Treatment of in-stent restenosis with beraprost sodium: an experimental study of short- and intermediate-term effects in dogs.

1. The aim of the present study was to evaluate the inhibitory effects of the short-term administration of beraprost sodium, a stable prostaglandin I(2) analogue, on neointimal thickening after stenting. 2. To examine the immediate and short-term effects, Z-stents were placed in the iliac veins of 12 dogs, which were randomly assigned to either a beraprost-treated or control (saline) group. Beraprost (0.35 microg/kg per min) or saline (1.5 mL/min) was administered 30 min before stenting and was continued for 5 h thereafter. Platelet aggregation was measured before and after drug administration. At 3, 7 and 14 days after stenting, dogs were killed and immunohistochemical staining for proliferating cell nuclear antigen was used to quantify the proliferation of vascular smooth muscle cells (SMC). To evaluate intermediate-term effects, a Z-stent was placed in the right iliac vein in 10 dogs, followed by beraprost treatment. Three days later, a second Z-stent was placed contralaterally with saline infusion as a control. After 4 weeks, dogs were killed and neointimal thickness was measured under a light microscope to calculate the intima : media area ratio. 3. Platelet aggregation was more significantly suppressed in the beraprost-treated than in the control group (P = 0.01). In addition, SMC proliferation was significantly lower in the beraprost-treated group 7 and 14 days after stenting (P < 0.05). Over the intermediate term, the intima : media area ratio was significantly lower in the beraprost-treated vein compared with control (P < 0.05). 4. In conclusion, short-term beraprost treatment during stenting suppresses in situ platelet aggregation and SMC proliferation, thus reducing neointimal thickening.

[Is "functional somatic syndrome" clinically useful?].

The functional somatic syndrome is applied to several syndromes characterized by medically unexplained physical symptoms, such as irritable bowel syndrome, fibromyalgia, chronic fatigue syndrome, etc. Both physical and psychiatric treatments are usually necessary for these syndromes and the term functional somatic syndrome was advocated to inform clinicians in America of this fact. However, We believe this term will not be useful in Japan, because most Japanese clinicians are already aware of this fact and treatment is different in each syndrome included in FSS.

Importance of a psychiatric approach in cosmetic surgery.

BACKGROUND: Some studies have suggested that certain types of psychiatric problems may be more prevalent in patients undergoing cosmetic surgery than in the general population. OBJECTIVE: In this study, 140 patients undergoing cosmetic surgery took a screening test before surgery. The results were statistically analyzed to evaluate the importance of a psychiatric approach in cosmetic surgery. METHODS: At the first visit to the clinic, an interview was carried out in the presence of a psychiatrist. If needed, a secondary evaluation was performed on those patients with suspected psychological disorders. RESULTS: Preoperative screening led to the diagnosis of psychiatric disorders in 45 of 140 patients (32%). Final psychiatric diagnoses included neuroses such as body dysmorphic disorder and depression/depressive states. CONCLUSIONS: It is sometimes beneficial to prioritize psychiatric treatment instead of focusing solely on surgical treatment to achieve better outcomes in patients undergoing cosmetic surgery who have psychiatric disorders. Preoperative psychiatric screening should be routine in the practice of cosmetic surgery.

Diagnosis of occlusal dysesthesia utilizing prefrontal hemodynamic activity with slight occlusal interference.

Clinical diagnosis of occlusal dysesthesia (OD), also referred to as phantom bite syndrome, is currently based on the absence of objective occlusal discrepancy despite the persistent complaint of uncomfortable bite sensation. We previously demonstrated that the subjective feeling of occlusal discomfort generated by artificial occlusal interference can be objectively evaluated using prefrontal hemodynamic activity in young healthy individuals. The aim of this study was to investigate whether dental patients with and without OD show distinct prefrontal activity during grinding behavior with an occlusal interference. Six dental patients with OD (OD group) and eight patients without OD (control group) grinded piled occlusal strips placed between their first molars and reported their perception and discomfort thresholds during continuous monitoring of prefrontal hemodynamic activity with a portable functional near-infrared spectroscopy. Although patients without OD showed the typical hemodynamic pattern of increased oxyhemoglobin and reduced deoxyhemoglobin (HHb) concentration, those with OD showed persistent incremental increases of HHb concentration that began at the loading of occlusal strips on their molars before they executed grinding. The intensities of the task-related HHb activities showed statistically significant differences between OD and control groups, particularly at channel 3, arranged over the left frontal pole cortex. When the discrimination criterion was set using the intensity values of channel 3 from both groups, the overall accuracy of the OD discrimination was 92.9%. Although physiological interpretation has yet to be elucidated, the task-related response of an increase in HHb may be a useful neuronal signature to characterize dental patients with OD.

