Determination of drugs in exhumed liver and brain tissue after over 9 years of burial by liquid chromatography-tandem mass spectrometry-Part 2: Benzodiazepines, opioids, and further drugs.

In this publication, benzodiazepines, opioids, and further drugs were analyzed in exhumed brain and liver tissue samples in 116 cases (total) after 9.5-16.5 years of burial. Solid phase extraction followed by liquid chromatography-tandem mass spectrometry was applied. Data from literature is listed summarizing the detectability of the presented analytes after a certain time of burial. In our study, 60% of the analyzed benzodiazepines, 100% of the opioids, and 82% of further drugs were detectable. Only the benzodiazepines lorazepam, nitrazepam, flunitrazepam, and its metabolite norflunitrazepam, and the drugs butylscopolamine, metronidazole, and omeprazole were not detectable at all. Percentage of positive findings (total, and separately for brain and liver tissue) and postmortem period are listed for each analyte. Correlation of detectability depending on postmortem period and condition of tissue are presented exemplarily for midazolam. No substantial correlation was observed. Despite a long time of burial, most benzodiazepines, opioids, and further drugs were detectable in the examined tissue samples. Our results may be a good support for future exhumations in which toxicological analyses are relevant.

Determination of drugs in exhumed liver and brain tissue after over 9 years of burial by liquid chromatography-tandem mass spectrometry-Part 1: Cardiovascular drugs.

This paper should serve as support for future exhumations in which an analysis of cardiovascular drugs is issued after over 9 years of burial. Amiodarone, amlodipine, atropine, bisoprolol, cafedrine, clonidine, esmolol, furosemide, hydrochlorothiazide, lisinopril, nifedipine, nitrendipine, phenprocoumon, torsemide verapamil, and xipamide were determined in liver and brain tissue of over 100 cases in which exhumation was performed after over 9 years of burial. Diagrams, showing the detectability depending on postmortem period as well as condition of tissues, are presented for furosemide.

[Assessment of clinical features in solitary minimum size (<1 cm) bladder cancer].

We retrospectively evaluated primary non-muscle-invasive bladder cancer diagnosed between 1999 and 2008 at 2 facilities (Kawasaki Municipal Hospital and Yokohama Minami Kyosai Hospital). Size (< 1 cm) solitary bladder cancer statistically evaluated the characteristics. Out of 463 bladder cancers, 52 were minimum-size solitary pTa bladder cancers less than 1 cm in diameter. The average follow-up period was 50.9 months. The recurrence rate of the minimum-size bladder cancer was significantly lower than that of bladder cancers of other sizes (1 to 3 cm or ≥ 3 cm). The 3-year non-recurrence rate was 80.7,71.0,and 62.9% in each group (< 1, 1 to 3, ≥ 3 cm). High-grade minimum size bladder cancer (pTa) showed a significantly higher recurrence rate than the low-grade cases (P = 0.0101). Intravesical chemotherapy with anti-cancer drugs significantly reduced the intravesical recurrence rate in the low-grade minimum-size bladder cancer group (P = 0.0418). There was no statistically significant difference in either the average recurrence number or the rate of multiple recurrences between the minimum-size tumor group and the 1 to 3 cm tumor group. Minimum size bladder cancer had a lower recurrence rate than tumors of other sizes; however, there were no differences in other characteristics between the groups. Therefore, sufficient treatment, in accordance with the guidelines, should be administered for minimum size tumors as well as tumors of other sizes.

[Assessments of progression in non-muscle-invasive bladder cancer].

We retrospectively studied 463 patients with primary non-muscle-invasive bladder cancer diagnosed between 1999 and 2008 at two facilities (Kawasaki Municipal Ida Hospital and Yokohama Minami Kyosai Hospital). In this study, disease progression was defined as invasion to the muscle or further (upstage) and presence of metastasis (metastasis). We detected progression in 22 cases, including 18 upstages and 4 metastasis. Univariate analysis showed that factors associated with progression were T category (pT1 p< 0.0001), grade (high grade p< 0.0001, G3 p< 0.0001) and number of tumors (multiple p=0.0213). Multivariate analysis showed that the only equivocal factor associated with progression was T category (T1). Use of a second tansurethral resection for high-grade pT1 cases was unrelated to progression. Among the patients with progression, many had a more advanced T category at the time of radical treatment, and the results of treatment were poor. The factors associated with progression of bladder cancer should be investigated in more detail, so that early radical treatment can be initiated in eligible patients.

Basaloid cell carcinoma of the esophagus with a metastatic neck tumor of unknown origin: report of a case.

A 51-year-old man was admitted to our hospital with a tumor in the right anterior region of his neck. Aspiration biopsy revealed squamous cell carcinoma (SCC). Further investigations, including upper gastro-intestinal series and endoscopy, showed two flush lesions in the middle and lower thoracic esophagus. An endoscopic biopsy was done and the pathological findings indicated poorly differentiated SCC. He underwent esophagectomy with three-field lymph node dissection, including the neck tumor. Histological findings revealed that the tumor in the middle thoracic esophagus was moderately differentiated SCC, and that the other tumor below it was basaloid cell carcinoma (BCC). The depths of invasion were to the lamina propria mucosae for the former and to the submucosal layer for the latter. There was no lymphatic invasion, venous invasion, or lymph node metastasis. A diagnosis of poorly differentiated SCC of unknown origin was made for the neck tumor. Postoperative recombinant chemotherapy with cisplatin and 5-fluorouracil was given for the unknown primary site, which we still have not identified. No recurrence of the esophageal cancer has been detected.