Laparoscopic Removal of an Infected Mesh Following TEP Procedure for Femoral Hernia with Omental Patch Closure of a Peritoneal Defect.

BACKGROUND Mesh infection following inguinal hernia repair is rare, and mesh removal is mandatory. However, the laparoscopic approach is challenging to perform. Here, we present a case of laparoscopic repair of a mesh infection using a totally extraperitoneal approach (TEP). CASE REPORT A 76-year-old woman underwent repair of a right femoral hernia via TEP approach using a prosthetic mesh with unabsorbable tacks. A month and a half after the surgery, she reported pain in the right groin. Computed tomography revealed a subcutaneous abscess in the right groin. We suspected mesh infection and initially chose conservative management, which included percutaneous drainage and systemic antibiotic administration. Her symptoms temporarily resolved; however, symptom relapse and purulent discharge from the right groin were observed. We performed laparoscopic removal of the infected mesh and all tacks via the transabdominal preperitoneal approach. A drain was placed in the infected preperitoneal space, and the peritoneal defect was covered using the greater omentum. The patient's postoperative course was uneventful, and she was discharged on postoperative day 20. Infection relapse, symptoms of femoral hernia, and adhesive intestinal obstruction have not been observed. CONCLUSIONS A laparoscopic approach for mesh infection after TEP hernia repair is feasible, even if the mesh is fixed using a tack. Greater omental use for peritoneal defects is useful in clinical situations associated with a contaminated surgical field.

Classification tree analysis to evaluate the most useful magnetic resonance image type in the differentiation between early and progressed hepatocellular carcinoma.

AIM: Using classification tree analysis, we evaluated the most useful magnetic resonance (MR) image type in the differentiation between early and progressed hepatocellular carcinoma (eHCC and pHCC). METHODS: We included pathologically proven 214 HCCs (28 eHCCs and 186 pHCCs) in 144 patients. The signal intensity of HCCs was assessed on in-phase (T1in) and opposed-phase T1-weighted images (T1op), ultrafast T2-weighted images (ufT2WI), fat-saturated T2-weighted images (fsT2WI), diffusion-weighted images (DWI), contrast enhanced T1-weighted images in the arterial phase (AP), portal venous phase (PVP), and the hepatobiliary phase. Fat content and washout were also evaluated. Fisher's exact test was performed to evaluate usefulness for the differentiation. Then, we chose MR images using binary logistic regression analysis and performed classification and regression tree analysis with them. Diagnostic performances of the classification tree were evaluated using a stratified 10-fold cross-validation method. RESULTS: T1in, ufT2WI, fsT2WI, DWI, AP, PVP, fat content, and washout were all useful for the differentiation (p < 0.05), and AP and T1in were finally chosen for creating classification trees (p < 0.05). AP appeared in the first node in the tree. The area under the curve, sensitivity and specificity for eHCC, and balanced accuracy of the classification tree were 0.83 (95% CI 0.74-0.91), 0.64 (18/28, 95% CI 0.46-0.82), 0.94 (174/186, 95% CI 0.90-0.97), and 0.79 (95% CI 0.70-0.87), respectively. CONCLUSIONS: AP is the most useful MR image type and T1in the second in the differentiation between eHCC and pHCC.

Drug sensitivity profile of minor KRAS mutations in colorectal cancer using mix culture assay: The effect of AMG-510, a novel KRAS G12C selective inhibitor, on colon cancer cells is markedly enhanced by the combined inhibition of MEK and BCL-XL.