Relationship between oral sensory thresholds and depressive moods.

AIMS: The aims were to compare the sensory thresholds on the tip of the tongue with on the dorsum of the hand, and to investigate the relationship between the sensory threshold and depressive mood with volunteers whose psychological conditions were normal. METHODS: Fifty-five subjects (28 women, 27 men) took psychiatric structured diagnostic interview and Self-rating Depression Scale (SDS). In the next step, the quantitative sensory tests (light touch sensation and thermal sensory test) were carried out on the tongue and the hand. Then we investigated the relationship between depressive moods and sensory thresholds on the tongue and the hand using logistic regression model. RESULT: The sensory thresholds on the tip of the tongues were significantly different from those on the dorsum of the hands. Only on tongue tip, increment of SDS had relation to the thresholds of innoxious thermal stimulation (OR=0.152, 95% CI. 0.049-0.478) and noxious heat stimulation (OR=0.352, 95% CI. 0.169-0.734). CONCLUSION: This finding might support for the idea that depressive mood had closer association with the tongue of the orofacial areas than the dorsum of the hand.

Relationships between radiosensitivity and microvascular density in esophageal carcinoma: significance of hypoxic fraction.

PURPOSE: The prognosis and the radiosensitivity of macroscopically infiltrative type of esophageal carcinoma are worse than those of the localized type of esophageal carcinoma treated with irradiation. The aim of this study was to investigate the cause of differences in radiosensitivity and prognosis of esophageal carcinoma according to macroscopic type from the viewpoint of tumor angiogenesis. METHODS AND MATERIALS: A total of 40 surgically resected esophageal carcinoma tissues with good material remaining were selected at random from macroscopically localized type (n = 20) and infiltrative type (n = 20) of esophageal carcinoma. The highest intratumoral microvascular density (h-MVD), average intratumoral microvascular density (a-MVD), Ki67 labeling index, and expression of vascular endothelial growth factor (VEGF) in each section were estimated. RESULTS: h-MVD was significantly (p = 0.0006) greater in the infiltrative type than in the localized type, whereas a-MVD (p = 0.0014) and Ki67 labeling index (p = 0.022) were significantly lower in the infiltrative type than in the localized type. The expression level of VEGF was significantly (p < 0.0001) higher in the infiltrative type. CONCLUSIONS: The generally underdeveloped vascular densities with low proliferation activities (suggesting increase of hypoxic fraction) seemed to be one of the reasons for unfavorable radiosensitivities of infiltrative type of esophageal carcinoma. The infiltrative type of esophageal carcinoma shows a high level of VEGF expression and high activity of tumor angiogenesis. The locally enhanced neovascularization, which occurs frequently in hematogenous metastasis seemed to be one of the reasons for the unfavorable prognosis of the infiltrative type of esophageal carcinoma.

Time-related changes of radiofrequency ablation lesion in the normal rabbit liver: findings of magnetic resonance imaging and histopathology.

