Bedrock sculpting under an active alpine glacier revealed from cosmic-ray muon radiography

Mountain glaciers form landscapes with U-shaped valleys, roche moutonées and overdeepenings through bedrock erosion. However, little evidence for active glacial carving has been provided particularly for areas above the Equilibrium Line Altitude (ELA) where glaciers originate. This is mainly due to our lack of information about the shape of the bedrock underneath active glaciers in highly elevated areas. In the past years, the bedrock morphology underneath active glaciers has been studied by geophysical methods in order to infer the subglacial mechanisms of bedrock erosion. However, these comprise surveys on the glaciers' surface, from where it has been difficult to investigate the lateral boundary between the ice and the bedrock with sufficient resolution. Here we perform a muon-radiographic inspection of the Eiger glacier (Switzerland, European Alps) with the aid of cosmic-ray muon attenuation. We find a reach (600 × 300 m) within the accumulation area where strong lateral glacial erosion has cut nearly vertically into the underlying bedrock. This suggests that the Eiger glacier has profoundly sculpted its bedrock in its accumulation area. This also reveals that the cosmic-ray muon radiography is an ideal technology to reconstruct the shape of the bedrock underneath an active glacier.

First muography of Stromboli volcano

Muography consists in observing the differential absorption of muons – elementary particles produced through cosmic-ray interactions in the Earth atmosphere – going through the volcano and can attain a spatial resolution of tens of meters. We present here the first experiment of nuclear emulsion muography at the Stromboli volcano. Muons have been recorded during a period of five months by a detector of 0.96 m² area. The emulsion films were prepared at the Gran Sasso underground laboratory and were analyzed at Napoli, Salerno and Tokyo scanning laboratories. Our results highlight a significant low-density zone at the summit of the volcano with density contrast of 30–40% with respect to bedrock. The structural setting of this part of the volcanic edifice controls the eruptive dynamics and the stability of the “Sciara del Fuoco” slope, which is affected by recurrent tsunamigenic landslides. Periodical imaging of the summit of the Stromboli volcano such as that provided by muography can become a useful method for studying the evolution of the internal structure of the volcanic edifice.

Laparoscopic Partial Cystectomy With Excision of Mesh Migration Into the Bladder Following Repair of Inguinal Hernia

Migration of hernia mesh into the bladder is a rare complication of inguinal hernioplasty. We present the case of an 85-year-old man who complained of hematuria and fever some 20 years after right hernioplasty. Cystoscopy and computed tomography revealed mesh migration into the right anterior wall of the bladder. Laparoscopic partial cystectomy with excision of the migrated mesh was performed successfully. To our knowledge, this is the first case of mesh migration into the bladder treated by laparoscopic partial cystectomy.

[A Case of Perirenal Non-Specific Lymphadenitis Resected by Laparoscopic Operation for the Possibility of Malignancy]

Various types of tumors, including benign tumors, arise from the renal parenchyma or renal capsule, but it is difficult to predict the histological type preoperatively. Here, we report a case of perirenal non-specific lymphadenitis resected laparoscopically. A 79-year-old man with a history of diabetic mellitus and noninvasive bladder cancer had an incidentally-detected enhanced mass in contact with the surface of the left kidney. Given the possibility that the tumor was malignant, we resected the mass laparoscopically. Intraoperative findings revealed that the tumor did not invade the renal parenchyma, and it could be easily resected. Microscopic findings showed that the tumor consisted of inflammation of a lymph node, lymphoid follicles with hyperplasia of germ center and granulomatous inflammation with giant cells, and there was no malignant finding. Despite various additional examinations, the specific cause of the lymphadenitis was not clarified, leading to a final diagnosis of non-specific lymphadenitis. To our knowledge this is the first report about perirenal non-specific lymphadenitis difficult to distinguish from perirenal malignant tumor in preoperative computed tomography imaging.

[MID-TERM ONCOLOGICAL OUTCOME AND TECHNICAL MODIFICATIONS FOR LAPAROSCOPIC RADICAL CYSTECTOMY AT OUR INSTITUTION: 60 CASES ANALYSIS]

(Objective) Although laparoscopic radical cystectomy (LRC) is becoming a standard care for invasive and high-risk non-invasive bladder cancer in Japan, the data about mid-and long-term oncological outcome is still lacking. We previously reported our initial experience of LRC compared to open radical cystectomy. In this study, we evaluated mid-term oncological outcome for LRC by updating our clinical data. In addition, we evaluated the effect of technical modifications for LRC. (Patients and methods) From March 2005 to September 2015, 60 patients underwent LRC at our institution. Treatment outcomes including surgical and oncological outcomes were analyzed. We also assessed the effect of technical modifications between first 30 cases and second 30 cases as to blood loss, operating time and complication rate. (Results) The overall complication rate was 47%, including 18% serious complications (Clavien score 3 or greater). The 5-year recurrence-free survival, cancer-specific survival, and overall survival were 56.2%, 74.4%, and 63.6%, respectively. The recurrence occurred in 19 (32%) cases, including distant metastasis in 12 (20%) cases, local recurrence in 6 (10%) cases, and both in 1 (2%) cases. As for the effect of technical modifications for LRC, the blood loss decreased and postoperative recovery was faster in second 30 cases. (Conclusion) These results indicate that LRC could be performed safely with acceptable oncological outcomes.

[CLINICAL FACTORS ASSOCIATED WITH SPONTANEOUS PASSAGE OF URETER STONES IN CONSERVATIVE MANAGEMENT: 6 mm IN MAXIMAL STONE SIZE MEASURED BY ULTRASONOGRAPHY CAN BE A PREDICTIVE BORDER]

