Inguinal hernias appearing after lateral lymph node dissection via extraperitoneal approach for advanced lower rectal cancer.

PURPOSE: Lateral lymph node dissection (LLND) is performed for advanced lower rectal cancer (ALRC) in Japan. The LLND in laparotomy is performed via the extraperitoneal approach, which is similar to radical retropubic prostatectomy (RRP). Inguinal hernias (IHs) appearing after RRP are common. However, there are few reports about IHs appearing after LLND. METHODS: In part A, we retrospectively investigated 108 patients who underwent LLND for ALRC between January 2004 and December 2014. In part B, we compared 13 patients who underwent IH repair after LLND and 57 patients who underwent IH repair after RRP in the same period. RESULTS: In part A, the incidence of IHs after LLND was 7% (8/108). All eight patients who developed IHs were male, and their median age was 60 years. More than 80% of IHs observed were the unilateral lateral type. In part B, the interval between the previous operation and IH occurrence was 4.9 years on average. Furthermore, 2 out of the 13 patients developed additional IHs occurring on the opposite side within 2 years. CONCLUSIONS: The characteristics associated with developing IHs after LLND were similar to those after RRP. Any pelvic operation via the extraperitoneal approach has a risk of IHs, and surgeons should pay attention to IHs after surgery.

Determination of full-energy peak and total efficiency functions for Ge-detectors by iteration calculation using a mixed radionuclide source.

Empirical calibrations of full-energy peak and total efficiency curves for well-type and coaxial p-type germanium detectors were carried out using several combinations of practical nuclides. As a result, reliable efficiency functions of both types of detectors were successfully obtained using a home-made program coded with Visual Basic for Applications (VBA) and the "Solver" add-in in Excel™. We also examined the applicability of our advanced program to volumetric sources using squared-to-linear curve technique.

Absolute peak-efficiency calibration of a well-type germanium detector using multiple gamma-emitting nuclides with the "Solver" add-in in Excel™.

When calibrating absolute peak efficiency and total efficiency functions for high efficient germanium detectors, single gamma-emitting nuclides are used in general to avoid coincidence summing effects. As another approach, Blaauw developed calibration technique using multiple gamma-emitting nuclides with least-square technique (Blaauw, 1993; Blaauw and Gelsema, 2003). In the present study, we tried to calibrate efficiency functions of a well-type germanium detector based on Blaauw's approach using a home-made iteration calculation algorithm with the "Solver" add-in in Excel™.

An evaluation of polyvinylidene film dressing for treatment of pressure ulcers in older people.

OBJECTIVE: To compare the effectiveness of polyvinylidene (PVL) food wrap as a dressing material versus conventional ointments and gauze dressings for pressure ulcers in patients aged 60 years or over. METHODS: A prospective open controlled trial was conducted. The severity of pressure ulcers in both groups was evaluated using the DESIGN system. Scores were compared at baseline, four, eight and 12 weeks. RESULTS: Twenty-five patients were treated with the PVL film (test) dressings and 24 with the conventional treatment (control). The test group showed greater improvement in DESIGN scores than the control group throughout the observation period, and the difference reached statistical significance at 12 weeks (p < 0.05). The incidences of local wound infection in the two groups were not statistically different (p > 0.999). CONCLUSION: The PVL film dressing was more effective than conventional treatment in the management of severe pressure ulcers.

Practical correction method for impurities on activity measurements using isotope calibrators.

Radioactive impurities might cause significant error in the activity determination of a target nuclide using ionization chambers. In the present study, an impurity correction technique for (201)Tl sources was performed by applying two different responses of an IG12A20 and IG11N20 ionization chamber. This technique can be extended to another method in which an attenuation filter made of tin was used to obtain different responses of an argon filled IG12A20. The results obtained with these techniques were very consistent with each other and with the reference value within their uncertainty after making the impurity correction. Examples of (64)Cu activity determination were also shown.

