Calibration phantoms for accurate water and lipid density quantification using dual energy mammography.

The aim of this study is to investigate the feasibility of water and lipid as calibration phantoms for accurate dual energy breast density quantification. Dual energy calibration was performed on a mammography system based on scanning multi-slit Si strip photon-counting detectors using plastic water and adipose-equivalent phantoms as the basis materials. Two different methods were used to convert the dual energy decomposition measurements in plastic phantom thicknesses into the true water and lipid basis materials. The first method was based entirely on the theoretically calculated effective attenuation coefficients of the investigated materials in the mammographic energy range. The conversion matrix was determined through the linear least-squares fitting of the target material using the calculated effective attenuation coefficients of water and lipid. The second method was based on experimental calibration with plastic water phantom, adipose-equivalent phantom, and its correlation to known water and lipid thicknesses. These two methods were then validated by using an independent measurement of water and lipid mixture phantoms and postmortem breasts. The correlation between the dual energy decomposition measurements and the known values was evaluated using linear regression analysis. The averaged root-mean-square errors for water density quantification derived from the theoretical and experimental conversions were 8.6% and 1.6%, respectively. The postmortem breast tissue study also indicates that the experimentally acquired conversion coefficient improved the accuracy in water density quantification, in comparison with that from the theoretical conversion. The results show that conversion of the dual energy measurements into water and lipid thicknesses improves the accuracy in breast tissue decomposition.

The importance of the Crohn's disease activity index in surgery for small bowel Crohn's disease.

AIM OF THE STUDY: Compared with patients with other benign intestinal conditions, patients with CD are at increased risk of developing postoperative complications following intestinal resection. We searched for useful tools for predicting postoperative complication in patients with CD by comparing the relationship between postoperative morbidity in these patients as measured by three different scoring tools: general surgical risk (POSSUM score), disease activity (CDAI), and nutritional screening (nutritional prognostic index). METHODS: We performed a retrospective review of 50 patients with small bowel CD who underwent surgical resection and primary anastomosis between 1999 and 2014. RESULTS: This study enrolled 34 men and 16 women. The mean age was 38.4 years (range: 20-81 years). There was no postoperative mortality. The overall postoperative morbidity rate (33.7%) predicted by POSSUM was similar to the rate in the study patients (36.0%). Although POSSUM score predicted higher postoperative morbidity rates in patients who underwent emergency surgery (estimated morbidity: 52.8%), the actual postoperative morbidity rate in the emergency surgery group (26.7%) was smaller than in the elective surgery group (40.0%). In addition, neither preoperative nutritional status nor POSSUM score was related to the severity of postoperative complications. CDAI score was significantly related to the severity of postoperative complications (P=0.032). CONCLUSION: Based on the above results, a high preoperative CDAI score can predict negative postoperative outcomes. We believe that disease activity should be controlled using various treatment modalities, such as enteral or total parenteral nutrition as well as medication, before performing surgery in patients with CD.

Scoring system for traumatic liver injury (SSTLI) in polytraumatic patients: a predictor of mortality.

PURPOSE: The aim of this study was to examine prognostic factors in polytraumatic patients with liver injury and to develop a scoring system for traumatic liver injury (SSTLI) to predict mortality. METHODS: The medical records of 175 patients treated for traumatic liver injury from July 2009 to April 2013 were reviewed. The primary outcome variable was hospital mortality. All risk factors were analyzed by multivariate logistic regression analysis. The SSTLI was created based on the predictive power of each factor. RESULTS: Age, injury severity score (ISS), trauma and injury severity score, the shock index, and the volume of packed red blood cells transfused were strong predictors of mortality. We hypothesized that the SSTLI would use five clinical measures (total bilirubin, prothrombin time, serum creatinine, age, and ISS). Each measure was scored 0-1 (age and ISS) or 0-3 (total bilirubin, prothrombin time, and creatinine), with 3 indicating the most severe derangement. The receiver-operating characteristic curve of the SSTLI was significant at post-traumatic days 0, 1, 3, and 5 [area under the curve (AUC), 0.830; AUC, 0.912; AUC, 0.941; and AUC, 0.930, respectively]. A value of 5 points was the threshold for reliability dividing low-risk (<5) from high-risk (≥5) patients. CONCLUSIONS: The SSTLI may be available to predict mortality in polytraumatic patients with liver injury, although external validation is needed before widespread implementation.