(Purpose) To date there was no consensus regarding expectant size of stone and time to expulsion in the conservative treatment of ureter stones. The aim of this study was to find the clinical factors associated with stone passage by evaluating the outcome of ureter stones with expectant management in Japanese. (Materials and methods) A total of 679 ureter stone cases who visited our hospital with acute real colic and/or hematuria between 2009 and 2013, and who had decided to be treated by expectant management with or without medical expulsive therapy were enrolled in this study. All cases were examined size, location and presence of stone, and degree of hydronephrosis with ultrasonography. The examined data plus clinical data such as gender, age, side and body mass index were analyzed to find the factors related to spontaneous passage of ureter stones. Statistical analysis was performed to predict whether the factors were associated with the ureteral stone expulsion or not. (Results) Accumulated residual stone curve using Kaplan-Meier method showed time to 50%-expulsion as 15.7 days in cases with stone size no more than 6.0 mm and that as 21.8 days in those with greater than 6.0 mm, and time to 50%-expulsion as 28.8 days in cases with upper ureter stone whereas 15.6 days in those with middle or distal ureter stone. Analysis in groups with 1 mm-interval in stone size showed statistical significance only when compared 5-6 mm group with 6-7 mm group in size. Multivariate analysis showed stone size and location as statistically significant and independent factors to predict time to expulsion within 30 days. (Conclusion) Stone size and location was statistically reconfirmed to be associated with spontaneous passage in expectant management of ureter stones. This study statistically demonstrated the possibility that 6 mm in maximal stone size measured by ultrasonography can be a predictive border. 75% of ureter stones within 6 mm in maximal size measured by ultrasonography may expect to be expelled within 30 days.

[A NOVEL SCORING SYSTEM: PREDICTING SEPTIC SHOCK AT DIAGNOSIS EASILY IN ACUTE COMPLICATED PYELONEPHRITIS PATIENTS]

(Objectives) Because acute complicated pyelonephritis can easily cause sepsis and concomitant shock status, it is a potentially lethal disease. However, the predictors for the severity of pyelonephritis is not well analyzed. In this study, we aimed at clarifying the clinical characteristic risk factors associated with septic shock in patients with acute complicated pyelonephritis. (Materials and methods) From May 2009 to March 2014, 267 patients with acute complicated pyelonephritis were treated at our institution. We investigated the characteristics of the patients associated with septic shock, and assessed risk factors in these patients. By using these risk factors, we established a novel scoring system to predict septic shock. (Results) 267 patients included 145 patients with ureteral calculi and 75 patients with stent-related pyelonephritis. Septic shock occurred in 35 patients (13%), and the mortality rate was 0.75%. Multivariate analysis revealed that (P): Performance Status ≥3 (p=0.0014), (U): Presence of Ureteral calculi (p=0.043), (S): Sex of female (p=0.023), and (H): the presence of Hydronephrosis (p=0.039) were independent risk factors for septic shock. P.U.S.H. scoring system (range 0-4), which consists of these 4 factors, were positively correlated with the rate of septic shock (score 0: 0%, 1: 5.3%, 2: 3.4%, 3: 25.0%, 4: 42.3%). Importantly, patients with 3-4 P.U.S.H. scores were statistically more likely to become septic shock than those with 0-2 score (p=0.00014). (Conclusions) These results suggest that P.U.S.H. scoring system using 4 clinical factors is useful to predict the status of septic shock in patients with acute complicated pyelonephritis.

[A Case of Adrenergic Crisis Caused by Spontaneous Rupture of Cystic Pheochromocytoma]

Pheochromocytoma crisis is a life-threatening situation. Herein we report a case of catecholamineinduced crisis caused by the rupture of cystic pheochromocytoma. A 76-year-old man with hypertension was referred to our hospital because of a cystic tumor in the retroperitoneal space adjacent to the aorta, which was suspicious of pheochromocytoma. Two days after admission, lower abdominal pain suddenly appeared, followed by hypertension with systolic pressure of 260 mmHg. Computed tomography revealed that the cystic tumor was ruptured spontaneously, leading to diagnosis of pheochromocytoma crisis. His blood pressure was successfully managed by medical treatment and he could recover from crisis. After adequate medical preparation by an α-adrenergic blocker, the tumor was successfully removed by laparoscopy, though the adhesion around the tumor was severe. To our knowledge adrenergic crisis caused by spontaneous rupture of cystic pheochromocytoma is rare, but we have to keep in mind that cystic pheochromocytoma can cause life-threatening crisis by the release of catecholamine due to rupture.

[A case of chronic expanding hematoma with xanthogranuloma in retroperitoneal space]

Chronic expanding hematoma (CEH), which is defined as persistent hematoma manifesting as enlarging space-occupying mass, rarely occurs in the retroperitoneal space. Here, we report a case of retroperitoneal CEH with xanthogranulama. A 72-year-old man with a history of genuine polycythemia was admitted for idiopathic renal subcapsular hematoma 3 years ago. Regular follow-up imaging revealed that the hematoma was gradually expanding in the left retroperitoneal space with the capsules invading psoas muscles. Given the possibility that the mass was a neoplastic intratumoral hemorrhage, we resected the mass. Complete removal of the capsule was impossible due to severe adhesion and its extension in his psoas muscles. Moreover, postoperative bleeding from psoas muscles occurred and emergency exploration to control the bleeding was required. Microscopic findings showed that the hematoma capsule consisted of collagenous tissue with chronic inflammatory infiltrate and foreign-body granuloma with foam cells and giant cells. The final diagnosis was CEH with xanthogranuloma. Our case suggests that early resection for retroperitoneal CEH may be desirable to avoid severe adhesion and invasion around the capsule.

Determining the efficacy of ultrasonography for the detection of ureteral stone

OBJECTIVE

To assess the efficacy of ultrasonography (US) for the detection of ureteral stone using non-contrast-enhanced computed tomography (NCCT) as a standard reference.

MATERIALS AND METHODS

From January 2009 to September 2011, 428 patients underwent both NCCT and US on the same day. The sensitivity and specificity of US to detect ureteral stone was evaluated. The detection rates using US imaging were examined according to location and stone size. The sizes of stones determined in the longest axis of NCCT and US were compared. We also performed group classification based on size to examine whether stone sizes measured by NCCT and US were similar. Moreover, the factors that may affect the detection of ureteral stone by US were analyzed.

RESULTS

Out of 856 ureters, NCCT could detect 171 stones in 169 patients, whereas US could detect 98 stones, yielding a sensitivity of 57.3% and a specificity of 97.5%. Expectedly, detection rate of US increased with stone size but was lower for distal ureter. With hydronephrosis, the sensitivity of US improved from 57.3% to 81.3%. Stone sizes measured by US correlated positively with those by computed tomography, and were concordant with those of NCCT in 68 of 98 patients (69.4%). Interestingly, stone size and the presence of hydronephrosis were factors that independently affected ureteral stone detection by US.