Activity measurement of (68)Ge-(68)Ga by use of 4π(ß(+)+γ) integral counting method.

A 4π(ß(+)+γ) integral counting method using 4πß-4πγ detector configuration composed of a large well type NaI(Tl) scintillation detector and stacked plastic scintillators positioned in the center of the well and coupled with a slender PMT was adopted for activity measurement of (68)Ge-(68)Ga. Several source preparation schemes were studied to reduce the activity loss due to volatility. The possible contribution of EC events were rejected with pulse-height discrimination. Owing to the high counting efficiencies in both channels and the multiplicity of photons and ß-particles emitted, the 4π(ß(+)+γ) integral counting system gives a count rate very nearly equal to the positron emission rate. The activity can be determined simply from this value divided by the positron emission branching ratio. The remaining overall inefficiency was evaluated by the EGS5 code.

Familial amyotrophic lateral sclerosis with a novel Leu126Ser mutation in the copper/zinc superoxide dismutase gene showing mild clinical features and lewy body-like hyaline inclusions.

BACKGROUND: Mutations in the SOD1 gene are responsible for approximately 25% of all familial amyotrophic lateral sclerosis (ALS) cases. However, the correlation between the clinical and pathological features and the various SOD1 gene mutations has not been well characterized. OBJECTIVES: To screen the SOD1 gene in search of potential mutations and to obtain clinical and pathological data for 2 Japanese families with ALS. DESIGN: Clinical histories and neurological findings, gross and microscopic pathological features, and DNA analysis of the SOD1 gene. RESULTS: The 2 families with ALS showed a novel missense mutation in the SOD1 gene, which was heterozygous for point mutation TTG to TCG, causing substitution of leucine for serine at codon 126 (Leu126Ser) in exon 5. Clinically, patients showed slower disease progression and lack of upper motor neuron signs. Neuropathologically, the autopsied patient showed the form of familial ALS with posterior column involvement, and the pontocerebellar tract and the dentate nuclei of the cerebellum were also involved. Furthermore, abundant Lewy body-like hyaline inclusions were observed in the affected motor and nonmotor neurons. CONCLUSIONS: Familial ALS with a novel Leu126Ser mutation in the SOD1 gene showed mild clinical features and lack of upper motor neuron signs. We believe that Leu126Ser might be associated with the clinical features and that the mutation site in the SOD1 gene and disease duration might be associated with the formation of Lewy body-like hyaline inclusions.

Expression of sex-hormone receptors and clinicopathological findings in hepatocellular-carcinoma.

We studied the expresssion of estrogen (ER), progesterone (PgR), and androgen receptors (AR) in hepatocellular carcinoma (HCC) and found expression in (7/36), 3.2% (1/31), 16.7% (4/24) of cases, respectively. The expression of ER did not correlate with histological grade, tumor size, or stage of disease. On the other hand, all the patients with AR-positive tumors had stage IV disease, and only 25% of the patients with AR-negative tumors had stage IV disease. The survival was not influenced by the expression pattern of ER, however, the survival of the patients with AR-positive tumors tended to be worse than that of patients with AR-negative tumors. We suggest that the AR expression correlates better with poor outcome in HCC than the ER expression.

Prediction of prognosis after resection in human hepatomas by nuclear-DNA analysis.

Nuclear DNA analysis with flow cytometry was performed in 81 patients with hepatocellular carcinoma. Thirty-eight cases (46.9%) were diploid type and forty-three cases (53.1%) aneuploid type. Microscopical portal vein invasion of the tumor was more frequent in the aneuploid group (p<0.05). Significantly higher frequency of intrahepatic metastasis was found in the aneuploid group (p<0.05). There was no correlation between the tumor nucleus DNA ploidy pattern and the recurrence rate, 23 (60.5%) of diploid cases and 28 (65.1%) of aneuploid cases, respectively. Disseminated recurrence was more frequent in the aneuploid group than in the diploid group (p<0.10). Significantly better survival rates were observed in the diploid group which had microscopical portal invasion. Moreover, the diploid group which had no capsular formation and intrahepatic metastasis showed significantly longer survival terms.

