Long-term survivor of a resected undifferentiated pancreatic carcinoma with osteoclast-like giant cells who underwent a second curative resection: A case report and review of the literature

An undifferentiated carcinoma with osteoclast-like giant cell tumors (UC-OGC) is a rare type of tumor, which predominantly occurs in the pancreas. Due to the rarity of UC-OGC, sufficient clinical data are not available and its prognosis following surgical resection remains unclear. In the current report the case of a 37-year-old female is presented, in whom an UC-OGC of the pancreas was removed and following this, a second carcinoma of the remnant pancreas was removed during a second surgical procedure. At the patient’s initial admission, the preoperative images demonstrated a well-demarcated mass with a marked cystic component at the pancreatic head. The patient underwent a pylorus-preserving pancreaticoduodenectomy. The final pathological diagnosis was UC-OGC of the pancreas and the tumor was considered to have been curatively resected based on the histopathological findings. Four years after the initial surgery, a small mass was detected in the remnant pancreas and a partial resection of the remnant pancreas was subsequently performed. Histopathologically, the tumor consisted of a poorly differentiated tubular adenocarcinoma. A retrospective pathological analysis showed a segment of a poorly differentiated tubular adenocarcinoma in the initial resected specimen. Therefore, the final diagnosis was considered to be an intra-pancreatic recurrence of UC-OGC. The patient survived 66 months following the initial surgery and 18 months since the second resection. A meta-analysis was performed in the current study by comparing UC-OGC patients who survived more than two years following surgical resection (long-term survivors) with those who succumbed less than one year following surgical resection (short-term survivors). The characteristics of the short-term survivors were patients of an older age, males, and those exhibiting smaller tumors, positive lymph node metastasis, and concomitant components of ductal adenocarcinoma, as well as pleomorphic giant cell carcinoma. The concomitant component of mucinous cystic neoplasm was not considered to be a prognostic factor. To the best of our knowledge, the patient in the current report is the first five-year survivor following a curative second resection.

[Early and mid-term results after cardiac or thoracic aortic surgery in patients aged 70 years and older--survival and quality of life]

The early and mid-term survival after cardiac or thoracic aortic surgery and influence of age to the operative mortality were examined in 168 consecutive patients aged 70 years and older from August 1994 to December 1998, together with assessment of postoperative quality of life (QOL). The mean age was 74.1 +/- 3.7 years old (70 to 86 years). 80 patients had IHD, 59 had VHD, 28 had TAA. Preoperative risk score was classified in 5 groups (good, fair, poor, high, extremely high) based on Parsonnet method. Current QOL of the survivors was assessed using Asanoi method with questionnaire by a letter. There were 9 early deaths (5.4%). Following the Parsonnet model observed mortality was absolutely lower than predicted mortality. When age score was excluded in the Parsonnet model, the observed mortality became almost equal with the predicted mortality. There were 22 late deaths (6.9%/P-Y). The actuarial survival rate of age 70 to 74 group was significantly higher than the age 75 years and older group (p = 0.0021). The actuarial survival rate of TAA group was significantly lower than the VHD or IHD group (p < 0.02). Postoperative NYHA and activity score of TAA group were better than VHD or IHD group. We got satisfactory answers for operation in 95% current survivors. Patients aged 70 years and older will be undergone cardiac or thoracic aortic surgery at a reasonable risk and well satisfaction.

Creatine kinase isoforms in the seminal plasma and the purified human sperm

In previous conventional reports sperm and seminal plasma were not well separated and therefore it was highly probable that isoform (CK-BB) of seminal plasma was determined together with that of sperm. The authors developed a method to purify sperm specimen free from seminal plasma. Human sperm was purified by means of the continuous-step density gradient centrifugation with an inner column and the subsequent modified swim-up procedure. CK isoforms in the purified sperm and the seminal plasma were analyzed by ion exchange chromatography and electrophoresis. The purified sperm contained mitochondrial CK-MiMi as well as cytosolic CK, of which isoform was almost occupied by CK-MM but CK-BB was not detected. On the other hand, CK isoform in the seminal plasma was detected as CK-BB alone. CK activity in human sperm and seminal plasma were 2.0 +/- 0.7 x 10(-6) IU/10(6) sperm and 661 +/- 360 IU/L, respectively. CK activity in the seminal plasma gave no correlation with the semen parameters.