Colorectal cancer with a Kirsten rat sarcoma 2 viral oncogene homolog (KRAS) gene mutation is considered to be resistant to anti-EGFR agents. G12D is the most common KRAS mutation in colorectal cancer, followed by G12V and G13D. According to clinical and basic research data, patients with colorectal cancer exhibiting G12D and G12V KRAS mutations are resistant to anti-EGFR agents; however, this is not true of G13D and other minor mutations, which are still not well understood. The current study focused on minor KRAS mutations (G12A, G12C, G12S, Q61H and A146T) and evaluated whether these were resistant to anti-EGFR antibodies using a mix culture assay. The results demonstrated that all KRAS mutations, including minor mutations, were resistant to two anti-EGFR agents: Cetuximab and panitumumab. The combined effect of MEK and BCL-XL inhibition on colorectal cancer cells with KRAS minor mutations were subsequently evaluated. The combined effect of MEK and BCL-XL inhibitors was confirmed in all KRAS minor mutations. The sensitivity of AMG510, a novel KRAS G12C selective inhibitor, was also assessed. The mix culture assay revealed that AMG510 selectively exerted an antitumor effect on colon cancer cells with a G12C KRAS mutation. The combination of MEK and BCL-XL inhibition markedly enhanced the effect of AMG510 in colon cancer cells. The current study suggested that AMG510 may have potential clinical use in combination with MEK and BCL-XL inhibitors in the treatment of patients with colorectal cancer exhibiting the G12C KRAS mutation.

Dynamic contrast-enhanced computed tomography diagnosis of primary liver cancers using transfer learning of pretrained convolutional neural networks: Is registration of multiphasic images necessary?

PURPOSE: To evaluate the effect of image registration on the diagnostic performance of transfer learning (TL) using pretrained convolutional neural networks (CNNs) and three-phasic dynamic contrast-enhanced computed tomography (DCE-CT) for primary liver cancers. METHODS: We retrospectively evaluated 215 consecutive patients with histologically proven primary liver cancers, including six early, 58 well-differentiated, 109 moderately differentiated, 29 poorly differentiated hepatocellular carcinomas (HCCs), and 13 non-HCC malignant lesions containing cholangiocellular components. We performed TL using various pretrained CNNs and preoperative three-phasic DCE-CT images. Three-phasic DCE-CT images were manually registered to correct respiratory motion. The registered DCE-CT images were then assigned to the three color channels of an input image for TL: pre-contrast, early phase, and delayed phase images for the blue, red, and green channels, respectively. To evaluate the effects of image registration, the registered input image was intentionally misaligned in the three color channels by pixel shifts, rotations, and skews with various degrees. The diagnostic performances (DP) of the pretrained CNNs after TL in the test set were compared by three general radiologists (GRs) and two experienced abdominal radiologists (ARs). The effects of misalignment in the input image and the type of pretrained CNN on the DP were statistically evaluated. RESULTS: The mean DPs for histological subtype classification and differentiation in primary malignant liver tumors on DCE-CT for GR and AR were 39.1%, and 47.9%, respectively. The highest mean DPs for CNNs after TL with pixel shifts, rotations, and skew misalignments were 44.1%, 44.2%, and 43.7%, respectively. Two-way analysis of variance revealed that the DP is significantly affected by the type of pretrained CNN (P = 0.0001), but not by misalignments in input images other than skew deformations. CONCLUSION: TL using pretrained CNNs is robust against misregistration of multiphasic images and comparable to experienced ARs in classifying primary liver cancers using three-phasic DCE-CT.

Compartment model analysis of intravenous contrast-enhanced dynamic computed tomography in hepatic hemodynamics: A validation study using intra-arterial contrast-enhanced computed tomography.

AIM: To verify the utility of the 2-in-1-out-compartment model analysis (CMA) of intravenous contrast-enhanced dynamic computed tomography (IV-CT) for evaluating hepatic arterial and portal venous flow using intra-arterial contrast-enhanced CT (IA-CT). METHODS: We retrospectively evaluated 49 consecutive patients who underwent IV-CT and were radiologically or histologically diagnosed as having hepatic malignant lesion (51 classical hepatocellular carcinomas [HCC], 4 early HCC, 3 cholangiolocellular carcinomas, 1 mixed HCC, 3 cholangiocellular carcinomas). As a gold standard for hepatic arterial and portal blood flows, we defined the normalized enhancement in CT values on CTAP (nCTAP) and CTHA (nCTHA). The hepatic arterial (k1a ) and portal venous inflow velocity (k1p ) constants in hepatic lesions and surrounding liver parenchyma were obtained from the CMA of IV-CT with various outflow velocity constant (k2 ) limits using the nonlinear least square method. The correlation coefficient between the normalized enhancement in IA-CT and CMA of IV-CT was statistically evaluated according to various k2 limits. RESULTS: The highest mean correlation coefficient between k1a and nCTHA (r = 0.65, P < 0.0001) was observed when k2 ≦0.035. The highest mean correlation coefficient between k1p and nCTAP (r = 0.69, P < 0.0001) was observed when k2 ≦0.045. The decrease in correlation coefficient was significant when the upper k2 limit was lower than 0.03 or higher than 0.07 compared to the best mean correlation coefficient (P < 0.05). CONCLUSION: Hepatic arterial and portal venous flows can be evaluated quantitatively to some extent with appropriate outflow velocity constant limits using the CMA of IV-CT.

