p-wave superconductivity in iron-based superconductors.

The possibility of p-wave pairing in superconductors has been proposed more than five decades ago, but has not yet been convincingly demonstrated. One difficulty is that some p-wave states are thermodynamically indistinguishable from s-wave, while others are very similar to d-wave states. Here we studied the self-field critical current of NdFeAs(O,F) thin films in order to extract absolute values of the London penetration depth, the superconducting energy gap, and the relative jump in specific heat at the superconducting transition temperature, and find that all the deduced physical parameters strongly indicate that NdFeAs(O,F) is a bulk p-wave superconductor. Further investigation revealed that single atomic layer FeSe also shows p-wave pairing. In an attempt to generalize these findings, we re-examined the whole inventory of superfluid density measurements in iron-based superconductors and show quite generally that single-band weak-coupling p-wave superconductivity is exhibited in iron-based superconductors.

Improved glucose tolerance via enhanced glucose-dependent insulin secretion in dipeptidyl peptidase IV-deficient Fischer rats.

Glucagon-like peptide-1 (GLP-1) is an incretin, which induces glucose-dependent insulin secretion. GLP-1 is rapidly degraded by dipeptidyl peptidase IV (DPPIV) after its release. We investigated whether DPPIV-deficient F344/DuCrj rats show improved glucose tolerance when compared with DPPIV-positive F344/Jcl rats. Oral glucose tolerance test indicated improved glucose tolerance in F344/DuCrj rats, but blood glucose levels of the two strains were almost the same 120 min after the glucose bolus. Valine-pyrrolidide, a DPPIV inhibitor, had no effect on the glucose tolerance of F344/DuCrj rats, but improved that of F344/Jcl rats. Enhanced insulin secretion and high plasma active GLP-1 levels were detected in an intraduodenal glucose tolerance test. Glucose tolerance is improved in DPPIV-deficient F344/DuCrj rats via enhanced insulin release mediated by high active GLP-1 levels. Our results suggest that DPPIV inhibition is a rational strategy to treat diabetic patients by improving glucose tolerance with low risk of hypoglycemia.

Complete agenesis of the dorsal pancreas.

Pancreatic anomalies are occasionally reported, but complete agenesis of the dorsal pancreas is extremely rare. We report a 47-year-old woman with complete agenesis of the dorsal pancreas. This patient initially presented with jaundice. Computed tomography did not reveal the pancreatic corpus or tail. Endoscopic retrograde cholangiopancreatography and magnetic resonance cholangiopancreatography did not visualize the dorsal pancreatic duct. Choledochojejunostomy was performed because she had obstructive jaundice. At laparotomy, there was an enlarged pancreatic head, but no distal pancreas was seen. Histological examination of the pancreatic biopsy specimen showed scattered islets of Langerhans in diffuse fibrosis, with destruction of the glandular parenchyma. This case was diagnosed as complete agenesis of the dorsal pancreas.

Experimental study on paratumoral injection of cisplatin-loaded microspheres for gastric cancer.

Microspheres from glycolide-L-lactide copolymers incorporating cisplatin (CDDP-MS) were prepared to evaluate the sustained release and anticancer effect by paratumoral injection on the gastric cancer with regional lymphnode metastases induced by VX2 tumor in rabbits. In the first set of experiment, the rabbits were divided into three groups subjected to treatment and compared the tissue cisplatin distribution. In the first group (CDDP-MS pt group), 1 mg/kg of cisplatin was administered by the method of paratumoral injection in the form of CDDP-MS. In the second group (CDDP solution pt group), the same dose was given in the form of CDDP aqueous solution in the same way and in the third group (CDDP solution i.v. group), the same dose was intravenously administered. In the second set of experiment, after twice of each therapy the anticancer effects were compared between CDDP-MS pt and CDDP solution i.v. groups. In results, the platinum concentrations of the tumor and regional lymphnodes were 3.14 +/- 6.22, 0.65 +/- 0.79 micrograms/g in the first group, 0.43 +/- 0.39, 0.16 +/- 0.16 microgram/g in the second group and 0.03 +/- 0.01, 0.07 +/- 0.05 microgram/g in the third group, respectively.

Clinicopathological features of esophageal cancer simultaneously associated with gastric cancer.

