Evaluation of epithelial and mesenchymal cell markers in canine urinary bladder transitional cell carcinoma

Canine transitional cell carcinoma (cTCC) is the most common malignant tumour in the urinary bladder: it is highly invasive and exhibits metastatic characteristics. Inflammation is also strongly related to cTCC. Epithelial tumours often exhibit a mesenchymal cell phenotype during tumour invasion and metastasis owing to epithelial-mesenchymal transition (EMT), which is often induced in chronic inflammation. The aim of this retrospective study was to investigate the expression of epithelial and mesenchymal cell markers in tumour cells and to evaluate its relationship with prognosis of cTCC. In this study, 29 dogs with cTCC who underwent surgical treatment were enrolled. Clinical parameters were reviewed using medical records. Tissue expression of epithelial and mesenchymal markers was evaluated by immunohistochemical analysis. The association between the expression of mesenchymal cell markers and clinical parameters, including prognosis, was statistically examined. In five normal bladder tissues used as controls, no expression of mesenchymal markers was observed, except for one tissue that expressed fibronectin. Conversely, epithelial tumour cells expressed vimentin and fibronectin in 23/29 and 19/28 cTCC tissues, respectively. Regarding clinical parameters, vimentin score in Miniature Dachshunds was significantly higher than those in other dog breeds (P < 0.001). Multivariate survival analyses revealed that age>12 years was related to shorter progression-free survival (P = 0.02). Higher vimentin score, lower fibronectin score, and advanced clinical T stage were significantly correlated with shorter median survival time (P < 0.05). The results of this study indicate that vimentin expression was associated with cTCC progression. Further studies are needed to examine the incidence and relevance of EMT in cTCC.

Imperceptible magnetic sensor matrix system integrated with organic driver and amplifier circuits

Artificial electronic skins (e-skins) comprise an integrated matrix of flexible devices arranged on a soft, reconfigurable surface. These sensors must perceive physical interaction spaces between external objects and robots or humans. Among various types of sensors, flexible magnetic sensors and the matrix configuration are preferable for such position sensing. However, sensor matrices must efficiently map the magnetic field with real-time encoding of the positions and motions of magnetic objects. This paper reports an ultrathin magnetic sensor matrix system comprising a 2 × 4 array of magnetoresistance sensors, a bootstrap organic shift register driving the sensor matrix, and organic signal amplifiers integrated within a single imperceptible platform. The system demonstrates high magnetic sensitivity owing to the use of organic amplifiers. Moreover, the shift register enabled real-time mapping of 2D magnetic field distribution.

A clinical comparison between dedifferentiated low-grade osteosarcoma and conventional osteosarcoma

AIMS

The purpose of this study was to clarify the clinical behaviour, prognosis, and optimum treatment of dedifferentiated low-grade osteosarcoma (DLOS) diagnosed based on molecular pathology.

PATIENTS AND METHODS

We retrospectively reviewed 13 DLOS patients (six men, seven women; median age 32 years (interquartile range (IQR) 27 to 38)) diagnosed using the following criteria: the histological coexistence of low-grade and high-grade osteosarcoma components in the lesion, and positive immunohistochemistry of mouse double minute 2 homolog (MDM2) and cyclin-dependent kinase 4 (CDK4) associated with MDM2 amplification. These patients were then compared with 51 age-matched consecutive conventional osteosarcoma (COS) patients (33 men, 18 women; median age 25 years (IQR 20 to 38)) regarding their clinicopathological features.

RESULTS

The five-year overall survival (OAS) rates in the DLOS and COS patients were 85.7% and 77.1% (p = 0.728), respectively, and the five-year progression-free survival (PFS) rates were 57.7% and 44.9% (p = 0.368), respectively. A total of 12 DLOS patients received chemotherapy largely according to regimens for COS. Among the nine cases with a histological evaluation after chemotherapy, eight showed a poor response, and seven of these had a necrosis rate of < 50%. One DLOS patient developed local recurrence and five developed distant metastases.