Quantitative estimation of progression of chronic liver disease using gadoxetate disodium-enhanced magnetic resonance imaging.

AIM: The purpose of this study was to determine whether the liver stiffness (LS) measured on magnetic resonance (MR) elastography can be estimated by a combination of gadoxetate disodium-enhanced MR imaging (EOB-MRI) and ordinary blood tests. METHODS: We evaluated 33 consecutive patients with suspected liver disease who underwent EOB-MRI using a Differential Subsampling with Cartesian Ordering MR sequence and MR elastography using a 1.5-T MR system in this prospective study. A stepwise multiple linear regression model analysis of LS was performed using various predictive values obtained from two-in-one-uptake, two-compartment model analysis of EOB-MRI (velocity constants of arterial inflow [K1a ], portal venous inflow [K1p ], hepatocellular uptake [Ki ]), and ordinary blood test results (blood platelet count, serum albumin level [ALB], total serum bilirubin level [T-BIL], and prothrombin time [PT%]). RESULTS: Multiple linear regression model analysis revealed that hepatic perfusion-uptake index (HPUI = -K1a + K1p + Ki ) (P < 0.0001), albumin-bilirubin linear predictor (ALBI-LP = 0.66 × log10 T-BIL - 0.085 × ALB) (P = 0.034), and blood platelet count (P = 0.046) were significant independent predictors of LS (r = 0.863). The area under receiver operator characteristics curve of multiple linear regression model in prediction of the liver stiffness corresponding to higher (LS > 5.0 kPa) and lower (LS < 4.2 kPa) risk for developing hepatocellular carcinoma were 0.956 and 0.938, respectively. CONCLUSION: LS can be estimated quantitatively with the use of HPUI obtained from compartment model analysis of EOB-MRI combined with ALBI-LP and blood platelet count.

Evaluation of user input methods for manipulating a tablet personal computer in sterile techniques.

PURPOSE: To determine a quick and accurate user input method for manipulating tablet personal computers (PCs) in sterile techniques. METHODS: We evaluated three different manipulation methods, (1) Computer mouse and sterile system drape, (2) Fingers and sterile system drape, and (3) Digitizer stylus and sterile ultrasound probe cover with a pinhole, in terms of the central processing unit (CPU) performance, manipulation performance, and contactlessness. RESULTS: A significant decrease in CPU score ([Formula: see text]) and an increase in CPU temperature ([Formula: see text]) were observed when a system drape was used. The respective mean times taken to select a target image from an image series (ST) and the mean times for measuring points on an image (MT) were [Formula: see text] and [Formula: see text] s for the computer mouse method, [Formula: see text] and [Formula: see text] s for the finger method, and [Formula: see text] and [Formula: see text] s for the digitizer stylus method, respectively. The ST for the finger method was significantly longer than for the digitizer stylus method ([Formula: see text]). The MT for the computer mouse method was significantly longer than for the digitizer stylus method ([Formula: see text]). The mean success rate for measuring points on an image was significantly lower for the finger method when the diameter of the target was equal to or smaller than 8 mm than for the other methods. No significant difference in the adenosine triphosphate amount at the surface of the tablet PC was observed before, during, or after manipulation via the digitizer stylus method while wearing starch-powdered sterile gloves ([Formula: see text]). CONCLUSIONS: Quick and accurate manipulation of tablet PCs in sterile techniques without CPU load is feasible using a digitizer stylus and sterile ultrasound probe cover with a pinhole.