Brain metastases from colorectal cancer: the role of surgical resection in selected patients.

AIM: Brain metastasis is infrequent in colorectal cancer patients, and the prognosis is poor. In this retrospective study survival and prognostic factors were determined in patients with brain metastasis from colorectal cancer. METHOD: Between 1997 and 2006, 39 patients with brain metastasis from colorectal cancer who survived more than 1 month were identified. Data were collected with regard to patient characteristics, location and stage of the primary tumour, extent and location of metastatic disease, and treatment modalities used. RESULTS: Most (79.5%) patients had pulmonary metastases before brain metastasis, and the brain was the site of solitary metastasis in only one patient. The most frequent symptom was weakness [18 (43.6%) patients]. Overall median survival was 5.0 months and the 1- and 2-year survival rates were 21.8 and 9.1%, respectively. Univariate analysis revealed uncontrolled extracranial metastases (P = 0.019), multiple brain lesions (P = 0.026), bilateral brain metastases (P = 0.032) and serum carcinoembryonic antigen levels greater than 5 ng/ml (P = 0.008) to be poor prognostic factors. The median survival after the diagnosis of brain metastasis was significantly longer in patients who underwent surgical resection (15.2 ± 8.0 months) than in those treated by other modalities (P = 0.001). Treatment modality was the only independent prognostic factor for overall survival in patients with brain metastases from colorectal cancers (P = 0.015). CONCLUSION: Aggressive surgical resection in selected patients with brain metastases from colorectal cancer may prolong survival, even in the presence of extracranial metastatic lesions.

Posterior lumbar interbody fusion for adult isthmic spondylolisthesis: a comparison of fusion with one or two cages.

Between March 2000 and February 2006, we carried out a prospective study of 100 patients with a low-grade isthmic spondylolisthesis (Meyerding grade II or below), who were randomised to receive a single-level and instrumented posterior lumbar interbody fusion with either one or two cages. The minimum follow-up was for two years. At this stage 91 patients were available for review. A total of 47 patients received one cage (group 1) and 44 two cages (group 2). The clinical and radiological outcomes of the two groups were compared. There were no significant differences between the two groups in terms of post-operative pain, Oswestry Disability Score, clinical results, complication rate, percentage of post-operative slip, anterior fusion rate or posterior fusion rate. On the other hand, the mean operating time was 144 minutes (100 to 240) for patients in group 1 and 167 minutes (110 to 270) for those in group 2 (p = 0.0002). The mean blood loss up to the end of the first post-operative day was 756 ml (510 to 1440) in group 1 and 817 ml (620 to 1730) in group 2 (p < 0.0001). Our results suggest that an instrumented posterior lumbar interbody fusion performed with either one or two cages in addition to a bone graft around the cage has a low rate of complications and a high fusion rate. The clinical outcomes were good in most cases, regardless of whether one or two cages had been used.

Surgical and pathological outcomes of laparoscopic surgery for transverse colon cancer.

PURPOSE: Several multi-institutional prospective randomized trials have demonstrated short-term benefits using laparoscopy. Now the laparoscopic approach is accepted as an alternative to open surgery for colon cancer. However, in prior trials, the transverse colon was excluded. Therefore, it has not been determined whether laparoscopy can be used in the setting of transverse colon cancer. This study evaluated the peri-operative clinical outcomes and oncological quality by pathologic outcomes of laparoscopic surgery for transverse colon cancer. MATERIALS AND METHODS: Analysis of the medical records of patients who underwent laparoscopic colorectal resection from August 2004 to November 2007 was made. Computed tomography, barium enema, and colonoscopy were performed to localize the tumor preoperatively. Extended right hemicolectomy, transverse colectomy, and extended left hemicolectomy were performed for transverse colon cancer. Surgical outcomes and pathologic outcomes were compared between transverse colon cancer (TCC) and other site colon cancer (OSCC). RESULTS: Of the 312 colorectal cancer patients, 94 patients underwent laparoscopic surgery for OSCC, and 34 patients underwent laparoscopic surgery for TCC. Patients with TCC were similar to patients with OSCC in age, gender, body mass index, operating time, blood loss, time to pass flatus, start of diet, hospital stay, tumor size, distal resection margin, proximal resection margin, number of lymph nodes, and radial margin. One case in TCC and three cases in OSCC were converted to open surgery. CONCLUSIONS: Laparoscopic surgery for transverse colon cancer and OSCC had similar peri-operative clinical and acceptable pathological outcomes.