CONCLUSION

These results indicate that US may be useful as an initial imaging modality for detecting ureteral stone.

[A case of lymphoepithelioma-like carcinoma of the bladder]

Lymphoepithelioma-like carcinoma (LELC) of the bladder is very rare and only a few cases have been reported so far. Here, we report a case of LELC of the bladder with distant metastasis. A 73-year-old man presented with macroscopic hematuria and miction pain. Cystoscopy revealed non-papillary tumor and tissue biopsy was performed. Histopathological examination showed pure type of LELC in the bladder. Fludeoxyglucose positron emission tomography revealed lymph node metastasis. The tumor progressed rapidly and the patient died 4 months later. Although the prognosis of pure type of LELC has been reported to be good, our case indicates that the prognosis of pure type with distant metastasis may be poor.

The efficacy of ultrasonography for the detection of renal stone

OBJECTIVE

To assess the efficacy of ultrasonography (US) for detecting renal stone using noncontrast enhanced computed tomography (NCCT) as a standard reference.

METHODS

We performed a retrospective study of 428 patients who underwent NCCT and US imaging on the same day from January 2009 to September 2011. The sensitivity of US to detect each individual stone and at least 1 stone per kidney was evaluated. The detection rates according to the location and stone size were also examined. We compared the sizes of stones determined in the longest axis of NCCT and US, and performed group classification based on size to examine whether stone sizes measured by NCCT and US were similar.

RESULTS

Of 856 kidneys, NCCT detected 474 stones in 361 kidneys, whereas US detected 332 stones of 474 stones detected by NCCT, yielding a sensitivity of 70.0% and a specificity of 94.4%. Similarly, US alone detected at least 1 stone in 285 kidneys, yielding a sensitivity of 78.9% and a specificity of 83.7%. Expectedly, the detection rate for the left upper calyx was lower than that for other sites (P = .002), and the detection rate increased with stone size. Furthermore, stone sizes obtained by US were positively correlated with those obtained by CT, and stone size measurement by NCCT and US was concordant in 240 of 332 cases (72%). Importantly, stone size was only a factor that affected renal stone diagnosis using US.

CONCLUSION

US is an effective imaging modality for detecting renal stones.

Hemoadsorption of high-mobility group box chromosomal protein 1 using a column for large animals

BACKGROUND

High-mobility group box chromosomal protein 1 (HMGB1) has recently been identified as an important mediator of various kinds of acute and chronic inflammation. A method for efficiently removing HMGB1 from the systemic circulation could be a promising therapy for HMGB1-mediated inflammatory diseases.

MATERIALS AND METHODS

In this study, we produced a new adsorbent material by chemically treating polystyrene fiber. We first determined whether the adsorbent material efficiently adsorbed HMGB1 in vitro using a bovine HMGB1 solution and a plasma sample from a swine model of acute liver failure. We then constructed a column by embedding fabric sheets of the newly developed fibers into a cartridge and tested the ability of the column to reduce plasma HMGB1 levels during a 4-hour extracorporeal hemoperfusion in a swine model of acute liver failure.

RESULTS

The in vitro adsorption test of the new fiber showed high performance for HMGB1 adsorption (96% adsorption in the bovine HMGB1 solution and 94% in the acute liver failure swine plasma, 2 h incubation at 37°C; p < 0.05 vs. incubation with no adsorbent). In the in vivo study, the ratio of the HMGB1 concentration at the outlet versus the inlet of the column was significantly lower in swine hemoperfused with the newly developed column (53 and 61% at the beginning and end of perfusion, respectively) than in those animals hemoperfused with the control column (94 and 93% at the beginning and end of perfusion, respectively; p < 0.05). Moreover, the normalized plasma level of HMGB1 was significantly lower during perfusion with the new column than with the control column (p < 0.05 at 1, 2, and 3 h after initiation of perfusion).

CONCLUSION

These data suggest that the newly developed column has the potential to effectively adsorb HMGB1 during hemoperfusion in swine.

[A case of abscess of corpus spongiosum associated with rectal cancer]

A 72-year-old man was admitted with a chief complaint of fever and bloody feces. Rectal cancer was detected with colon fiber, and hematuria and abdominal pain appeared. Fluid-filled tissue in the corpus spongiosum and the rectum were detected by computed tomographic scan and magnetic resonance imaging, indicating that the abscess with necrotized tissue developed in them. Perineal skin and tissue were incised to drain and debride the necrotic tissue, which revealed that a drop of pus and the necrotic tissue were limited in the corpus spongiosum. Based on the imaging findings and the intraoperative findings, we finally diagnosed it as abscess of corpus spongiosum. Then we set a drainage tube around corpus spongiosum and closed the incision. The postoperative course was uneventful, followed by a second operation for the treatment of the rectal cancer. To our knowledge, this is the first report of abscess of corpus spongiosum.

Increased plasma levels of high mobility group box 1 in patients with acute liver failure

BACKGROUND

High-mobility group box 1 (HMGB1) is a monocyte-derived late-acting inflammatory mediator, which is released in conditions such as shock, tissue injury and endotoxin-induced lethality. In this study, we determined the plasma and hepatic tissue levels of HMGB1 in patients with acute liver failure (ALF).

PATIENTS AND METHODS

We determined the plasma levels of HMGB1 and aspartate aminotransferase (AST) in 7 healthy volunteers (HVs), 40 patients with liver cirrhosis (LC), 37 patients with chronic hepatitis (CH), 18 patients with severe acute hepatitis (AH), and 14 patients with fulminant hepatitis (FH). The 14 patients with FH were divided into two subgroups depending upon the history of plasma exchange (PE) before their plasma sample collection. The hepatic levels of HMGB1 were measured in tissue samples from 3 patients with FH who underwent living-donor liver transplantation and from 3 healthy living donors. Hepatic tissue samples were also subjected to immunohistochemical examination for HMGB1.