CONCLUSION

Based on our study of 13 DLOS cases that were strictly defined by histological and molecular means, DLOS showed a poorer response to a standard chemotherapy regimen than COS, while the clinical outcomes were not markedly different. Cite this article: Bone Joint J 2019;101-B:745-752.

The Application of an Institutional Clinical Data Warehouse to the Assessment of Adverse Drug Reactions (ADRs)

Objectives: To apply an institutional clinical data warehouse (CDW) to the assessment of adverse drug reactions (ADRs) and demonstrate its utility through a specific example.

Methods: We modeled the process for assessing ADRs through retrospective cohort design by using CDW at the Osaka University Hospital as follows: 1) We defined a drug X, an adverse drug reaction (ADR) Y, and a laboratory measurement Z to assess Y during a given study period; 2) we excluded those whose Z value exceeded the defined criteria or were not available at the inception of the cohort; 3) we divided the patients into two groups based on exposure or non-exposure to X; 4) we matched the patient characteristics between the two groups through stratification and randomization; and 5) we compared the frequency of patients who presented Y during the study period between the two groups. Aminoglycoside and Cephalosporin associated nephrotoxicity in pediatric inpatients was used as an example to demonstrate the usefulness of this approach.

Results: Our evaluation indicates that there is an increased risk of nephrotoxicity for pediatric inpatients who were prescribed cephalosporin either alone or in combination with aminoglycoside; further, aminoglycoside tends to increase the cephalosporin-associated nephrotoxicity.

Conclusions: Our findings are consistent with those drawn from other studies, indicating thatthe method of a pplying an institutional CDW is useful for assessing ADRs.

Wireless EEG patch sensor on forehead using on-demand stretchable electrode sheet and electrode-tissue impedance scanner

A wireless electroencephalogram (EEG) sensor using a stretchable electrode sheet and electrode-tissue impedance measurement module is presented herein. The sensor can be attached to the forehead using biocompatible gel with the electrode sheet. The sensor is compactly designed for 3 cm × 9 cm × 6 mm with weight of 12 g. Impedance scanning circuit is also proposed to evaluate the skin surface condition before EEG measurements. We developed the impedance scanning board for 3 cm × 5 cm × 3 mm, with weight of 5.6 g. Results show that the proposed system demonstrates a promising performance in diagnosing the Alzheimer's disease using frequency domain analysis.

Prognostic significance of gene amplification of ACTN4 in stage I and II oral tongue cancer

Despite complete resection of the early stage of oral tongue cancer by partial glossectomy, late cervical lymph node metastasis is frequently observed. Gene amplification of ACTN4 (protein name: actinin-4) is closely associated with the metastatic potential of various cancers. This retrospective study was performed to demonstrate the potential usefulness of ACTN4 gene amplification as a prognostic biomarker in patients with stage I/II oral tongue cancer. Fifty-four patients with stage I/II oral tongue cancer were enrolled retrospectively, in accordance with the reporting recommendations for tumour marker prognostic studies (REMARK) guidelines. The copy number of ACTN4 and the protein expression of actinin-4 were evaluated by fluorescence in situ hybridization (FISH) and immunohistochemistry (IHC), respectively. The overall survival time of patients with gene amplification of ACTN4 was significantly shorter than that of patients without gene amplification (P=0.0010, log-rank test). Gene amplification of ACTN4 was a significant independent risk factor for death in patients with stage I/II oral tongue cancer (hazard ratio 6.08, 95% confidence interval 1.66-22.27). Gene amplification of ACTN4 is a potential prognostic biomarker for overall survival in oral tongue cancer.