Cloning and sequence of the SCS3 gene which is required for inositol prototrophy in Saccharomyces cerevisiae.

The SCS3 gene of Saccharomyces cerevisiae was cloned by functional complementation, using a conditional mutant exhibiting myo-inositol auxotrophy in the presence of choline, and sequenced. The sequence contained an open reading frame capable of encoding 380 amino acids with a calculated molecular weight of 42,734. Disruption of the SCS3 locus caused myo-inositol auxotrophy. The gene appeared to be involved in the synthesis of inositol phospholipids from inositol but not in the control of inositol synthesis.

Occurrence of ganglioside GD3 in neoplastic astrocytes. An immunocytochemical study in humans.

GD3 immunocytochemical analysis was performed in 25 human specimens obtained by autopsy and biopsy from patients with astrocytomas, anaplastic astrocytomas, cerebellar astrocytomas and glioblastoma multiforme (GM), using the ABC method. Extraction of the ganglioside fraction from GM was used for thin-layer chromatography (TLC) analysis to confirm the specificity of anti-GD3 monoclonal antibody (DSG-1). Normal astrocytes were not immunoreactive for GD3. Neoplastic astrocytes of low- to high-grade tumours were GD3 immunoreactive. In GM, the multinucleated giant cells were also immunoreactive. All immunoreactivity present was within the cytoplasm. In TLC analysis, enzyme immunostaining of gangliosides from GM with DSG-1 showed only one positive band, which had the same TLC migration rate as GD3, indicating that GD3 of the ganglioside fraction from GM is the antigen detected by DSG-1. The presence of GD3 within the cytoplasm of neoplastic astrocytes showing invasive and proliferative properties, is of considerable interest. The implications and possible significance of the presence of GD3 in the cytoplasm in glioma cells are discussed.

Tau pathology in diffuse neurofibrillary tangles with calcification (DNTC): biochemical and immunohistochemical investigation.

Diffuse neurofibrillary tangles with calcification (DNTC) represents a primary and sporadic presenile dementia that is characterized by temporal or fronto-temporal atrophy with diffuse neurofibrillary tangles (NFTs), neuropil threads and Fahr-type calcification without senile plaques. We examined the tau pathology in five autopsy cases of DNTC by immunoblotting and immunohistochemistry using phosphorylation-dependent and -independent anti-tau antibodies. The pattern of staining for different epitopes of beta-amyloid (A beta) was also investigated. NFTs were immunopositive with all the anti-tau antibodies used in this study. On the immunoblots, sarkosyl-insoluble tau appeared as three major bands of 60, 64 and 68 kDa, and as a minor band at 72 kDa. The majority of extracellular NFTs were weakly immunopositive only with the antibody recognizing the 40 carboxyl-terminal of A beta in DNTC. These results suggest that Alzheimer's disease-like tau pathology could exist independently of A beta deposits in DNTC.

Lead content of brain tissue in diffuse neurofibrillary tangles with calcification (DNTC): the possibility of lead neurotoxicity.

Diffuse neurofibrillary tangles with calcification (DNTC) is a form of presenile dementia, characterized pathologically by fronto-temporal atrophy with neurofibrillary tangles (NFTs), neuropil threads and Fahr-type calcification, in which no senile plaques are observed. As already noted, chronic exposure to lead (Pb) might be one of the etiological factors of Fahr-type calcification. Until now, there have been no reports in which Pb concentration has been quantified in DNTC brains. We examined the concentration of Pb in fresh-frozen brain tissue and in 10% formalin-fixed brain tissue from six cases of DNTC, four cases of Alzheimer's disease, and in nine non-demented elderly controls by flameless atomic absorption spectrometry, and demonstrated a high concentration of Pb in DNTC brains. Although it remains unclear how these findings are related to the formation of NFTs, they suggest that Pb neurotoxicity may be involved in the pathogenesis of DNTC.