RATIONALE AND OBJECTIVES: To study time-related magnetic resonance imaging (MRI) and histopathological findings after radiofrequency ablation (RFA) in the normal liver. METHODS: Under ultrasound guidance, RFA was performed in 22 rabbits with a 15-gauge expandable probe inserted into the liver. The RF power was applied at 10 W initially with a 5-W increment every minute until RF power "roll-off" occurred. The rabbits subjected to postmortem MRI at 3 days (n = 6), 2 weeks (n = 6), 4 weeks (n = 6), and 12 weeks (n = 4) after RFA. Spin-echo (SE) T(1)-weighted image (WI) (TR/TE=500/12) and fast SE T2-WI (TR/TE= 3500/99) were obtained. The liver specimens were excised and processed for conventional histologic study. The MRI and pathologic findings were compared qualitatively and quantitatively. RESULTS: The lesion diameters measured with MRI and liver specimen were well correlated (P < 0.05). The coagulated regions presented 2 of 4 laminar patterns on T1/T2-WI 3 days after RFA, and 2 of 3 laminar patterns on T1/T2-WI 2 to 4 weeks after RFA. 12 weeks after RFA, the signal intensity in coagulated regions increased on T1-WI with a 2-laminar pattern still visible on T2-WI, the same as that of 2 to 4 weeks. The observed pathologic changes (enlarged sinusoids, marginal fibrous tissue and hepatocyte degeneration) could be responsible for the MRI laminar patterns and signal intensity changes. CONCLUSION: The time-related pathologic changes of RFA lesions in rabbit livers can be reflected as laminar patterns on MR images. Understanding of the zone structure of the lesions is useful for the evaluation of follow-up MRI.

Intrinsic radiosensitivity by metallothionein expression has no great influence on clinical radiosensitivity in esophageal carcinoma.

Several studies have shown that macroscopically infiltrative type of esophageal carcinoma generally has a poorer local response to radiation therapy than that of localized type. The aim of this study was to determine the role of metallothionein (MT) as a radioprotective agent in the difference of clinical radiosensitivities in esophageal carcinoma. A total of 45 surgically resected esophageal carcinoma tissues [20 macroscopically localized type without preoperative treatment (PT), 20 macroscopically infiltrative type without PT and 5 macroscopically infiltrative type with PT] were stained for MT by immunohistochemistry and were analyzed. MT expression level of macroscopically localized type of esophageal carcinoma was significantly higher than that of infiltrative type without PT (P=0.026) and was significantly higher than that of infiltrative type with PT (P=0.024). No significant difference was found between MT expression levels in infiltrative type of esophageal carcinoma without PT and that with PT. The results of this study suggest that there is less possibility that clinical radioresistance of the tumor is due to MT expression in esophageal carcinoma and also suggest that there is less possibility that MT synthesis is induced by fractionated irradiation of a moderate dose or by an anti-cancer agent during a course of treatment.

Significance of plasminogen-activation system in the formation of macroscopic types and invasion in esophageal carcinoma.

BACKGROUND: The roles of urokinase-type plasminogen activator (uPA) and plasminogen activator inhibitor-1 (PAI-1) in the formation of macroscopic types and invasion were investigated. MATERIALS AND METHODS: A total of 40 surgically-resected esophageal carcinoma tissues were immunohistochemically stained, and the expression of uPA, PAI-1 and the uPA/PAI-1 ratio, were evaluated. RESULTS: The expression of uPA was significantly stronger in the macroscopically infiltrative type (n = 20: p = 0.0027), whereas PAI-1 was significantly stronger in the localized type (n = 20: p = 0.0005). The uPA/PAI-1 ratio was significantly higher in the infiltrative type (p < 0.0001). A significant correlation was found between the U/P ratio and the depth of tumor invasion (r = 0.511, p = 0.0014). Analysis of tumors of uniform size (4.0-6.0 cm in length), showed that the depth of invasion was significantly greater in the infiltrative type (p = 0.0038). CONCLUSION: The results demonstrated that uPA and PAI-1 play important roles in invasion and formation of macroscopic types of esophageal carcinoma.

Detecting mental disorders in dental patients with occlusion-related problems.

Dentists often treat patients who may be suffering from comorbid mental disorders without paying attention to their symptoms. This leads to a delay in starting the treatment of mental disorders and to inappropriate dental treatments for physical symptoms originating from mental disorders. In the present study, the ways in which dentists can easily detect mental disorders in dental patients with occlusion-related problems were examined. Fifty-three patients who visited the Occlusion Clinic of Kanagawa Dental College were interviewed by a psychiatrist and a dentist specialized in psychosomatic medicine. Thirty-five patients (66.0%) were diagnosed as having DSM-IV Axis I disorders. The demographic and psychological factors that correlate with the presence of mental disorders are duration of chief complaint, number of clinics and hospitals visited for the current symptom, total score of the General Health Questionnaire (GHQ), the scores of the anxiety and insomnia and social dysfunction subscales in the GHQ and the scores of the confusion-bewilderment and fatigue-inertia subscales in the Profile of Mood States (POMS). A logistic regression analysis indicated that number of clinics and hospitals visited markedly correlated with cormobidity of a mental disorder. This information may be useful for screening mental disorder patients. Dental patients having comorbid mental disorders should be treated both odontologically and psychologically.