Prevalence and management of colorectal neoplasia in surgically treated esophageal cancer patients.

AIMS: The existence of other primary tumors during the treatment of esophageal cancer patients has been an important issue. Our aim is to investigate the prevalence and management of colorectal neoplasia (CRN) in surgically treated esophageal cancer patients. METHODS: Between 2002 and 2008, 93 patients with esophageal cancer were surgically treated. Seventy-three patients underwent subtotal esophagectomy and 20 underwent lower esophagectomy for esophageal cancer. Colonoscopy was available for detecting CRN before and after surgery. RESULTS: Eighty-nine (95.7%) of the 93 patients were screened by colonoscopy preoperatively or within a year from the operation. Thirty-nine patients (43.8%) with CRN were synchronously identified: adenoma in 34 (38.2%) and adenocarcinoma in 5 patients (5.6%). Eleven adenomas with high grade-dysplasia and 8 adenomas with low grade-dysplasia were removed endoscopically. Three superficial adenocarcinomas were endoscopically removed before surgery, and 2 adenocarcinomas were surgically removed. Seventy-four patients (83.1%) were followed using colonoscopy, and 11 subsequent CRN, including 2 superficial adenocarcinomas, were endoscopically detected in 8 patients (10.8%). The size of esophageal cancer was larger in the patients with than without CRN (p = 0.036). The body mass index in esophageal cancer patients with CRN tended to be higher than in those without CRN (p = 0.065). CONCLUSIONS: We noted that esophageal cancer is frequently associated with synchronous and/or metachronous colorectal cancer and adenomas. Colonoscopy is useful to detect and manage CRN before and after esophagectomy, although a few limitations exist.

Relationships of obesity and diabetes mellitus to other primary cancers in surgically treated gastric cancer patients.

BACKGROUND: Other primary cancers (OPC) have been reported in gastric cancer (GC) patients. Recent studies have shown relationships of obesity and diabetes mellitus to cancer development in several organs. The purpose of this study was to investigate the relationships of obesity and diabetes mellitus (DM) to the prevalence of OPC in GC patients. METHODS: We reviewed 435 GC patients who were treated surgically and followed their outcomes after surgery. Patients with body mass index (BMI) ≥ 25 kg/m(2) were defined as obese. Fasting plasma glucose (FPG) and HbA1c levels were examined before surgery. RESULTS: OPC was observed in 109 GC patients (25.1%): 40 (9.2%) with synchronous OPC and 76 (18.2%) with metachronous OPC. The most common OPC was colorectal cancer (22.8%). OPC was frequently observed in patients with DM (p = 0.0022), and DM was an independent risk factor for the occurrence of OPC (odds ratio, 2.215; 95% confidence interval, 1.2007-4.0850; p = 0.011). Synchronous OPC was frequently observed in patients with obesity (p = 0.025), and obesity was an independent risk factor for the occurrence of synchronous OPC (odds ratio, 2.354; 95% confidence interval, 1.1246-4.9279; p = 0.023). Metachronous OPC was frequently observed in patients with DM (p = 0.0071), and DM was an independent risk factor for the occurrence of OPC (odds ratio, 2.680; 95% confidence interval, 1.0291-6.9780; p = 0.044). CONCLUSION: There is a need to be aware of the possibility of OPC in GC patients with DM/obesity. They should undergo intensive screening for OPC before and after gastrectomy.

Liver dysfunction and thrombocytopenia diagnosed as intravascular large B-cell lymphoma using a timely and accurate transjugular liver biopsy.