Diffuse neurofibrillary tangles with calcification (a form of dementia): X-ray spectrometric evidence of lead accumulation in calcified regions.

Diffuse neurofibrillary tangles with calcification (DNTC) is a form of slowly progressive dementia in which no senile plaques are observed. The calcification is one of the most characteristic features of DNTC. We examined the elemental content of certain mineral deposits (lead, magnesium, phosphorus, calcium, iron, copper and zinc) in the calcified and non-calcified regions of eight cases of DNTC, five cases of Alzheimer's disease (AD) and in eight non-demented elderly controls. The study was performed using a combination of scanning electron microscopy and X-ray spectrometry on 10% formalin-fixed brain tissue. A marked abundance of calcium and phosphorus was observed in the calcified regions of DNTC and non-DNTC brains. Although no lead was observed in the non-calcified regions of DNTC and in non-DNTC brains, traces of lead were detected exclusively in the calcified regions of DNTC brains. The implications and possible significance of the lead accumulation in DNTC brains are discussed.

Diagnostic significance of tau protein in cerebrospinal fluid from patients with corticobasal degeneration or progressive supranuclear palsy.

Distinguishing corticobasal degeneration (CBD) from progressive supranuclear palsy (PSP) is clinically and pathologically difficult, and a useful biological marker to discriminative these two diseases has been a subject of clinical interest. In the present study, we assessed tau protein levels in cerebrospinal fluids by sandwich ELISA to distinguish CBD from PSP. The subjects consisted of 27 cases of CBD, 30 cases of PSP, and 36 healthy controls (CTL). The tau values in CBD were significantly higher than those in PSP (P<0.001) and those in CTL (P<0.001). The assay of CSF tau provided diagnostic sensitivity of 81.5% and specificity of 80.0% between CBD and PSP according to receiver-operating characteristic (ROC) curve analysis. When values were compared separately with respect to stage of the disease, differences in the values for moderate CBD vs. moderate PSP had the greatest significance (P<0.001 sensitivity 92.3%, specificity 100.0%), followed by cases of mild CBD and PSP (P<0.005, sensitivity 100.0%, specificity 87.5%). The values in severe CBD and PSP were not significantly different (P=0.07, sensitivity 100%, specificity 75.0%). Using data obtained from a larger number of disease cases, we confirmed our previous findings that tau protein levels in cerebrospinal fluids in patients with CBD are significantly higher than those in patients with PSP. Because tau protein levels in cerebrospinal fluids are significantly higher in early CBD cases than in early PSP cases, measurement of tau protein levels in cerberospinal fluids may be useful for the differential diagnosis of early CBD from early PSP.

Treatment of hepatocellular carcinoma associated with extrahepatic primary cancer.

Association of extrahepatic primary cancers (EPC) were studied in 533 consecutive hepatocellular carcinoma (HCC) cases. EPCs were found in 30 cases (5.6%). Three patients had two EPCs. The most frequent sites of EPC were the stomach (n=10, 30.3%), the colon (n=8, 24.2%), otolarynx (n=5, 15.2%), and the lung (n=2, 6.1%). Twenty-nine of 33 EPCs were treated by resection. EPCs did not affect the survival rate, however, the survival of the 20 patients who underwent resection of HCC was better than the 10 patients who did not. Liver cirrhosis was present in 8 of the 30 cases. Advanced stages of HCC were more frequently seen (P<0.05) in cases without cirrhosis.

Km genotyping by polymerase chain reaction (PCR) using allele-specific amplification primers.