Identification of a Unique Amyloid Sequence in AA Amyloidosis of a Pig Associated With Streptococcus Suis Infection

Here we report a pig with amyloid A (AA) amyloidosis associated with Streptococcus suis infection and identification of a unique amyloid sequence in the amyloid deposits in the tissue. Tissues from the 180-day-old underdeveloped pig contained foci of necrosis and suppurative inflammation associated with S. suis infection. Congo red stain, immunohistochemistry, and electron microscopy revealed intense AA deposition in the spleen and renal glomeruli. Mass spectrometric analysis of amyloid material extracted from the spleen showed serum AA 2 (SAA2) peptide as well as a unique peptide sequence previously reported in a pig with AA amyloidosis. The common detection of the unique amyloid sequence in the current and past cases of AA amyloidosis in pigs suggests that this amyloid sequence might play a key role in the development of porcine AA amyloidosis. An in vitro fibrillation assay demonstrated that the unique AA peptide formed typically rigid, long amyloid fibrils (10 nm wide) and the N-terminus peptide of SAA2 formed zigzagged, short fibers (7 nm wide). Moreover, the SAA2 peptide formed long, rigid amyloid fibrils in the presence of sonicated amyloid fibrils formed by the unique AA peptide. These findings indicate that the N-terminus of SAA2 as well as the AA peptide mediate the development of AA amyloidosis in pigs via cross-seeding polymerization.

Independently driven four-probe method for local electrical characteristics in organic thin-film transistors under controlled channel potential

We describe an independently driven four-probe method to investigate local channel mobility in organic field-effect transistors (OFETs). In OFET devices, probe-organic contact resistance affects device characteristics even in four-probe measurement because a change in contact resistance at the source probe induces a change in channel potential, resulting in different local carrier density. To overcome this problem, we introduced a feedback circuit between the source probe and a channel voltage probe to keep the channel potential constant. We demonstrate four-probe I-V measurement on a pentacene thin film (50 nm thick) under controlled channel potential. The feedback successfully enables us to separate contact resistance and channel resistance even under different contact conditions. We also measured four-probe resistance as a function of gate bias and channel probe position. The present results were in good agreement with two-dimensional model calculation by arranging four probes in a defect-free area; the mobility of the pentacene single grain was evaluated to be 0.25 cm(2)/(V s).

Xenopus W-linked DM-W induces Foxl2 and Cyp19 expression during ovary formation

The molecular mechanisms of vertebrate ZZ/ZW-type sex-determining systems remain unclear. We recently indicated that a W-linked gene, DM-W is a likely ovary-determining gene in Xenopus laevis. We first examined whether Cyp19 for estrogen-synthesizing enzyme P450 aromatase and Foxl2 showed female-specific expression in developing gonads. Both genes showed much higher expression in ZW than in ZZ gonads during and after sex determination. Importantly, transgenic ZZ gonads expressing exogenous DM-W at the sex-determining stage showed a ZW-type pattern of Cyp19 and Foxl2 expression. These results suggest that DM-W up-regulates Cyp19 and Foxl2 expression to guide primary ovary development in X. laevis.

Matrix metalloproteinase 2 improves the transplanted adipocyte survival in mice

BACKGROUND

Fat tissue is a common material for autologous transplantation in plastic and reconstructive surgery. Basic fibroblast growth factor (bFGF) ameliorates the fat graft survival. A transplantation model has shown the gene expression of matrix metalloproteinases (MMPs) to increase in adipocytes. The aim of this study is to investigate the role of MMPs in the amelioration of survival by bFGF.

MATERIALS AND METHODS

3T3-L1 adipocytes were incubated with or without 10 microg mL(-1) bFGF for 8 h in the presence or absence of the MMP inhibitor GM6001, vascular endothelial growth factor (VEGF), MMP-2 or anti-bFGF antibody to study the effect of bFGF on MMP-2 mRNA expression, MMP-2 activity, fat accumulation or 2-deoxyglucose uptake. Collagen sheets containing l x l0(7) adipocytes with or without bFGF in the presence or absence of GM6001 were subcutaneously transplanted into mice, and the appearance, histology, mRNA expression and fat accumulation of the grafts were analysed 4 weeks after transplantation.