A 72-year-old man suffered from paraparesis with a sensory impairment and bladder and rectal disturbances. Magnetic resonance imaging T2-weighted images depicted a high-intensity lesion in the spinal cord that was consistent with myelitis. A blood examination revealed severe thrombocytopenia and liver dysfunction. No malignant cells were detected by peripheral smears or bone marrow biopsy. Systemic computed tomography detected hepatosplenomegaly and ascites but no lymphadenopathies. Transjugular liver biopsy (TJLB) safely confirmed a diagnosis of intravascular large B-cell lymphoma (IVLBCL), and the patient achieved a complete response following treatment with an appropriate chemotherapy. TJLB is therefore a timely and accurate diagnostic approach for IVLBCL, especially when a bleeding tendency and ascites are noted.

Occurrence and potential activity of denitrifiers and methanogens in groundwater at 140 m depth in Pliocene diatomaceous mudstone of northern Japan.

Anaerobic microbial activity has a major influence on the subsurface environment. We investigated the denitrification and methanogenesis in anoxic groundwater at a depth of 140 m in two boreholes drilled in a sedimentary geological setting, where the redox potential fluctuated. The average maximum potential denitrification rates, measured under anaerobic conditions in the two boreholes using an (15) N tracer, were 0.060 and 0.085 nmol (30) N2  mL(-1)  h(-1) . The deduced NirS amino acid sequences obtained from in situ samples were similar to those of isolates belonging to the α-, ß-, and γ-Proteobacteria, and the Firmicutes (72-100% similarity). Based on the nirS gene, the same operational taxonomic unit dominated incubated samples from each borehole. Methanogenesis candidates were detected by 16S rRNA gene analysis, but no sequence was detected using primers for the functional methanogenesis gene mcrA. Although the stable isotope signatures suggested that some of the dissolved methane was of biogenic origin, no potential for methane production was evident during the incubations. The groundwater at 140 m depth did not contain oxygen, had an Eh ranging from -144 to 6.8 mV, and was found to be a potential field for denitrification.

Treatment of a GIST patient with modified dose of sunitinib by measurement of plasma drug concentrations.

In this study we report the pharmacokinetics and severe adverse effects of sunitinib in a woman with a gastrointestinal stromal tumor (GIST). A 60-year-old woman with small intestinal GIST developed severe thrombocytopenia (1.7×10(4)/µl) following 1 week of treatment with sunitinib at 50 mg/day. Although the dose of sunitinib was reduced to 25 mg/day, platelet levels remained low. On day 7, the trough concentration of sunitinib plus SU12662 was 46.1 ng/ml and the area under the curve (AUC) was 1,393.0 ng·h/l. The dose was again reduced to 12.5 mg/day. However, the day after resumption of treatment, the patient developed symptoms of left heart failure due to myocardosis caused by sunitinib. Sunitinib has been reported to inhibit platelet-derived growth factor receptor (PDGFR) phosphorylation at concentrations over the range of 50-100 ng/ml (sunitinib plus SU12662) in vivo. In this case, the plasma concentration was sufficient to inhibit PDGFR at 25 or 50 mg/day. However, thrombocytopenia appeared at both dosages. Although the results in this case did not suggest a correlation between thrombocytopenia and plasma concentration, the degree of thrombocytopenia was decreased by reduction of the dose. In conclusion, the findings reported here indicate that the plasma concentration of sunitinib plus SU12662 is an important indicator to reduce adverse effects.

Stable hydrogen isotopic analysis of nanomolar molecular hydrogen by automatic multi-step gas chromatographic separation.

We have developed a new automated analytical system that employs a continuous flow isotope ratio mass spectrometer to determine the stable hydrogen isotopic composition (δD) of nanomolar quantities of molecular hydrogen (H(2)) in an air sample. This method improves previous methods to attain simpler and lower-cost analyses, especially by avoiding the use of expensive or special devices, such as a Toepler pump, a cryogenic refrigerator, and a special evacuation system to keep the temperature of a coolant under reduced pressure. Instead, the system allows H(2) purification from the air matrix via automatic multi-step gas chromatographic separation using the coolants of both liquid nitrogen (77 K) and liquid nitrogen + ethanol (158 K) under 1 atm pressure. The analytical precision of the δD determination using the developed method was better than 4‰ for >5 nmol injections (250 mL STP for 500 ppbv air sample) and better than 15‰ for 1 nmol injections, regardless of the δD value, within 1 h for one sample analysis. Using the developed system, the δD values of H(2) can be quantified for atmospheric samples as well as samples of representative sources and sinks including those containing small quantities of H(2) , such as H(2) in soil pores or aqueous environments, for which there is currently little δD data available. As an example of such trace H(2) analyses, we report here the isotope fractionations during H(2) uptake by soils in a static chamber. The δD values of H(2) in these H(2)-depleted environments can be useful in constraining the budgets of atmospheric H(2) by applying an isotope mass balance model.