Expression of the apolipoprotein C-II gene during myelomonocytic differentiation of human leukemic cells.

Apolipoprotein C-II (apoC-II), which is known to activate lipoprotein lipase (LPL), was identified by ordered differential display (ODD)-polymerase chain reaction (PCR) as a cDNA fragment exhibiting a distinct increase in expression during 12-O-tetradecanoylphorbol 13-acetate (TPA)-induced differentiation of promonocytic U937 cells into monocytes and macrophages. The amount of apoC-II mRNA expression detectable in U937 cells significantly increased and reached a maximum 24-48 h after treatment with 32 nM TPA. apoC-II mRNA was also detected in monocytic THP-1 cells but was not detected in promyelocytic HL-60 cells. In healthy human tissues, the most significant expression of apoC-II mRNA was in the liver. Although apoC-II mRNA expression was markedly up-regulated during the induced differentiation of HL-60 cells into monocytes and macrophages with 32 nM TPA, such expression was not induced during the differentiation of HL-60 cells into granulocytes with 1.25% dimethyl sulfoxide. These results suggest that human apoC-II expression is induced at the transcription level during myelomonocytic differentiation and may confer an important role to macrophages involved in normal lipid metabolism and atherosclerosis.

Nucleotide sequence and differential expression of the human 3-phosphoglycerate dehydrogenase gene.

The nucleotide sequence of Hs 3-PGDH gene, encoding human 3-phosphoglycerate dehydrogenase that catalyzes the initiating step in the phosphorylated pathway of serine biosynthesis, has been determined. The 3-PGDH gene has a predicted 533 amino acid open reading frame, encoding a 56.8kDa protein that shares 94.0% similarity with rat-liver 3-PGDH. Two different transcripts corresponding to 3-PGDH mRNA were detected in human normal tissues. A dominant 2.1kb transcript was expressed at high levels in prostate, testis, ovary, brain, liver, kidney, and pancreas, and weakly expressed in thymus, colon, and heart. A 710bp transcript also appeared as a weaker band where the 2.1kb mRNA was expressed, and it was more significant than the 2.1kb mRNA in heart and skeletal muscle. The TPA-induced monocytic differentiation of U937, which also resulted in growth arrest, abruptly downregulated the expression of 3-PGDH. Removal of TPA restored cell growth through the retrodifferentiation process and subsequent expression of 3-PGDH. The 3-PGDH mRNA was markedly expressed in human leukemias, lymphoma Sup-T1, colon adenocarcinoma COLO 320DM, epitheloid carcinoma HeLa S3, and murine lymphoma BW5147.G.1.4, but not in human leukemia K562. This report demonstrates that the human 3-PGDH gene is regulated at the transcriptional level depending on tissue specificty and cellular proliferative status, and its transcriptional regulation mechanism may be a useful target for diagnosis and therapy of cancer.

A case of subcutaneous seeding of hepatocellular carcinoma after fine needle aspiration biopsy.

Cancer spread along the needle track following fine needle aspiration biopsy is said to be a rare complication. The authors report a case of subcutaneous implantation of hepatocellular carcinoma following ultrasono-guided fine needle aspiration biopsy. The patient, a 67-year-old Korean male was found to have a large hepatocellular carcinoma diagnosed by fine needle aspiration biopsy. Four months later, the patient felt two subcutaneous growing lumps at the previous aspiration site. The authors confirmed them histologically 11 months after aspiration.