RESULTS

The MMP-2 expression was drastically induced by bFGF among MMPs in 3T3-L1 adipocytes. MMP-2 accelerated fat accumulation, peroxisome proliferator-activated receptor gamma (PPAR gamma) mRNA expression, and glucose uptake to an extent similar to those induced by bFGF, respectively. The bFGF-induced increases were inhibited by the blocking of MMP-2. The transplantation of adipocytes into mice showed that bFGF ameliorates the appearance and fat accumulation, as well as mRNA expression in grafts. These effects were almost or partly inhibited by a MMP blockade.

CONCLUSIONS

MMP-2 may be involved in the mechanism by which bFGF ameliorates the survival of fat grafts.

High-yield synthesis of conductive carbon nanotube tips for multiprobe scanning tunneling microscope

We have established a fabrication process for conductive carbon nanotube (CNT) tips for multiprobe scanning tunneling microscope (STM) with high yield. This was achieved, first, by attaching a CNT at the apex of a supporting W tip by a dielectrophoresis method, second, by reinforcing the adhesion between the CNT and the W tip by electron beam deposition of hydrocarbon and subsequent heating, and finally by wholly coating it with a thin metal layer by pulsed laser deposition. More than 90% of the CNT tips survived after long-distance transportation in air, indicating the practical durability of the CNT tips. The shape of the CNT tip did not change even after making contact with another metal tip more than 100 times repeatedly, which evidenced its mechanical robustness. We exploited the CNT tips for the electronic transport measurement by a four-terminal method in a multiprobe STM, in which the PtIr-coated CNT portion of the tip exhibited diffusive transport with a low resistivity of 1.8 kOmega/microm. The contact resistance at the junction between the CNT and the supporting W tip was estimated to be less than 0.7 kOmega. We confirmed that the PtIr thin layer remained at the CNT-W junction portion after excess current passed through, although the PtIr layer was peeled off on the CNT to aggregate into particles, which was likely due to electromigration or a thermally activated diffusion process. These results indicate that the CNT tips fabricated by our recipe possess high reliability and reproducibility sufficient for multiprobe STM measurements.

The application of an institutional clinical data warehouse to the assessment of adverse drug reactions (ADRs). Evaluation of aminoglycoside and cephalosporin associated nephrotoxicity

OBJECTIVES

To apply an institutional clinical data warehouse (CDW) to the assessment of adverse drug reactions (ADRs) and demonstrate its utility through a specific example.

METHODS

We modeled the process for assessing ADRs through retrospective cohort design by using CDW at the Osaka University Hospital as follows: 1) We defined a drug X, an adverse drug reaction (ADR) Y, and a laboratory measurement Z to assess Y during a given study period; 2) we excluded those whose Z value exceeded the defined criteria or were not available at the inception of the cohort; 3) we divided the patients into two groups based on exposure or non-exposure to X; 4) we matched the patient characteristics between the two groups through stratification and randomization; and 5) we compared the frequency of patients who presented Y during the study period between the two groups. Aminoglycoside and Cephalosporin associated nephrotoxicity in pediatric inpatients was used as an example to demonstrate the usefulness of this approach.

RESULTS

Our evaluation indicates that there is an increased risk of nephrotoxicity for pediatric inpatients who were prescribed cephalosporin either alone or in combination with aminoglycoside; further, aminoglycoside tends to increase the cephalosporin-associated nephrotoxicity.

CONCLUSIONS

Our findings are consistent with those drawn from other studies, indicating that the method of applying an institutional CDW is useful for assessing ADRs.

A possible paracrine hedgehog signalling pathway in neurofibromas from patients with neurofibromatosis type 1

BACKGROUND

Hedgehogs (Hhs) and their receptors are involved in organ development as well as in tumorigenesis observed in basal cell carcinoma. Among Hhs, Desert hedgehog secreted from Schwann cells mediates the formation of peripheral nerve sheaths. However, there has been no study on the role of Hhs and their receptors in tumorigenesis of neurofibromas in neurofibromatosis type 1 (NF1).

OBJECTIVES

To clarify the expression and localization of Hhs and their receptors in neurofibromas of NF1 patients.