Mechanical stability of compact modules of barnase

Globular proteins are composed of structural elements such as secondary structures and modules. Modules are compact segments consisting of 10-40 contiguous amino acid residues and are often encoded by exons. Therefore, the view that the modular organization of proteins is a result of exon-shuffling or -fusion is given support. Secondary structures such as alpha-helix and beta-sheet are stabilized by hydrogen bonds and are thus considered to be stable, structural elements of a globular domain. Since module boundaries are often located on alpha-helices or beta-sheets, it is not obvious whether the modules are mechanically stable. We carried out molecular dynamics simulations on modules of barnase, a bacterial RNase from Bacillus amyloliquefaciens, for 1 ns in vacuo and 150 ps in water. Five of six modules (M1, 1-24; M2, 25-52; M3, 53-73; M4, 74-88; M5, 89-98) retained native-like conformations during these simulations. Only the C-terminal module (M6, 99-110) was deformed; it is less compact than the other modules. As the modules are mechanically stable they are suitable as parts combined into proteins. Together with RNase activity of the three isolated modules of barnase, M2, M3 and M6, our study supports the view that modules were indeed original building blocks of proteins.

Eleven-year survey of safety and efficacy of endoscopic injection sclerotherapy using 2% sodium tetradecyl sulfate and contrast medium

We conducted a retrospective 11-year survey to evaluate the post-treatment course in 285 patients with esophagogastric varices following administration of endoscopic injection sclerotherapy as an emergency, elective, or prophylactic procedure using freshly prepared 2% sodium tetradecyl sulfate not containing benzyl alcohol. These agents were injected into the varices and the supplying veins under fluoroscopic observation, usually in a single treatment. In all patients the variceal size was greatly reduced following one treatment. The amount of sclerosant necessary to fill the varices and the supplying veins varied widely among the patients. Acute variceal bleeding was controlled in 80 (96.4%) of the 83 patients, and the risk of rebleeding during the first month was 0.0548 in the emergency procedures. The serious complication of perforation was observed in one patient. The cause of death was established in the 122 patients who died and included esophageal variceal bleeding in eight (6.6%) and gastric variceal bleeding in one (0.8%). The overall 50% survival period was 5 years and 4 months. Multivariate analysis disclosed that the factors with the greatest negative effect on survival were poor hepatic status and the presence of hepatocellular carcinoma. The method of preparation and the procedure itself may be considered safe and effective in the treatment of esophagogastric varices.

Incorporation of acetyl-CoA generated from peroxisomal beta-oxidation into ethanolamine plasmalogen of rat liver

We have reported that peroxisomal beta-oxidation has an anabolic function, supplying acetyl-CoA for biosyntheses of bile acids and phospholipids. Here we deal with its role in the biosynthesis of the subclasses of ethanolamine- and choline-containing phosphoglycerides (EPG, CPG, respectively). Rats were fed for 2 weeks on chow containing 0.25% clofibrate, which inhibits cholesterol and bile acid biosyntheses, but stimulates peroxisomal beta-oxidation. [1-14C]Lignoceric acid, which is exclusively degraded by peroxisomal beta-oxidation to acetyl-CoA, was intravenously injected, and 3 h later the rats were killed. The EPG-rich and CPG-rich fractions were prepared from the liver. When they were treated with phospholipase A2, the radioactivity was predominantly recovered in the 1-radyl group. The radioactivity in EPG was easily dissociated with HCl vapor, and the lipid containing radioactivity was found to be a fatty aldehyde mixture consisting of steary aldehyde (approx. 58%) palmityl aldehyde (approx. 40%) and oleyl aldehyde (approx. 2%). Thus, in the case of EPG, acetyl-CoA from peroxisomal beta-oxidation is incorporated mainly into the 1-alkenyl group of ethanolamine plasmalogen. The radioactivity in CPG, however, was found in fatty alcohol (formed from fatty acid), but not in alkylglycerol after reduction of the fraction with Vitride. Thus, in the case of CPG, acetyl-CoA from peroxisomal beta-oxidation is exclusively incorporated into the 1-acyl group of diacyl glycerophosphocholine, but not into the 1-alkyl group. The above results were supported by the results of phospholipase C treatment. The above data indicate that peroxisomal beta-oxidation plays a role in supplying acetyl-CoA for 1-alkenyl group of plasmalogen-type phospholipid, but this channel may open only to synthesis of EPG, and almost not to CPG.