RESULTS

The plasma levels of HMGB1 (ng/ml) were higher in patients with liver diseases, especially in FH patients with no history of PE, than in HVs (0.3 ± 0.3 in HVs, 4.0 ± 2.0 in LC, 5.2 ± 2.6 in CH, 8.6 ± 4.8 in severe AH, 7.8 ± 2.7 in FH with a history of PE, and 12.5 ± 2.6 in FH with no history of PE, p < 0.05 in each comparison). There was a strong and statistically significant relationship between the mean plasma HMGB1 level and the logarithm of the mean AST level (R = 0.900, p < 0.05). The hepatic tissue levels of HMGB1 (ng/mg tissue protein) were lower in patients with FH than in healthy donors (539 ± 116 in FH vs. 874 ± 81 in healthy donors, p < 0.05). Immunohistochemical staining for HMGB1 was strong and clear in the nuclei of hepatocytes in liver sections from healthy donors, but little staining in either nuclei or cytoplasm was evident in specimens from patients with FH.

CONCLUSION

We confirmed that plasma HMGB1 levels were increased in patients with ALF. Based on a comparison between HMGB1 contents in normal and ALF livers, it is very likely that HMGB1 is released from injured liver tissue.

[Laparoscopic partial nephrectomy for renal leiomyoma: a case report]

A 60-year-old man visited our hospital with a complaint of right renal incidentaloma which was pointed out on abdominal ultrasonography for a medical check-up. Abdominal computed tomography showed a renal tumor in the right kidney, which was a slightly high-dense relative to the renal parenchyma and was enhanced in the arterial phase. The tumor had grown gradually from 1.4 to 1.7 cm in diameter. After the observation for 4 years, he underwent pure laparoscopic non-ischemic partial nephrectomy using a microwave tissue coagulator. Histological examination of the specimen revealed a leiomyoma of the kidney. This is the 5th case of successful laparoscopic partial nephrectomy for renal leiomyoma in Japan within the retrieved references.

[A case of small cell carcinoma of the renal pelvis]

A 77-year-old man visited our hospital with a chief complaint of asymptomatic gross hematuria. He was diagnosed with right renal pelvic tumor (7 cm) involving right renal hilar and inter-aortocaval lymph node metastases by radiological evaluation, and cytologic examination of urine indicated small cell carcinoma. After neoadjuvant chemotherapy with gemcitabine and cisplatin, right nephroureterctomy with bladder cuff, and right renal hilar and inter-aortocaval lymph node dissection was performed. Histological examination of the specimen revealed a small cell carcinoma of the renal pelvis (ypT3N2). After the operation, adjuvant chemotherapy with etopside and carboplatin was administered in combination with radiation therapy. At 5 months after the operation, there has been no evidence of recurrence. To our knowledge, this is the 38th report of a small cell carcinoma originating from the kidney in the literature.

[Assessment of clinical usefulness of Eviprostat for benign prostatic hyperplasia--comparison of Eviprostat tablet with a formulation containing two-times more active ingredients]

We compared the usefulness of Eviprostat tablet, a therapeutic agent for benign prostatic hyperplasia (BPH), and EVI-F tablet, a new formulation of Eviprostat containing two times more active ingredients (Chimaphila umbellata extract, Populus tremula extract, Pulsatilla pratensis extract, Equisetum arvense extract and purified wheat germ oil) and consequently designed to reduce the number of tablets per dose by half. In this study, patients with BPH were randomly assigned to either Eviprostat group (6 tabs/day) or EVI-F group (3 tabs/day) using the envelope method. The clinical efficacy of these two drugs were evaluated by the International Prostate Symptom Score (IPSS) and QOL score at the end of the treatment period, and their safety was evaluated by the incidence of side effects. Based on the clinical study guidelines for dysuria, the change in the IPSS total score and QOL score were comparable to the previously reported data for other treatment agents for BPH, and these indices showed gradual improvement with the treatment period. Both treatments were well tolerated. The clinical usefulness of the monotherapy with EVI-F tablet or Eviprostat tablet was reasonably demonstrated in this study. Furthermore, both treatments reduced nocturia, which has an impact on the QOL of patients with BPH.

Transurethral coil embolization for the management of ureteroarterial fistula: a case report

A 71-year-old woman who had undergone a total abdominal hysterectomy and pelvic irradiation for cervical cancer and fecal diversion for adhesive ileus was referred to us for a "left" ureteral stone and intermittent gross hematuria. Bilateral ureteral stents had been indwelled because of lower ureteral strictures for a long time. Hematuria continued after the removal of the ureteral stone, and she once went into hypovolemic shock at the time of exchange of the right ureteral catheter. Selective arteriography revealed a "right" ueteroarterial fistula. Endovascular management alone failed to resolve the fistula, but a subsequent transurethral metal coil embolization was effective, and the hematuria was relieved. She is still free from disease at 7-month followup. As far as we know, there has been no previous report of a transurethrally managed ureteroarterial fistula.

Apoptosis and the expression of Bax and Bcl-2 in hyperplasia and adenocarcinoma of the uterine endometrium

BACKGROUND

Apoptosis plays a crucial role in carcinogenesis in various tumours. This study was designed to investigate the occurrence of apoptosis and the expression of Bcl-2 and Bax proteins in endometrial tumours of corpus uteri.

METHODS

Endometrial tissues were obtained from 20 patients with endometrioid adenocarcinoma, 16 patients with endometrial hyperplasia, and 4 patients with myoma uteri (which were used as controls). The occurrence of apoptosis was examined by using molecular biochemical techniques. The expression of Bcl-2 and Bax proteins was also investigated using immunohistochemical staining with appropriate antibodies.

RESULTS

The labelling of DNA in situ indicated that apoptotic cells were sporadically seen in postmenopausal endometrium (5.2 +/- 2.1, n = 4) and endometrial hyperplasia without atypia (2.6 +/- 0.5, n = 9). In contrast, labelled cells were detected in atypical endometrial hyperplasia (15.9 +/- 2.2, n = 7), and their numbers increased intensely in adenocarcinoma (29.3 +/- 3.7, n = 20). Autoradiographic analysis revealed DNA laddering in many cases of carcinoma. Bcl-2 was highly immunopositive in hyperplasia without atypia (36.2 +/- 6.5%, n = 9), but was decreased in the atypical endometrial hyperplasia (16.3 +/- 4.8%, n = 7). Large fractions of the carcinoma (6.3 +/- 1.8%, n = 20) and normal endometrium (2.8 +/- 1.4%, n = 4) were immunonegative or slightly immunopositive to Bcl-2. In contrast, Bax immunoreactivity was more frequent and stronger in adenocarcinoma (43.6 +/- 4.1%, n = 20) than that in normal endometrium (17.6 +/- 6.7%, n = 4) and hyperplasia (7.2 +/- 2.2%, n = 16).