METHODS

Expression of Hhs and their receptors was studied by immunohistochemistry using neurofibromas from NF1 patients and control normal skin samples.

RESULTS

In neurofibromas, CD57-positive tumour cells with delicate elongated processes were positive for the receptor PTCH2. Perineurial cells of involved nerves within neurofibromas as well as those of normal cutaneous nerves expressed Indian hedgehog and Sonic hedgehog. Schwann cells of normal cutaneous nerves were positive for PTCH2.

CONCLUSIONS

Our study suggests that a paracrine Hh signalling pathway may be involved in tumorigenesis of neurofibromas in NF1.

Effects of nutrition on the cell survival and gene expression of transplanted fat tissues in mice

Fat tissue transplantation is a useful and common clinical technique in the plastic and reconstructive surgeries. To know the nutritional effects on the survival and maintenance of fat grafts, the weights of tissues and cell sizes, and the gene expressions in the fat tissues were analyzed 14 days after transplantation. The body weight and the plasma insulin level in high nutritional group (HNG) were significantly higher (p<0.05) than those in low nutritional group (LNG), respectively. The measurements of cell size showed that there were 32.5% distributed in the diameter less than 2 microm in LNG, significantly higher than 28.5% in HNG. There were 7.5% distributed in the diameter more than 6 microm in LNG, significantly lower than 10.0% in HNG. The mRNA levels of leptin, lipoprotein lipase, and beta(3)-adrenergic receptor were 2.0-, 1.5-, and 1.7-fold higher in HNG than those in LNG, respectively. The levels of hormone sensitive lipase and hexokinase 2 transcripts were not significantly different in both groups. These results show that the systemic nutritional status in host causes the changes of cell size and tissue weight as well as gene expression in the transplanted fat using mice model. The nutritional condition is probably important for the fat graft clinically both as lipid-storage and functional cells.

[Rheological characteristics of the aneurysm at the middle cerebral artery bifurcation]

We performed a retrospective clinical study to estimate the morphological index such as aspect ratio (aneurysm depth/neck) and area ratio (ratio of the cross-sectional area of bifurcated arteries) of 64 cases with saccular aneurysms (ruptured aneurysms: 41, unruptured aneurysms: 23) at the bifurcation of the middle cerebral artery (MCA) and made a flow visualization study using a flat three dimensional acrylic aneurysm model to define the flow characteristics in conditions similar to those obtained from the clinical study. The mean aspect ratio and area ratio of the ruptured and unruptured aneurysm cases were 2.81 +/- 1.45, 2.52 +/- 0.91 and 1.56 +/- 0.59, 1.73 +/- 0.38. These respective values differ statistically. The area ratio of the MCA bifurcation with no aneurysm was 1.25 +/- 0.35. This value was also statistically different from the ruptured aneurysm case. The visualization study was performed changing the neck size and flow ratio into the peripheries to simulate various aspect ratio and flow ratio into peripheries. The results showed that intraanerysmal flow was definitely influenced by aspect ratio and area ratio. The aspect ratio over 2.0 and area ratio below 2.0 failed to drive the inflow inside the aneurysms and developed as a stagnant area in the dome side. The morphological index of aspect ratio and area ratio reflected the flow characteristics in the aneurysm and was statistically different in ruptured and unruptured aneurysm cases. The unruptured aneurysms with an aspect ratio of more than 1.6 and an area ratio of more than 2.0 must be followed up, because of the risk that they might rupture in the near future.