BACKGROUND AND OBJECTIVES: We usually use the stomach for esophageal substitution in the surgical treatment of esophageal cancer, although it is often associated with gastric cancer. In order to improve the likelihood of safe and curative surgery of esophageal cancer, we investigated the clinicopathological characteristics of synchronous esophageal and gastric cancer. METHODS: Among 288 patients with primary esophageal cancer who had undergone esophageal resection, this cancer was associated with gastric cancer in 11 cases, and 1,416 gastric cancer patients operated on during the same period, were analyzed. The clinicopathological characteristics and surgical procedures of the 11 patients were compared with those of the other esophageal cancer patients and with those with the gastric cancer only. RESULTS: There were significant differences between the synchronous double cancer and the gastric cancer only in sex (P < 0.01) and location of the gastric cancer (P < 0.05). All of the patients with the synchronous double cancer were men, and the incidence of patients with cardiac cancer was high. CONCLUSIONS: Our findings suggest that, in cases of synchronous esophageal and gastric cancer, an adequate surgical procedure must be chosen in terms of the stage, location, and operative burden.

Surgical treatment of patients with psychiatric disorders: a review of 21 patients.

Between January 1985 and September 1994, 21 patients with psychiatric disorders underwent various forms of surgery at our hospital. There were 12 men and 9 women with an average age of 57.6 years. The coexisting psychiatric disorders were schizophrenia in 15 patients, depression in 2, dementia in 2, mental retardation with epilepsy in 1, and Parkinson's disease in 1. All the patients had been receiving neuroleptic medications for a long period. The indications for surgery were: cholelithiasis in 6 patients, acute appendicitis in 4, perforation of the small intestine in 3, incarceration of an inguinal hernia in 2, and esophageal cancer, stomach cancer, bleeding from a gastric ulcer, perforation of a duodenal ulcer, strangulating ileus, and burns in 1 patient each, respectively. All of the patients who underwent elective surgery were given epidural anesthesia with or without general anesthesia. Antipsychotic medications were given until just prior to surgery and recommenced concurrent with the first meal. Abnormal behavior was observed in 11 patients (52.4%) postoperatively, but all the patients were discharged in accordance with recovery from their surgical disorder. Intra- and postoperative hypotension resistant to intravenous catecholamine administration was recognized in 9 patients (42.9%), and this peculiar complication should be borne in mind when patients with psychiatric disorders require surgical management.

A study of patients having survived curative operation for esophageal cancer for five years or more.

In order to analyze the prognostic factors for curatively resected esophageal cancer, 42 patients who had survived their operation more than 5 years (long-term survivors) were compared for clinicopathologic items with 30 recurrent patients who had died within 5 years postoperatively (recurrent cases). Moreover, to estimate the prognosis for the current survivors, we investigated the cause of death of long-term survivors who had died. This comparison showed that the rate of lymphatic invasion was 36.4% and of blood vessel invasion 19.4% for the survivors, much lower than those of the recurrent cases which were respectively 62.1% and 31.0%. It was found that the significantly unfavorable prognosis-determinant factors was lymphatic invasion (p < 0.05). Ten out of 12 n (+) survivors (83.3%) had single metastasing region, one in the neck, three in the mediastinum and six in the abdomen. This was not significantly different from the recurrent cases, of whom, ten out of 14 n (+) cases had a single metastasing region, six in in the mediastinum and four in the abdomen. As for the number of metastatic lymph nodes, nine out of 12 n (+) survivors (75%) had only one matastatic lymph node, and none of them had more than three. On the other hand, two of the recurrent cases had more than three. Of the 42 long-term survivors, 21 patients are still alive (current survivors' average age: 70.1 +/- 7.9) and 21 have died. The cause of death was recurrence in six cases, metachronous primary malignant tumor in three, other disease in six and unknown in six. The average age of death was 62.1 +/- 10.3 in cases of recurrence or double cancer, and 71.8 +/- 9.5 in others. The former were thus significantly younger than the latter (p < 0.05).

Lennox-Gastaut syndrome associated with leukoencephalopathy.

We report a 13-year-old boy with Lennox-Gastaut syndrome (LGS) associated with leukoencephalopathy. He was diagnosed with unclassified acute lymphocytic leukemia at the age of 3 years. After initial chemotherapy, he received intravenous methotrexate (total dosage 1,035 mg), intrathecal methotrexate (total dosage 221 mg), and whole brain irradiation (2,400 cGy). From about the age of 8 years, he developed slurred speech, hyperactivity, and mental deterioration. Cranial CT revealed calcification of the subcortical white matter. At age 9 years, he exhibited tonic seizures and atonic seizures. EEG showed diffuse slow spike-wave discharges, which are characteristic of LGS. Although multiple antiepileptic drugs have been prescribed, the frequency of seizures remains unchanged and his mental state is becoming progressively worse.