CONCLUSIONS

These results suggest that cells in hyperplasia expressing Bcl-2 might have prolonged survival ability. Neoplastic cells in adenocarcinoma might show apoptosis in association with a decreased expression of Bcl-2 and an increased expression of Bax. Therefore, the frequency of apoptosis and the expression of Bcl-2 and Bax might be correlated with carcinogenesis in the uterine endometrium of humans.

Interleukin-2 receptor beta subunit-dependent and -independent regulation of intestinal epithelial tight junctions

Interleukin (IL)-15 is able to regulate tight junction formation in intestinal epithelial cells. However, the mechanisms that regulate the intestinal barrier function in response to IL-15 and the involved subunits of the IL-15 ligand-receptor system are unknown. We determined the IL-2Rbeta subunit and IL-15-dependent regulation of tight junction-associated proteins in the human intestinal epithelial cell line T-84. The IL-2Rbeta subunit was expressed and induced signal transduction in caveolin enriched rafts in intestinal epithelial cells. IL-15-mediated tightening of intestinal epithelial monolayers correlated with the enhanced recruitment of tight junction proteins into Triton X-100-insoluble protein fractions. IL-15-mediated up-regulation of ZO-1 and ZO-2 expression was independent of the IL-2Rbeta subunit, whereas the phosphorylation of occludin and enhanced membrane association of claudin-1 and claudin-2 by IL-15 required the presence of the IL-2Rbeta subunit. Recruitment of claudins and hyperphosphorylated occludin into tight junctions resulted in a more marked induction of tight junction formation in intestinal epithelial cells than the up-regulation of ZO-1 and ZO-2 by itself. The regulation of the intestinal epithelial barrier function by IL-15 involves IL-2Rbeta-dependent and -independent signaling pathways leading to the recruitment of claudins, hyperphosphorylated occludin, ZO-1, and ZO-2 into the tight junctional protein complex.

Apoptosis and the expression of Bcl-2 and Bax in patients with endometrioid, clear cell, and serous carcinomas of the uterine endometrium

OBJECTIVES

Clear cell and serous carcinoma of the uterus are rare types of endometrial carcinomas. This study was designed to investigate the differential occurrence of apoptosis, Bcl-2, and Bax in endometrioid, clear cell, and serous carcinomas.

METHODS

In a total of 28 endometrial carcinomas as well as 4 samples of normal postmenopausal endometria, apoptotic changes were examined using molecular biochemical techniques. The expression of Bcl-2 and Bax proteins was also investigated by immunohistochemical staining with appropriate antibodies.

RESULTS

Labeling of DNA in situ indicated that apoptotic cells were sporadically seen in postmenopausal endometrium (5.2 +/- 2.1, n = 4). In contrast, cells undergoing apoptosis apparently were detected in endometrioid carcinoma (29.3 +/- 3.7, n = 20), and their numbers increased intensely in clear cell (49.5 +/- 5.6, n = 5) and serous carcinomas (50.8 +/- 6.0, n = 3). Autoradiographic analysis revealed that high-molecular-weight DNA was predominant in postmenopausal endometrium. However, a DNA ladder was identified in 7 of 10 carcinomas. Although Bcl-2 was immunonegative or faintly immunopositive in all cases, many cases of endometrioid carcinoma (43.6 +/- 4.1%, n = 20) were immunopositive for Bax, unlike postmenopausal endometrium (17.6 +/- 6.7%, n = 4). Moreover, the number of cells expressing Bax increased in clear cell (60.4 +/- 6.5%, n = 5) and serous carcinomas (66.8 +/- 7.6%, n = 3) compared with that in endometrioid carcinoma.

CONCLUSIONS

These results indicate that apoptosis occurs in a specific population of cells in different histologic components of endometrial carcinomas. The expression of Bax, but not of Bcl-2, might suggest histologic differentiation in endometrial carcinomas.

Management of pancreatic arteriovenous malformation

Pancreatic arteriovenous malformations (AVM), while extremely rare, are frequently complicated by gastrointestinal bleeding. The elimination of pancreatic AVM is difficult once portal hypertension has developed. We describe herein a patient with congenital AVM of the pancreatic head presenting with recurrent episodes of melena, in whom pylorus-preserving pancreatoduodenectomy provided a means of definitive management. We also review the literature and focus on the diagnostic and therapeutic approaches. Angiography is always necessary to facilitate tactics of treatment, even if diagnosis has been established by non-invasive imaging modalities. To obtain complete regression, total extirpation of the affected organ, or at least the involved portion, should be performed before this disease leads to the lethal complications of gastrointestinal bleeding and portal hypertension. Transcatheter arterial embolization is the only alternative treatment for the control of hemorrhage.

Construction of male and female PAC genomic libraries suitable for identification of Y-chromosome-specific clones from the liverwort, Marchantia polymorpha

Unlike higher plants, the dioecious liverwort, Marchantia polymorpha, has uniquely small sex chromosomes, with X chromosomes present only in female gametophytes and Y chromosomes only in male gametophytes. We have constructed respective genomic libraries for male and female plantlets using a P1-derived artificial chromosome (pCYPAC2). With an average insert size of approximately 90 kb, each PAC library is estimated to cover the entire genome with a probability of more than 99.9%. Male-specific PAC clones were screened for by differential hybridization using male and female genomic DNAs as separate probes. Seventy male-specific PAC clones were identified. The male specificity of one of the clones, pMM4G7, was verified by Southern hybridization and PCR analysis. This clone was indeed located on the Y chromosome as verified by fluorescence in situ hybridization (FISH). This result shows that the Y chromosome contains unique sequences that are not present either on the X chromosome or any of the autosomes. Thus, the respective male and female libraries for M. polymorpha offer an opportunity to identify key genes involved in the process of sex differentiation and this unique system of sex determination.