[Advantage of internal thoracic artery for coronary arterial bypass surgery in patients over 70 years of age]

Between April 1988 and September 1991, 16 among 23 patients over 70 years of age underwent coronary bypass grafting (CABG) with at least one arterial graft. The age ranged from 70 to 77 years (mean, 72.1 years) and involved coronary lesions were two vessels in two patients and three vessels in 14 patients. Seven patients with unstable angina received emergency CABG. The number of distal anastomosis with arterial graft was mean of 1.3 per patient and left internal thoracic artery (ITA) was used as a pedicled graft in all patients. Sequential grafting with left ITA arterial graft was performed in two and right gastroepiploic artery was concomitantly used in three patients. No atherosclerosis was seen in left ITA, however, poor quality saphenous vein graft (SVG) was in five and atherosclerosis of ascending aorta was in five patients. After operation deep vein thrombosis of leg after harvesting SVG occurred in one patient. The angiogram performed within one month of operation in nine patients showed that the patency rate of arterial graft was 100% and that of SVG was 94.4%. The longest follow-up period was 42 months and New York Heart Association Functional Class improved to Class I or II in all patients. The use of pedicled ITA in elderly patient showed advantage for diseased ascending aorta and it seemed to prevent the postoperative complication due to the use of SVG.

Effectiveness of house dust-mite allergen avoidance through clean room therapy in patients with atopic dermatitis

We have investigated the effectiveness of house dust-mite (HDM) allergen avoidance through clean room (CR) therapy in patients with atopic dermatitis (AD) having high HDM-specific IgE RAST levels. All patients (N = 30) demonstrated marked improvement in symptom, a long-term remission (mean, 8.4 months), and significant decreases in eosinophil count (p less than 0.01), basophil count (p less than 0.05), serum lactate dehydrogenase activity (p less than 0.01), and HDM-specific IgG levels (p less than 0.05). By contrast, the patients with AD (N = 11), who scored 0 on HDM allergen-specific IgE RAST score underwent "CR" therapy, and the patients with AD (N = 10) having high HDM-specific IgE RAST levels were hospitalized in a common sickroom (nonclean room). All the patients (N = 21) exhibited slight improvement in symptoms and a significant decrease in serum lactate dehydrogenase activity. The period of recurrence after the therapy was brief. The results of measurement of airborne house-dust particles indicated that our "CR" fell within class 10,000. Therefore, it is very likely that the mechanism at work in the CR therapeutic approach is its ability to eliminate fecal pellets of the HDM.

[A case of surgical repair of aortic dissection associated with tear of the right coronary artery]

A 39-year-old female with dissecting aortic aneurysm of DeBakey type I, underwent replacement of the ascending aorta. We found that the right coronary artery originated just distally from the left sinus of Valsalva, run transversally in the aortic wall. Because the entry of dissection occurred at the right coronary artery, it was torn longitudinally. Aorto (graft)-rt. coronary bypass grafting was performed. She had no ischemic heart symptoms postoperatively. It is supposed that the dissecting aortic aneurysm was caused by the anomalous origin of the right coronary artery.

Is recombinant human granulocyte colony-stimulating factor (G-CSF) orally available in rats?

Oral availability of recombinant human granulocyte colony-stimulating factor (G-CSF) was investigated in rats by measuring the blood total leucocyte (BTL) counts. Oral test G-CSF solution was prepared with 10% HCO-60 (polyoxyethylated, 60 mumol, castor oil derivative), 1% DK ester (sugar ester) or 10% MYS-40 (polyethyleneglycol monostearate), in which the G-CSF concentration was 500 or 250 micrograms/ml. Each test solution was injected into the duodenum of three rats at the G-CSF dose level of 300 or 600 micrograms/kg, and BTL counts were monitored for 48 h. All of the test G-CSF solution raised the BTL levels within 24 h after injection. In particular, the HCO-60 solution increased the BTL levels over 2 times as compared to the predose level at 600 micrograms/kg dose and the effect was apparently dose-dependent. A short-term study suggested that the effect of G-CSF on the BTL level appeared at the fastest at about 5 h after administration of HCO-60 test solution, 300 micrograms/kg. In view of the pattern of BTL dynamics obtained after i.v. injection of HCO-60 solution at 25 and 50 micrograms/kg, the increase of BTL levels observed after oral administration of the HCO-60 solution is considered to be due to the orally supplied G-CSF.

Immunohistochemical studies on the localization of fibronectin in human thyroid neoplastic tissues

Fibronectin (FN) has been considered to be involved in the malignant transformation of cells. It was thus of interest to morphologically study the cell surface distribution of FN in various types of thyroid neoplasms employing immunohistochemical techniques. Immunohistochemical staining using the specific anti-human FN antibody was performed by the avidin-biotin-peroxidase complex procedure. Compared to the staining pattern of normal thyroid tissues (control), differences in staining in malignant thyroid lesions and even in fetal and embryonal adenomas were evident, often on the lateral and basal aspects of the cell membrane. Colloid adenomas, however, showed FN staining on the basement membrane, basically similar to the controls. Moreover, in thyroid carcinoma, different staining patterns relating to each of the histological types were observed. The present investigation demonstrates the heterogeneity of the thyroid neoplasms in terms of FN binding.