Bone scintigraphy in detection of bone invasion by oral carcinoma.

Detecting osseous involvement is clinically important in the management of oral carcinoma. Thirty-one patients with osseous involvement due to oral carcinoma who underwent panoramic radiography and bone scintigraphy were evaluated retrospectively. Bone scintigraphy confirmed osseous involvement in all 31 (100%) of these patients. In 27 (87%) of 31 patients with osseous involvement, both the panoramic radiogram and bone scintigram were positive. In the remaining four patients (13%), bone scintigram was positive for mandibular or maxillary invasion, while panoramic radiogram was negative. There were no instances of an abnormal radiogram with a normal bone scintigram. These findings strongly suggest that bone scintigraphy is more sensitive than panoramic radiography in detecting osseous involvement of the mandible and maxilla due to oral carcinoma. Furthermore, bone scintigraphy was a critical pre-surgical in determining the extent of the osseous involvement.

[A case of gastric cancer with multiple liver metastasis responding to combined therapy with UFT and mitomycin C].

A 66-year-old female was admitted to our hospital with the complaint of anorexia and epigastric pain. Examination of the gastrointestinal tract revealed Borrmann III type gastric carcinoma, 5 cm x 5 cm in size, in the lesser curvature of the stomach. Multiple liver metastases were detected on abdominal computed tomography. In January 1993, she underwent subtotal gastrectomy as a palliative therapy. Pathological diagnosis of the resected specimen was poorly differentiated adenocarcinoma. Two weeks after operation, administration of UFT (300-450 mg/day, orally) and mitomycin C (12 mg/three months, intravenously) was started. This chemotherapy had to be discontinued within six months because of its severe side effects, such as leukopenia and acral erythema. However, a marked reduction in the size of the metastatic liver tumors was observed on abdominal computed tomogram, and the patient is now (15 months after operation) alive without local recurrence or re-growth of liver metastatic tumors.

[An experimental study on radiotherapy for esophageal cancer using intraluminal administration of radiosensitizer].

This study was undertaken to evaluate the efficacy of intraluminal administration of 5-bromo-2'-deoxyuridine (BUdR) as a radiosensitizer during radiotherapy for esophageal cancer. Lipid-surfactant mixed micelles (MM) was used as an absorption promoter. VX2 carcinoma cells were endoscopically injected into the esophageal wall of rabbits. Two weeks after tumor inoculation, BUdR (100 mg/body) with MM was administered into the esophageal lumen and kept for 3 hours. Subsequently, animals were irradiated with 60Co at dosages of either 5 or 10 Gy. Twelve days after, animals were sacrificed to determine tumor diameter and to evaluate histological effect of radiation. BUdR uptake rates of tumor tissue were determined two weeks after tumor inoculation. Tumor diameters in control animals and those treated with simple irradiation at a dose of 5 Gy were similar. In contrast, irradiation at a dose of 5 Gy significantly reduced tumor diameters when combined with intraluminal administration of BUdR with MM. In cancer bearing animals receiving irradiation under intraluminal injection of BUdR with MM, the histological effect were apparently enhanced as compared to animals receiving simple irradiation. BUdR uptake rates of primary tumors showed a significant increase in animals with the intraluminal administration of the drug as compared the those with intravenous one shot bolus and intravenous drip infusion. Based on those results, we conclude that preoperative radiotherapy combined with intraluminal administration of radiosensitizer could be an effective method.

Simple and sensitive quantitation method for mevalonic acid in plasma using gas chromatography/mass spectrometry.

The combination of gas chromatography and mass spectrometry using a polar capillary column and isobutane chemical ionization made it possible to determine mevalonic acid (MVA) as the lactone at subnanogram levels using 1 mL of plasma. The pretreatment procedure consisted of only three steps, namely lactonization, washing with chloroform and liquid/liquid extraction. This simple, rapid and sensitive method, having good precision and accuracy, is useful for evaluating the change of plasma MVA, which is well correlated with whole-body cholesterol biosynthesis.

Second cutaneous neoplasms after acute lymphoblastic leukemia in childhood.