Marginal ulceration after pylorus-preserving pancreaticoduodenectomy

Marginal ulceration is a serious problem after both standard pancreaticoduodenectomy (PD) and pylorus-preserving pancreaticoduodenectomy (PPPD). The relationship between this complication and the method of reconstruction after PPPD was analyzed in this study. Patients who underwent standard PD (n = 72) or PPPD (n = 28) in the 20-year period from 1978 to 1997 were retrospectively reviewed. After PPPD, 4 patients (14.3%) developed marginal ulceration on the jejunal side of the duodenojejunal anastomosis, while none of the patients had marginal ulceration after standard PD. The marginal ulcer occurred in 3 of 14 patients treated with the Roux-en-Y method, and in 1 of 9 treated with pancreatogastrostomy. In the Roux-en-Y method, the anal jejunal loop anastomosed to the bulb was directly exposed to gastric juice without neutralization by pancreatic juice from the oral jejunal limb. Of the 4 patients with marginal ulceration, 2 of those treated by the Roux-en-Y method required gastrectomy; the other 2 patients were treated medically. Our analysis of the literature showed that the Roux-en-Y method had the highest incidence of marginal ulcerations. The gastrointestinal reconstruction method without a mixture of gastric juice and pancreatic juice may be a causal factor in the marginal ulceration that occurs after PPPD. In reconstruction after PPPD, we should not create a jejunal loop that is exposed to gastric juice alone.

Comparison of expressed sequence tags from male and female sexual organs of Marchantia polymorpha

A total of 935 expressed sequence tags (ESTs) from male immature sexual organ were determined, of which 600 ESTs were assembled into 110 non-redundant groups, resulting in 445 unique EST sequences. Of these, 244 sequences shared significant similarities to known nucleotide or amino acid sequences in other organisms. The remaining 201 unique sequences showed no significant matches and thus are likely to be novel transcripts. ESTs from male and female immature sexual organs of a liverwort, Marchantia polymorpha, were compared to characterize gene expression patterns during sex differentiation. Ninety-nine male ESTs turned out to be common genes found also in the female library. Interestingly, one of the ESTs found only in male shows a significant similarity to the transformer-2 gene involved in sex determination in Drosophila. In female, several unique lectin ESTs were found that are not present in the male library.

[Clinical experiences and problems with home medical treatment in an orthopedic clinic]

Twenty-five patients who received home medical treatment were reviewed. There were 11 males and 14 females, with a mean age of 77 years. In an orthopedic clinic, it is difficult to secure the time for to visit a patient's home. Another problem for doctor is that the medical fee for home treatment is very low. To promote home treatment by orthopedists, it is important to secure the time to visit a patient's home, to improve the fees for home treatment, and to establish a connection with a visiting nurse care station and visiting rehabilitation workers.

Bryophyte 5S rDNA was inserted into 45S rDNA repeat units after the divergence from higher land plants

The 5S ribosomal RNA genes (5S rDNA) are located independently from the 45S rDNA repeats containing 18S, 5.8S and 26S ribosomal RNA genes in higher eukaryotes. Southern blot and fluorescence in situ hybridization analyses demonstrated that the 5S rDNAs are encoded in the 45S rDNA repeat unit of a liverwort, Marchantia polymorpha, in contrast to higher plants. Sequencing analyses revealed that a single-repeat unit of the M. polymorpha nuclear rDNA, which is 16,103 bp in length, contained a 5S rDNA downstream of 18S, 5.8S and 26S rDNA. To our knowledge, this is the first report on co-localization of the 5S and 45S rDNAs in the rDNA repeat of land plants. Furthermore, we detected a 5S rDNA in the rDNA repeat of a moss, Funaria hygrometrica, by a homology search in a database. These findings suggest that there has been structural re-organization of the rDNAs after divergence of the bryophytes from the other plant species in the course of evolution.

The vascular endothelial growth factor/fms-like tyrosine kinase system in human ovary during the menstrual cycle and early pregnancy

In human ovaries, angiogenesis is known to be associated with the development of follicles and the formation of the corpus luteum (CL). A complex vascular network is formed within the thecal cell layer during follicular growth, and rapid neovascularization occurs toward the granulosa cell layer after ovulation. Vascular endothelial growth factor (VEGF) is a multifunctional cytokine, stimulating endothelial cell growth and enhancing microvascular permeability. A specific receptor for VEGF, fms-like tyrosine kinase (Flt-1), is expressed in vascular endothelial cells that mediates the action of VEGF. We examined the localization and expression of VEGF and Flt-1, using an immunohistochemical technique and RT-PCR analysis, in human follicles and corpora lutea during the normal menstrual cycle and early pregnancy. We measured concentrations of VEGF in extracts of human CL using an enzyme-linked immunosorbent assay during the luteal phase and early pregnancy. Immunostaining for VEGF was observed in granulosa cells from small antral follicles to preovulatory follicles. The staining was detected in thecal cells from medium-sized to preovulatory follicles. The intensity of the staining was gradually increased as a follicle grew. Flt-1 was localized in granulosa and thecal cells of preovulatory follicles as well as in endothelial cells. In the human CL, the intense staining for VEGF was observed in granulosa and thecal lutein cells, especially in the midluteal phase. The immunostaining for Flt-1 was faint in endothelial cells in the CL, whereas it was distinct in granulosa and thecal lutein cells. The concentrations of VEGF in lutein extracts were high in the early and midluteal phases and tended to decrease toward the late luteal phase. During early pregnancy, a measurable amount of VEGF was detected. RT-PCR analysis demonstrated that messenger ribonucleic acids encoding VEGF121, VEGF165, and Flt-1 were expressed in the CL. These results suggest that VEGF might have an autocrine role in the ovulatory process and luteal function as well as a paracrine role in angiogenesis.

Two mRNA species encoding calcium-dependent protein kinases are differentially expressed in sexual organs of Marchantia polymorpha through alternative splicing

In plants, calcium-dependent calmodulin-independent protein kinases (CDPKs) are the predominant calcium-regulated protein kinases and their genes are encoded by a multigene family. A CDPK gene was cloned from a liverwort, Marchantia polymorpha, which showed a high level of sequence similarities to other higher plant CDPK genes. The liverwort CDPK gene consisted of 9 exons and 8 introns. The 6th and 7th exons (Exon 6A and Exon 6B) were almost identical except for 4-amino acid substitutions, both of which coded for EF-hands in the calcium-binding domain. RT-PCR analysis revealed that two species of mature mRNA containing either Exon 6A or Exon 6B were generated from a single CDPK gene by mutually exclusive alternative splicing. Both histidine-tagged fusion proteins derived from cDNAs containing either Exon 6A or Exon 6B exhibited calcium-dependent protein kinase activity in vitro. Preferential accumulation of the mature mRNA with Exon 6A detected in male sexual organ implies possible sexual control of the ratio between the two CDPK isozymes through alternative splicing. Functions and evolution of CDPKs are discussed based on the structure and expression of the liverwort CDPK gene.

