time is a key determinant of vascular endothelial cell damage. From these results, it is concluded that sclerotherapy for esophageal varices will be more effective if a high concentration of sclerosant is used for large varices with high blood flow, provided that a suitable ethylene oxide chain length is used and that the sclerosant is retained in the varices for 30–60 seconds.     

SULFAPYRIDINE STONE REPORT OF A CASE

Recently it has been demonstrated that the renal tubules and the ureters might be blocked with the Acetyl Sulfapyridine crystals if large amounts of Sulfapyridine or similar drugs were administered. Antopol and Robinson reported the appearance of uroliths in monkeys, rats and rabbits following the oral administration of large amounts of Sulfapyridine. Tsao described a series of cases with renal complication after Sulfapyridine treatment. Plumer and McLellan reported two cases of Sulfapyridine renal stone in man.     

Percutaneous Balloon Mitral Commissurotomy by the Inoue Balloon Resulting in Fatal Cardiac Tamponade: Stitching Phenomenon

This article presents the first case of fatal pericardial tamponade following immediately after- successful percutaneous balloon mitral commissurotonry by the Inoue balloon. The patient had a large right atrium associated with severe tricuspid regurgitation and this led to incorrect atrial puncture (so culled stitching phenomenon) under the Inoue method fir determining the site of fossa ovalis. (J lnterven Cardiol 1994; 7:33–37)     

Case Report: Multiple Cancers: Hepatocellular carcinoma and adenocarcinomas of the common bile duct and the gall-bladder in a woman with primary biliary cirrhosis

We present a case of primary biliary cirrhosis associated with simultaneous triple cancers: a hepatocellular carcinoma and adenocarcinomas of the common bile duct and gall-bladder. A 70 year old Japanese woman, who had been diagnosed with primary biliary cirrhosis (stage 2 by Scheuer) 15 years before, was admitted to Koseiren Kamo Hospital in a comatose state. Laboratory data were as follows: the ammonia level was high (164.0 μg/dL), the antimitochondrial antibody showed a 320-fold increase, a high level of alpha-fetoprotein was indicated (2677 ng/mL), hepatitis B surface antigen was negative and hepatitis C antibody by enzyme immunoassay was negative, although a test for the RNA of hepatitis C virus by polymerase chain reaction was positive (10^3.5 copies/50 μL). The patient's condition gradually worsened and the patient died of liver failure. Autopsy showed triple cancers in the liver (hepatocellular carcinoma; trabecular type, moderately differentiated), the common bile duct (well-differentiated papillary adenocarcinoma) and the gall-bladder (well-differentiated papillary adenocarcinoma) with primary biliary cirrhosis (stage 4). Primary biliary cirrhosis has been believed to be a low risk for the development of hepatocellular carcinoma, despite the high risk of extrahepatic malignancy. The simultaneous occurrence of triple cancers with primary biliary cirrhosis, to the best of our knowledge, has never been reported. The present case may provide additional evidence for a predisposition to malignancy in primary biliary cirrhosis.     

Histopathological Features of Plasma Cell Dyscrasia with Polyneuropathy and Endocrine Disturbances, with Special Reference to Germinal Center Lesions

The biopsy and autopsy materials of 41 cases showing clinicalmanifestations consistent with those of plasma cell dyscrasiawith polyneuropathy and endocrine disturbances were studiedby light microscopy and immunohistochemistry. The results obtainedare as follows: 1) Lymph node swelling was generalized and thesize of the nodes varies up to that of a thumb tip. 2) Angiosclerosisin the germinal centers of swollen lymph nodes is one pathognomonicfeature in this disorder and was common to all the cases examinedand occurred in the early stage. 3) The other feature is monoclonalproliferation of plasma cells (plasmacytoma) occurring not onlyin the bone marrow (five biopsy cases, seven autopsy cases)but also in the lymph nodes (nine biopsy cases, four autopsycases). 4) If all the bone lesions detected roentgenologicallyare regarded as being due to monoclonal proliferation of plasmacells, it was demonstrated in 26 of 31 biopsy cases (84%) andin 14 of 16 autopsy cases (88%). This suggests that the plasmocytomaparticipates in the development of clinical manifestations ofthe disorder. 5) Besides the characteristic lesions in the lymphnodes, proliferation of small blood vessels and hemangioma-likelesions were found in the spleen, subcutaneous connective tissueand visceral adipose tissues, and hemangiomatous verrucae werealso seen in the skin. As to the pathogenesis of the vascularlesions, vasculitis may be suggested. 6) The his-tologic featuresin the other organs and tissues seem to be closely related tothe development of varied clinical manifestations and are representedby atrophy in the sural nerves, gastrocnemius muscles, and endocrineor reproductive organs.