We developed a method for identifying genetic polymorphisms of the human immunoglobulin kappa light chain, namely the Km allotypes, by allele-specific amplification by means of the polymerase chain reaction (PCR). This procedure consisted of first and second PCR. In the first PCR, the 353 bp fragment of the human immunoglobulin kappa light chain constant gene was amplified without differentiating individual alleles. In the second PCR, the specific sequence in each of the three alleles Km*1, Km*1,2 and Km*3, in the first PCR product was specifically amplified using allele-specific primers. The product of the second PCR was separated by electrophoresis on a polyacrylamide gel and the band was observed by means of UV trans-illumination after staining with ethidium bromide. From DNA extracted from lymphocytes, the specific sequence of each Km allele was selectively amplified, and the Km genotype was identified. Moreover, the Km genotype could be ascertained from whole blood, saliva and hair roots without DNA extraction. No genetic contradiction was found in the results of Km genotyping among parents and their children. The estimated gene frequency of 115 Japanese individuals living in Okayama Prefecture, Japan, was: Km*3 = 0.739 and Km*1,2 = 0.261.

Species identification of blood and bloodstains by enzyme-linked immunosorbent assay (ELISA) using anti-human immunoglobulin kappa light chain monoclonal antibody.

A series of experiments was conducted to establish a species identification method by means of the enzyme-linked immunosorbent assay (ELISA) using monoclonal antibody with high specificity, the result of which is reported. The limit of human IgG detection by inhibition ELISA using mouse anti-human immunoglobulin kappa light chain (Ig kappa) monoclonal antibody is 0.01 microgram. Using this method it was possible to detect human Ig kappa from bloodstains in dilutions up to 1:100,000 (dilution multiple of bloodstain extract to the original amount of blood). Human Ig kappa was detectable in human bloodstains in dilutions up to 1:50,000 one year after stain preparation and in dilutions up to 1:10,000 4 years after stain preparation, showing that this method is applicable to species identification of old bloodstains. When primates other than human were studied for specificity, red-chested tamarin and Japanese monkey showed no cross reaction at all. Cross reaction was noted with a chimpanzee, but experimentally it could be differentiated from human. Furthermore, no cross reaction was noted with respect to blood samples from non-primates (guinea pig, sheep, horse, dog and cat).

Sex identification of bloodstains by radioimmunoassay of sex hormones.

A forensic application is reported for the sex determination of subjects whose dried bloodstains are analyzed by radioimmunoassay for testosterone and progesterone. Blood specimens of ten males and 15 females were collected, prepared as bloodstains, and then assayed at four different time intervals for testosterone (T) and progesterone (P) contents up to 3 months later. The ratio of the two hormone contents (P/T, log P/T) was used to establish the sex origin of the dried blood specimens.

Effects of cocaine administration route on the formation of cocaethylene in drinkers: an experiment using rats.

The effects of cocaine administration route on the formation of cocaethylene, an active metabolite of cocaine produced in the presence of ethanol, were investigated using rats. When 20 mg/kg cocaine was administered into the stomach together with 2 g/kg ethanol, maximum liver concentrations of cocaine and cocaethylene, 8410 +/- 3600 and 1680 +/- 520 ng/g, respectively, were observed at 15 min. In other tissues the maximum levels of both the substances were attained in 30 min, but were much lower than those in the liver. Intramuscular administration of 20 mg/kg cocaine with 2 g/kg oral ethanol gave levels of liver cocaine as low as 103 +/- 29 to 150 +/- 35 ng/g, resulting in no detection of liver cocaethylene over the entire 180-min study period, although gradual accumulation of cocaethylene was observed in other tissues. The accumulation patterns of cocaine and cocaethylene in blood of alcohol-intoxicated rats after the i.m. administration of cocaine were similar to those in blood of drinkers after nasal insufflation of cocaine. Despite i.v. administration of 1 mg/kg cocaine with 2 g/kg oral ethanol, no detectable amounts of cocaethylene appeared in any tissues over the entire 60-min study period. The present findings are considered to be of importance in the fields of forensic and clinical toxicology for clarifying (1) the rate of in vivo cocaethylene formation and (2) the distribution of cocaine and cocaethylene in blood and tissues.