Outcome after treatment of high-risk papillary and non-Hürthle-cell follicular thyroid carcinoma

BACKGROUND

Treatment of differentiated thyroid cancer has been studied for many years, but the benefits of extensive initial thyroid surgery and the addition of radioiodine therapy or external radiation therapy remain controversial.

OBJECTIVE

To determine the relations among extent of surgery, radioiodine therapy, and external radiation therapy in the treatment of high-risk papillary and non-Hürthle-cell follicular thyroid carcinoma.

DESIGN

Analysis of data from a multicenter study.

SETTING

14 institutions in the United States and Canada participating in the National Thyroid Cancer Treatment Cooperative Study Registry.

PATIENT

385 patients with high-risk thyroid cancer (303 with papillary carcinoma and 82 with follicular carcinoma).

MEASUREMENTS

Death, disease progression, and disease-free survival.

RESULTS

Total or near-total thyroidectomy was done in 85.3% of patients with papillary carcinoma and 71.3% of patients with follicular cancer. Overall surgical complication rate was 14.3%. Total or near-total thyroidectomy improved overall survival (risk ratio [RR], 0.37 [95% CI, 0.18 to 0.75]) but not cancer-specific mortality, progression, or disease-free survival in patients with papillary cancer. No effect of extent of surgery was seen in patients with follicular thyroid cancer. Postoperative iodine-131 was given to 85.4% of patients with papillary cancer and 79.3% of patients with follicular cancer. In patients with papillary cancer, radioiodine therapy was associated with improvement in cancer-specific mortality (RR, 0.30 [CI, 0.09 to 0.93 by multivariate analysis only]) and progression (RR, 0.30 [CI, 0.13 to 0.72]). When tall-cell variants were excluded, the effect on outcome was not significant. After radioiodine therapy, patients with follicular thyroid cancer had improvement in overall mortality (RR, 0.17 [CI, 0.06 to 0.47]), cancer-specific mortality (RR, 0.12 [CI, 0.04 to 0.42]), progression (RR, 0.21 [CI, 0.08 to 0.56]), and disease-free survival (RR, 0.29 [CI, 0.08 to 1.01]). External radiation therapy to the neck was given to 18.5% of patients and was not associated with improved survival, lack of progression, or disease-free survival.

CONCLUSIONS

This study supports improvement in overall and cancer-specific mortality among patients with papillary and follicular thyroid cancer after postoperative iodine-131 therapy. Radioiodine therapy was also associated with improvement in progression in patients with papillary cancer and improvement in progression and disease-free survival in patients with follicular carcinoma.

Inhibition of nuclear envelope reconstitution in Xenopus interphase egg extract by hemin

Addition of hemin to the nuclear reconstitution system of Xenopus interphase egg extract using sperm head chromatin resulted in abnormal pseudonuclei exhibiting flattened membrane patches randomly distributed both on the surface and inside the nuclei. The structures that resembled nuclear pores were observed on these flattened membrane patch structures. Although the nucleosome structure was formed as revealed by the micrococcal nuclease digestion, the B-type lamin uptake into the nuclei was inhibited by hemin. Using heminagarose affinity chromatography, we isolated several hemin-binding proteins from fully reconstituted pseudonuclei. Some of the hemin-binding proteins bound concanavalin A (Con A). Comparison of hemin-binding proteins with those isolated from both fractions of supernatant and pellet separated by high speed centrifugation of the egg extract showed that the hemin-binding proteins of pseudonuclei were supplied from both fractions. The uptake of nuclear hemin-binding proteins did not occur in the incompletely reconstituted nuclei resulting from addition of excess sperm chromatin to the system. These results suggest that the hemin-binding proteins participate in the late steps of nuclear reconstitution during formation of the nuclear envelope.

Tall-cell variant of papillary thyroid cancer: disregarded entity?

The tall-cell variant of papillary thyroid carcinoma (TCV) has been described as an aggressive tumor with a significantly higher incidence of recurrence and mortality than other forms of papillary carcinoma. In some series it has accounted for up to 10%, whereas in other series it has not been reported at all, indicating that there are difficulties identifying it. In a series of 162 consecutively treated patients with papillary thyroid carcinoma treated by total thyroidectomy according to a highly standardized procedure, all specimens were specifically examined by an international group of pathologists to establish the occurrence of TCV. All patients with TCV were studied with regard to local aggressiveness, the presence of metastases, iodine uptake, DNA pattern, thyroglobulin production, treatment (surgical and adjuvant), and outcome (follow-up 3-17 years, median 10 years). At primary histopathologic evaluation by the local pathologist, three patients were recorded as having TCV. At special evaluation by the expert group, eight more cases were found, giving a total of 11 patients in this series (7%). Five of them had extracapsular growth, and four were multifocal. Three had metastases at the time of admission. Seven tumors were diploid, one tetraploid, and three aneuploid. Of the three patients with primary distant metastases two died (8 and 24 months after operation), and one is still alive after 10 years. Four other patients developed recurrences, one of whom died from cardiac failure, but the others have so far been treated successfully. Two of these recurrences had no radioiodine uptake, and one had no rise in thyroglobulin concentrations; the other two had rising values that correlated with recurrence. The other four patients are alive without recurrence. It was concluded that identification of the TCV requires examination by an experienced pathologist. Moreover, it may have a higher incidence than is generally recognized. No reliable criteria for prognostic classification were identified. The results suggest that early identification and active treatment can lead to an outcome more favorable than has previously been described.

Overexpression of p53 in tall cell variants of papillary thyroid carcinoma

BACKGROUND

The tall cell variant (TCV) is a clinically aggressive subtype of papillary thyroid cancer. The aim of this study was to discover the prevalence of mutant forms of p53 protein in this subtype and relate it to clinical outcome.