Two cases of second cutaneous neoplasms, one with adenoid cystic carcinoma of the skin and the other with basal cell carcinoma, both occurring 7 years after treatment for childhood acute lymphoblastic leukemia (ALL) are reported. Although such cutaneous neoplasms are generally reported in patients over 40 years of age, our cases, which were diagnosed at the ages of 9 and 14, are the first report of the occurrence of such cutaneous neoplasms following ALL. The neoplasms arose from the scalp of two patients who had received cranial irradiation for central nervous system prophylaxis. The possible link between leukemia therapy incorporating irradiation and the pathogenesis of second cutaneous neoplasms in the scalp is discussed.

The use of autologous blood in the surgical treatment of spinal disorders.

A program of autologous blood transfusion in 101 patients who underwent spinal surgery was analyzed. Autologous transfusion was achieved by intraoperative blood salvage using a cell saver and with predeposited blood. The techniques of predeposition of blood included freezing the blood and using a storage solution. Forty-eight patients had scoliosis and received mainly cryopreserved autologous blood and 53 patients had other spinal diseases. Surgery was performed using only autologous blood transfusion in more than 90% of all patients cases. The program was well tolerated by the patients and easily managed by the blood center staff. There were no severe complications associated with this program. The use of instrumentation and extensive spinal fusion were found to be factors associated with increased intraoperative blood loss. This finding suggests that instrumentation surgery and extensive spinal fusion are indications for autologous blood transfusion. Cryopreserved autologous blood transfusion is an effective method for storing a sufficient volume of blood for scoliosis surgery without affecting the patients' preoperative hemodynamic status.

[A case of complete remission of lymph nodes metastasis from esophageal cancer with combination treatment of UFT and radiation].

A 65 year old female patient, who had developed left atelectasis because of mediastinal lymph nodes metastasis after esophageal resection for esophageal cancer, underwent the combination treatment with UFT (300 mg/day) and radiation (1.5 Gy/day, total dosage: 70.2 Gy). The symptoms soon subsided, and mediastinal CT and bronchoscopy revealed a complete disappearance of metastatic lymph nodes after one month. During one year of CR she enjoyed her daily life, however the relapse occurred. It is suggested that the combination treatment is an effective and safe way even in a patient who went through a lot of invasive surgeries.

A new method of myocardial revascularization by laser.

There are some problems in surgical treatment for those patients with small branches or diffuse stenotic lesions of the coronary arteries, for whom coronary artery bypass grafting can not be carried out at all. To resolve these problems, we have planned to supply arterial blood from the left ventricle into the ischemic myocardium through holes cut into the myocardium by laser. It was clearly recognized that arterial blood could be hemodynamically supplied from the left ventricle into the ischemic myocardium. In trials on dogs laser holes 0.2 mm in diameter have been shown microscopically to be patent even 3 years after their creation, thus this procedure could be used as a new method of myocardial revascularization. Consequently, myocardial revascularization by laser was employed in a 55-year-old male patient with severe angina pectoris who had undergone pericardiectomy 2 years before. He is doing well 5 years and 3 months after surgery.

[Experimental and clinical studies on the laser application in the cardiovascular surgery; analysis of clinical experience of 112 patients].

Since 1980, we have applied lasers experimentally in the following three categories in the fields of cardiovascular surgery. That is, Group 1: New myocardial revascularization in the patients whose coronary arteries are too small or diffuse due to atherosclerosis, Group 2: Laser vascular anastomosis especially for small-caliber vessels, such as coronary artery bypass grafting, Group 3: Laser angioplasty for obstructive arterial disease. Subsequently, efficacy of laser application could be obviously recognized in these fields. On the basis of excellent results of our experimental studies, laser was clinically employed for 112 patients with anginal pain, intermittent claudication and renal failure. They consisted of new myocardial revascularization in one case and vascular anastomosis in 89 cases including 7 cases (LIMA-LAD2, SVG-LAD5) of the coronary artery bypass grafting and laser angioplasty in 22 cases including 5 cases (LAD3, RCA2) of intraoperative laser coronary angioplasty. Optimal conditions of vascular anastomosis were 20-40mW in output and 6-12sec/mm in irradiation time. On the other hand, optimal conditions for laser angioplasty were 6 watts in output and 3sec in irradiation time for each shot. Laser irradiation was carefully repeated according to the grade of atherosclerotic changes. These patients are doing well without any complications throughout laser. Our experimental and clinical experiences of laser application in the fields of the cardiovascular surgery were presented in detail.