Changes of HDL subfractions by eicosapentaenoic acid intake and physical load in 20- to 25-year-old men

The effects of daily eicosapentaenoic acid (EPA) intake and physical activity on high-density lipoprotein (HDL) subfraction, which may be an index of health status, were examined. The HDL subfraction, triglyceride and T-chol levels in the serum of 10 male volunteers aged 20-25 were examined before, immediately after and 1 h after being subjected to a physical load by bicycle ergometer at 90 W for 20 min. Subjects were then given 1.25 g EPA/day for 2 weeks, and the above test was repeated. By EPA intake, the distribution of HDL3b and 3c decreased significantly by 16.8 and 15.3%, respectively, and that of 2b increased significantly by 17.9%. The rate of change of subfraction of the 29th part (2b) of 30 parts in the total range of HDL increased by 67%, and decreased by 47% in 7th part (3c). By physical load, the distribution of HDL2a increased significantly by 15.4%, while 3b tended to decrease. By physical load after EPA intake, the distribution of 2a decreased significantly by 9.7%, and those of 3b and 3c increased significantly by 20.5 and 5.4%, respectively, and that of the 7th part (3c) increased by 37%. Thus, the physical load after EPA intake is effective to prevent arteriosclerosis as increasing the rate of change of HDL3c and as showing the longevity pattern of the HDL subfraction. Concentration of TG in a modal HDL pattern group increased by 95% after EPA intake, but that of a bimodal group did not show any change. HDL-cholesterol level in the bimodal group was higher than that in the modal group, especially after EPA intake. Two type III subjects changed to type IV by the load and the EPA intake, respectively. Thus, it seemed that the transformation from a modal pattern to a bimodal pattern by a certain lifestyle, especially regular physical activity and proper food intake, is a very important trial for the prevention of cerebrovascular diseases.

Prevalence of human immunodeficiency virus, hepatitis B and hepatitis C virus antibodies and hepatitis B antigen among commercial sex workers in Japan

OBJECTIVE

To investigate the prevalence of antibodies to human immunodeficiency virus (HIV), hepatitis B virus (HBV) and hepatitis C virus (HCV), and of hepatitis B surface (HBs) antigen in commercial sex workers (CSW) who attended a sexually transmitted disease (STD) clinic in Tokyo.

METHODS

Surveys were conducted on 308 CSW and 384 control subjects for HIV antibody or 241 control subjects for HBs antibody and antigen and HCV antibody.

RESULTS

HIV antibody was not detected in either CSW or control subjects. The positive rates for HBs antigen and antibody were 0.6 and 23.4%, respectively, in the CSW group, and 0.4 and 71.8% in the control group. The HCV antibody positive rate was 3.2% in the CSW group and 0.4% in the control group.

CONCLUSION

A statistically significant difference between the two groups was observed only in HCV antibody positive rate. STD checkup for CSW alone is inadequate--STD health education and screening for the general public are also required.

[Microtia: a new chronology for the total external ear reconstruction. A retrospective study of eight cases]

After 14 months of personal training with Professor Ichinose's team in Chiba (Japan), the author reports a new chronology of the total external ear reconstruction for microtia. This approach, proposed by Dr Yoshimoto, subtracts in time spent on creating the cartilaginous framework from the total general anesthesia time. The principles of this technique and its chronology are described. The results of eight patients operated according to this method between February 1994 and October 1999 are analyzed and compared to the 35 previous reconstructions performed by this team. The advantage of this chronology has been established: this method allows a considerable reduction of the general anesthesia time, a rationalization of the cost of these reconstructions, an increased comfort for the patients and an easier learning process for young plastic surgeons.

Effects of interferon-alpha on peripheral neutrophil counts and serum granulocyte colony-stimulating factor levels in chronic hepatitis C patients

Granulocytopenia is commonly observed in interferon-alpha (IFN-alpha) therapy. Granulocyte colony-stimulating factor (G-CSF) has been identified as a primary cytokine that regulates neutrophil production, but the kinetics of G-CSF in IFN-alpha-induced granulocytopenia remains unclear. We investigated the effects of IFN-alpha on serum G-CSF levels and peripheral neutrophil counts (NC) in 15 chronic hepatitis C patients treated with standard-dose (10 MU) recombinant IFN-alpha for 24 weeks by using a chemiluminescent enzyme immunoassay for G-CSF. The time course of change after a single IFN-alpha injection showed that mean serum G-CSF levels and NC increased significantly compared with pretreatment values (p < 0.05), and were statistically correlated (r = 0.914, p = 0.0015). On repeating IFN-alpha administration, this change gradually became unclear, and granulocytopenia occurred, accompanied by a significant increase in serum G-CSF (p < 0.01). Both values reached a plateau within 2 weeks after starting treatment, and recovered rapidly after the cessation of therapy. Although continuous administration of IFN-alpha caused a time-dependent granulocytopenia, our results suggest that a single injection of IFN-alpha would be a potent inducer of G-CSF and NC in vivo as a short-term effect and that there would be negative-feedback regulation between them during long-term IFN-alpha therapy.