METHODS

Eighteen patients with TCV and a control group with common papillary cancers, matched for age and gender, were studied. The p53 mutations were identified by means of immunohistochemical staining. Data reviewed were overall survival, recurrence, TNM stage, and p53 positivity.

RESULTS

p53 mutations occurred in 11 (61%) patients with TCV compared with two (11%) in control group (p = 0.05). In the TCV group two patients died of the disease (11%) and eight (44%) had local recurrences or distant metastases compared with none in the control group. All deaths and 70% of the recurrences occurred in patients with stage III or IV disease. p53 positivity did not correlate with any reduction in survival (7% compared with 9%) but with increased rate of local (23% compared with 4%) and distant (23% compared with 13%) recurrences.

CONCLUSIONS

TCV was associated with a significantly higher rate of p53 positivity than common papillary carcinoma. The stage of the disease seemed to be a better prognostic indicator than p53 positivity for overall survival.

Hepatocellular carcinoma associated with lupoid hepatitis: a review of Japanese reports

A 66-year-old woman was diagnosed as having lupoid hepatitis due to the presence of hypergammaglobulinemia, lupus erythematosus cells, and positivity for antinuclear, anti-DNA, and anti-smooth muscle antibodies. None of the serum hepatitis B markers were positive. Symptomatic relief was obtained by prednisolone administration. Five years after the diagnosis of lupoid hepatitis, hepatocellular carcinoma (HCC) was detected by ultrasonography and computed tomography, after which hepatectomy was performed. Although transcatheter arterial embolization was done on two occasions and repeat hepatectomy was performed twice for recurrent HCC, her liver function remained good with the prednisolone treatment. Antibody for hepatitis C virus has been negative since our first check in 1992. As of this writing, the patient has been alive and well 6 years and 2 months after the first hepatectomy. There have been no previous reports of 6-year survival after hepatectomy for HCC associated with lupoid hepatitis.

Hepatic release of endothelin-1 after warm ischemia. Reperfusion injury and its hemodynamic effect

This study investigated the release of endothelin (ET)-1 from the liver after warm ischemia/reperfusion (I/R) injury. Wistar rats were subjected to 120 min of warm hepatic ischemia by clamping the hepatic hilum under porto-jugular shunting. Reperfusion was performed by unclamping. The rats were divided into 2 groups receiving intravenous treatment with an anti-ET-1 mAb before ischemia (AET group) and with mouse immunoglobulin G (sham group). Hepatic blood flow was assessed by laser-Doppler flowmetry and reflectance spectrophotometry and was compared between the 2 groups along with the bile flow rate. The ET-1 concentrations of hepatic venous and portal blood were determined in the sham group, and the portal blood endotoxin levels were assayed in both groups. Both groups developed transient hypotension after reperfusion, but hepatic blood flow subsequently showed a significant improvement in the AET group. Hepatic congestion was detected in the sham group by both reflectance spectrophotometry and histological examination. After reperfusion, bile flow was significantly greater in the AET group. The portal endotoxin concentration showed no increase in both groups, and the hepatic venous blood ET-1 level in the sham group was significantly higher until 3 hr after reperfusion compared to the portal blood level. The 30-day survival rate was 50% in the AET group, whereas all the sham rats died within 12 hr. ET-1 was released from the liver after I/R injury and apparently participated in systemic and local hemodynamic changes that affected survival.

The role of endothelin in the pathophysiology of renal impairment during acute liver rejection

We assessed the role of endothelin in the development of renal dysfunction during acute rejection by examining the effect of a selective endothelin A (ETA) receptor antagonist BQ-123 in rats with acute liver rejection. Serum endothelin levels and endogenous creatinine clearance (Ccr) were monitored on days 1, 3, 5, 7, and 9 postoperatively. As indicators of renal hemodynamics, the estimated hemoglobin concentration of renal tissue (IHb) and the oxygen saturation of hemoglobin in renal blood (ISO2) were determined by reflectance spectrophotometry. In addition, the clearance of inulin and P-aminohippurate were determined, and the renal tissue blood flow was estimated by laser-Doppler flowmetry (LDF). As a model of allograft rejection, Lewis rats were transplanted orthotopically with DA rat livers. The serum endothelin level of allografted rejectors was significantly (P < 0.05) higher than that of isografted controls (Lewis rats with Lewis livers) on postoperative day 5, and it increased to a maximum of 5.38 +/- 0.95 pg/ml on day 9 (versus 1.23 +/- 0.18 pg/ml preoperatively). The values of Ccr, IHb, and ISO2 were all significantly (P < 0.05) lower in allografted rejectors than in isografted controls on day 5, and subsequently declined to a minimum on day 9 (P < 0.01). Treatment of allografted rejectors with BQ-123 markedly improved the renal parameters to levels similar to those in the isografted controls. These results strongly suggest that endogenous endothelin may play an important role in the development of renal impairment during acute liver rejection by reducing renal blood flow through binding with ETA receptor.

Hepatopancreatoduodenectomy for advanced gallbladder carcinoma

OBJECTIVE

To assess the effectiveness of hepatopancreatoduodenectomy (HPD) in patients with advanced gallbladder carcinoma directly invading the liver and pancreas, generally considered to be nonresectable.

PATIENTS AND METHODS

Sixty patients with gallbladder carcinoma admitted to our hospital from 1978 to 1992, of whom 55 had Nevin stage V carcinoma and 21 had resectable tumors. Of these patients, seven underwent HPD. The remaining 34 patients had nonresectable tumors. The outcomes of patients undergoing HPD and those with nonresectable tumors were compared and the effect on their quality of life was also analyzed.

RESULTS

Postoperative complications occurred in five of the seven patients after HPD, but there were no operative deaths. The 1- and 2-year survival rates were 57% and 28.6%, respectively, with a median survival time of 12 months. In contrast, the 1- and 2-year survival rates of the 34 patients with nonresectable tumors were both 5.8%, and the median survival time was 2 months. The median and mean durations of home stay after HPD were 6 and 10.5 months, respectively.

CONCLUSION

Hepatopancreatoduodenectomy has the potential to improve both survival and the quality of life for carefully selected patients with advanced gallbladder carcinoma.