Time-related changes in computed tomographic appearance and pathologic findings after radiofrequency ablation of the rabbit lung: preliminary experimental study.

PURPOSE: To evaluate correlations between computed tomographic (CT) appearance and pathologic findings after radiofrequency (RF) ablation of lungs and to determine whether CT appearance could predict the extent of the effective therapeutic area. MATERIALS AND METHODS: The lungs of 14 rabbits were subjected to RF ablation and CT scans were obtained immediately and at various intervals thereafter. Four rabbits were killed immediately after the initial CT imaging (n = 4). The remaining 10 rabbits were killed after additional CT scans at intervals of 3 days (n = 2), 1 week (n = 4), 2 weeks (n = 2), and 3 weeks (n = 2) after RF ablation. Pathologic findings were correlated with CT appearance. RESULTS: Immediately after RF ablation, a restricted area of central dense opacity enclosed by an extensive area of ground-glass opacity was noted in the ablated region on CT images. Pathologically, the former corresponded to destructive tissue and the latter corresponded to tissue with some degree of injury. After 1 week, the entire ablated region appeared as a well-demarcated homogeneous dense opacity on CT that corresponded to necrotic tissue and its surrounding rim of granulation tissue on histopathologic examination, indicating that the enclosing extensive area of ground-glass opacity on the initial CT scan represented an ongoing necrosis. Within 2-3 weeks, the ablated region gradually contracted on the CT images, representing a tissue repairing process in which the granulation tissue was encroaching on the inner necrotic tissue. CONCLUSION: Ground-glass opacity of the ablated region on CT immediately after RF ablation represents an ongoing necrosis.

[Correlation between CT and pathological findings after radiofrequency ablation of rabbit lung: evaluation of therapeutic effective area].

The purpose of this study was to correlate the CT and pathologic findings after radiofrequency ablation (RFA) of rabbit lung and evaluate the therapeutically effective area. RFA was performed in eight rabbit lungs, and ablated regions were imaged immediately after RFA (n=8) and 1 week later (n=4). Immediately after RFA, the ablated regions showed ground-glass opacity. At one week, the ablated region showed very dense opacity, which corresponded to necrotic tissue. Ground-glass opacity signified the therapeutically effective area that would later turn into necrosis.

[Radiofrequency ablation of rabbit liver: correlation between dual CT findings and pathological findings].

PURPOSE: To present the time-related imaging findings and correlative pathologic findings of radiofrequency pulse-irradiated regions of the liver. MATERIALS AND METHODS: Radiofrequency (RF) ablation was performed in 22 rabbit livers with 15-gauge RF probes inserted percutaneously. Regions were imaged with dual-phase CT at 3 days (n = 6), 2 weeks (n = 6), 4 weeks (n = 6), and 12 weeks (n = 4) after RF ablation. RESULTS: At 3 days, the regions showed a two-zone structure on plain CT and peripheral enhancement. The regions presented a three-zone structure on pathological study. Hepatocytes appeared as acidophilic bodies, and nuclei were pyknotic at the inner necrotic zone. The middle whitish zone showed enlarged sinusoids. The marginal zone was a regenerative band. At 2 weeks, the two-zone structure was obscured on unenhanced CT. The region showed a two-zone structure on pathological study. At the inner zone, acidophilic degeneration had progressed, however, cell structure remained. The marginal zone showed fibrous tissue bundles. At 12 weeks, the region was obscured on plain CT. Nuclei and cell structures had disappeared almost completely at the inner zone. Collagen fiber had replaced the marginal zone. CONCLUSION: Zone structural CT findings reflect the pathological findings and time-related changes after RF ablation. Peripheral enhancement in the arterial phase reflects the granulation tissue layer, and its time-related decrease reflects replacement by fibrous tissue.