[Treatment strategy for cervical node metastasis from squamous cell carcinoma of the oropharynx]

The purpose of this study is to ascertain the role of neck surgery and radiation therapy for cervical lymph node metastasis in oropharyngeal cancer patients. We reviewed 217 previously untreated patients with squamous cell carcinoma of the oropharynx who were treated at the Cancer Institute Hospital in Tokyo between 1971 and 1995. The N stage distribution was; N0: 83(38.2%), N1: 42(19.4%), N2a: 23(10.6%), N2b: 27(12.4%), N2c: 33(15.2%), and N3: 9(4.2%). A predominance of cervical node metastases in level II and III was revealed and there were no skip metastases outside of level II and III. The control rate of cervical metastasis for each N stage was; N0: 96.9%, N1: 90.0%, N2a: 76.5%, N2b: 62.5%, N2c: 50.0%, and N3: 0%. Definitive irradiation provided sufficient treatment for small nodes, when the primary tumor growth was well controlled by radiation therapy. Neck dissection was necessary for more advanced neck metastases. Selective limited neck dissection (level II and III) is recommended for N0 and N1 patients, and modified or classical RND is considered to be better for most cases with N2 and N3.

[Position of venous outflow: a crucial aspect in flaps with 2 opposed pedicles. Application to the cutaneous delay phenomenon. Experimental study with rats]

In the present study, the authors decided to focus on the effect of the venous outflow location in the survival of a flap with a choke vessels barrier by means of a rat bipedicled ventral island flap. In a first experiment, the extent of flap necrosis was examined in three experimental groups: group 1, alternate vein and artery ligation (n = 5); group 2, unilateral artery ligation (n = 5); group 3, unilateral pedicle ligation (n = 5). Less than 10% necrosis occurred in group 1; 28% in group 2 and 33% in group 3. In a second experiment we applied the first results to the delay phenomenon. 10 rats were divided into 2 groups: group 4, primary ligation of a complete pedicle on one side; group 5, primary alternate vein and artery ligation and the flaps were raised 21 days later. We observed 20% necrosis in group 4 and only 4% in group 5. The data of the first experiment indicate that a vein remaining near the artery can be a dramatic obstacle to the efficiency of choke vessels. The second experimental study shows the superiority of primary selective ligation in the delay phenomenon.

Repair of wide coup de sabre without cutaneous excision by means of pericranial-galeal padding flap

A case of double linear scleroderma of the forehead (coup de sabre) is described. The histopathology of this rare lesion is now well known with a normal epidermis and a sclerotic dermis. The correction was done with an original two-stage procedure: the lesion with alopecia was first treated by excision-suture and a transfer of the involved subcutaneous tissue along the right inner canthus; 1 year later, by a hemicoronal incision, we transferred a galeal-pericranial flap beneath the wider forehead lesion. We think that the use of a filling flap to correct wide coup de sabre lesions without cutaneous excision can be a simple alternative to the classic treatment by complete excision and flap reconstruction. The subcutaneous fascial system of the scalp can provide a good donor site with minimal morbidity.