[7 fractionated cyberknife radiotherapy for giant skull metastasis: a case report].

This is a report on the experience of using stereotactic radiotherapy for a large symptomatic metastatic skull tumor. The stereotactic radiotherapy was delivered in 7 fractions using the Cyberknife and produced excellent therapeutic results. This case concerns a 75-year-old female. Nineteen months after uterine cancer surgery, the patient demonstrated metastasis to the mediastinum lymph node and a tumor at the parietal bone tumor but was still undergoing observation. An increase of the parietal bone tumor became evident and the appearance of right hemiplegia, aphasia, and cognitive dysfunction caused her to consult this hospital. We observed a large 236 cm3 tumor spread over the subcutaneous tissue of the superior sagittal sinus, pressing the brain out of the dura mater and causing bone destruction. As a result of our findings, we began stereotactic Cyberknife radiotherapy delivered in 7 fractions. At the follow up visit one month after the treatment, the image of the tumor had already decreased, and after three months it was confirmed that the image of the tumor had disappeared. The patient's symptoms ameliorated rapidly. As a result, the patient has returned to an independent home-lifestyle, with amelioration of her quality-of-life defects. Six months after irradiation, there is no evidence of tumor regrowth or complications such as dermatopathy, cerebral edema, or necrosis. Cyberknife radiotherapy could shorten the treatment period and result in a reduction of the amount of irradiation to unaffected parts of the brain. In this case, though the tumor had spread widely in the subcutaneous tissue, the exposure doses were delivered at 2Gy/time and could be limited to under 70Gy. It is thought that Cyberknife radiotherapy will become one of the key treatments to help improve quality of life when treating symptomatic metastatic tumors.

Esophageal cancer associated with other primary cancers--historical comparison of clinicopathologic features in 359 esophageal cancer patients.

BACKGROUND/AIMS: We historically investigated the clinicopathologic features of esophageal cancer associated with other primary cancers (OPC), and discussed differences between the last decade and the previous period. METHODOLOGY: A total of 359 patients with esophageal cancer treated between 1981 and 2006 were enrolled. They were divided into 2 groups; 213 patients between 1981 and 1996 (Group-A), and 146 patients between 1997 and 2006 (Group-B). RESULTS: Between Group-A and Group-B, there was a significant difference in the frequency of OPC (15.5% vs. 32.2%, p < 0.001). Regarding the site of OPC, there was a significant difference in the frequency of head and neck cancers (p < 0.001). There was a significant difference in the frequency of metachronous OPC between Group-A and Group-B (5.6% vs. 18.5%, p < 0.001). Antecedent OPC was more frequently observed in Group-B than Group-A (3.3% vs. 11.0%, p < 0.01), and subsequent OPC was also more frequently observed in Group-B than Group-A (2.8% vs. 7.5%, p < 0.05). Although the 5-year survival rate after esophagectomy of the patients without OPC was better in Group-B than Group-A (31.5 % vs. 52.7 %; p < 0.01), there was no difference in that of the patients with OPC between Group-A and Group-B, (40.7% vs. 54.2%). CONCLUSION: Metachronous as well as synchronous OPC in esophageal cancer patients were more frequent in the recent period than in the previous period. We should consider antecedent, synchronous, and subsequent OPC in esophageal cancer patients.

Gastric schwannoma exhibiting increased fluorodeoxyglucose uptake.