New classification of stage IV squamous cell carcinoma of the oropharynx

OBJECTIVE

The recent progress in reconstructive surgery for the treatment of head and neck carcinomas has made it possible to radically resect cancers. However. the choice of treatment for oropharyngeal carcinoma is rather difficult. Radical treatment sometimes results in severe complications, suggesting that some modes of treatment might reduce the quality of life. The 5-year survival rate of patients with stage IV oropharyngeal carcinoma is still very poor. It is necessary to re-classify stage IV squamous cell carcinoma of the oropharynx in relation to the prognosis. Foote et al. (Base of tongue carcinoma: patterns of failure and predictors of recurrence after surgery alone. Head Neck 1993:15:300-307) demonstrated the two subgroups of stage IV oropharyngeal squamous cell carcinoma, as favorable stage IV and unfavorable stage IV. In this study, we have re-examined the validity of these subsets and we have demonstrated the new subsets of stage IV squamous cell carcinoma of the oropharynx.

METHODS

We have examined 221 cases of oropharyngeal squamous cell carcinoma at the Cancer Institute Hospital in Tokyo between 1971 and 1994. A total of 107 cases of stage IV were included. We analyzed these cases retrospectively.

RESULTS

Based on the subsets demonstrated by Foote et al., there were no significant differences between the two groups in our cases, suggesting that these subsets were not useful for the choice of the treatment. In order to make a new classification in view of better choice of treatment, either radical treatment or palliative therapy, these cases were divided into two new groups of stage IV. one group with relatively good results (T1-3 N2 M0 and T4 NO-1 M0; new favorable stage IV), and the other with very poor results (any-T any-N M1 and any-T N3 M0 and T4 N2 M0; new unfavorable stage IV). Patients with the new favorable stage IV have a 5-year survival rate of 30.4%, and those with the new unfavorable stage IV had a survival rate of 0%.

CONCLUSION

These new subsets of stage IV can be directly related to the prognosis, and are therefore useful in the choice of treatment.

Ligation of medically refracted patent ductus arteriosus (PDA) in an extremely low body weight premature infant

Medically refracted patent ductus arteriosus (PDA) in an extremely low birth weight (ELBW) preterm (gestation 24 weeks 2 days) infant was successfully ligated under general anesthesia in the neonatal intensive care unit (NICU). Pharmacological agents are more effective to close PDA in preterm infants than in full-term infants, although within 48 h three doses of indomethacin were not sufficient to close PDA in this case. At the age of 69 h the infant developed severe symptoms including bradycardia, systemic hypotension, pulmonary hypertension, diastolic steal (reverse distal aorta flow velocity), and anuria. A PDA ligation was thus performed surgically at 72 h of age. General anesthesia and surgical stress were tolerated by this 531 g infant. Postoperatively all symptoms improved dramatically and the general conditions were stable. On the 38th day the endotracheal tube was extubated and on the 50th day nasogastric milk feeding was started. The oxygen supply was weaned on the 78th day. Growth and development until 6 months were within the normal range of very low birth weight infants. A surgical ligation as early as possible in medically refracted PDA in an ELBW infant is thus considered to be a safe and effective treatment. It prevents the development of further complications of cardiopulmonary vascular problems. Color Doppler echocardiography can reliably measure the PDA size, flow velocity, and hemodynamic changes of persistent PDA, even in tiny infants.

Parvovirus B19-associated transient pure red cell aplasia with lymphadenopathy: a case report

There have been few reports on lymph node swelling in human parvovirus (HPV) B19 infection. A report of a 42-year-old female, who developed HPV B19-associated transient red cell aplasia with lymphadenopathy, is presented. The lymph node swelling began with the appearance of atypical lymphocytes in the peripheral blood and it disappeared as the patient recovered from the aplasia. Microscopically, the patient's bone marrow showed characteristic giant proerythroblasts with no maturation of the erythroid series. An excised inguinal lymph node showed florid, reactive follicular hyperplasia with paracortex expansion, and neutrophil infiltration and hemophagocytosis in the medullary sinus. These findings were compatible with the histology of a viral infection. A polymerase chain reaction study revealed HPV B19 in her serum and lymph node, but an immunohistochemical study failed to demonstrate HPV B19 capsid antigen in the lymph node or bone marrow. Although the present case suggests that reactive lymphadenopathy is associated with HPV B19 infection, the mechanism of the lymph node swelling still remains to be elucidated.