This is the first case of gastric schwannoma that exhibited increased accumulation of [(18)F] fluorodeoxyglucose (FDG) on positron emission tomography (PET) imaging. The patient was a 60-year-old woman in whom esophagogastroduodenoscopy showed a submucosal tumor, about 25 mm in size, in the upper body of the stomach, with ulceration at the top of the tumor. Endoscopic ultrasonography revealed a well-defined hypoechoic mass located in the proper muscle layer of the stomach. The specimen taken from the tumor showed only inflammatory degenerative tissue. Abdominal computed tomography revealed a tumor in the upper body of the stomach. FDG-PET showed FDG uptake (standardized uptake value [SUV] max 5.8) coincident with the tumor. Hence, the tumor was diagnosed initially as a gastrointestinal stromal tumor of the stomach. Laparoscopic partial gastrectomy was performed. Pathological examination showed that the tumor consisted of spindle cells with large nuclei, and mitosis was absent. The Ki-67 labeling index of the tumor cells was 4%. Immunohistochemically, the tumor cells showed a positive reaction for S-100 protein, whereas they were negative for KIT, CD 34, and alpha-smooth muscle actin protein. The tumor was diagnosed as a benign gastric schwannoma. Gastric schwannoma should be included in the differential diagnosis of submucosal tumors of the stomach with FDG uptake.

Increase of the trophoblast giant cells with prolactin-releasing peptide (PrRP) receptor expression in p53-null mice.

Trophoblast giant cells in the mouse placentas are polyploid cells that form as a result of endoreduplication. The giant cells form the outermost layer of the extraembryonic compartment and produce a number of pregnancy-specific hormones, including prolactin family members. Here we demonstrate that trophoblast giant cells are increased, and display upregulation of prolactin releasing peptide (PrRP) receptor in the p53-null (p53(-/-)) embryonic placentas. At day 13.5 of gestation, the weight of p53(-/-) placentas was less than that of both wild-type and p53(+/-) placentas. In p53(-/-) placentas, the spongiotrophoblast layer was significantly decreased in thickness, and the trophoblast giant cells were observed not only in the outer layer of placentas but in both the spongiotrophoblast layer and the labyrinthine layer. The giant cells spread over the spongiotrophoblast and labyrinthine layer in p53(-/-) placentas displayed more intensive expression of immunoreactive PrRP receptor than in wild-type placentas. Previous studies indicated that the association between PrRP and PrRP receptor physiologically involves in the expression and secretion of the peptide hormones, including prolactin and growth hormones. These results suggest that p53 may regulate the differentiation of trophoblast giant cells, and may control the physiological PrRP stimuli in mouse placentas.

Neurilemoma originating from the left recurrent nerve in the superior mediastinum: report of a case.

We report a rare case of neurilemoma originating from the left recurrent nerve in the superior mediastinum.

[Weekly administration of paclitaxel and pirarubicine for recurrent breast cancer].

The therapeutic efficacy of weekly coadministration of paclitaxel (TXL) and pirarubicin (THP) on docetaxel (TXT)- and epirubicin-resistant recurrent breast cancer, adverse reactions caused by this therapy, and the possibility of ambulatory treatment using it were evaluated. The present study was conducted in 11 patients with recurrent breast cancer with pretreatment with CEF and TXT. The site of recurrence was the lung in 9 patients, lymphnodes in 2, bones in 1, liver in 1 and local foci in 1. One cycle consisted of 20 mg/m2 of THP followed by 80 mg/m2 of TXL 4 h later, repeated three times every other week. Three to six cycles were conducted in each patient. An anti-emetic drug was administered before administration of THP as short premedication. Dexamethasone (16 mg; i.v.) and d-chlorpheniramine maleate (12 mg; p.o.) were administered 1 h before administration of TXL and ranitidine (100 mg; i.v.) was administered 30 min before administration of TXL. Ubidecarenone (30 mg/day; p.o.) was administered for 3 days. The response rate was 27.3% with a rating of PR in 3 patients, NC in 6, and PD in 2. Adverse reactions observed included transient facial hot flushes, alopecia grade 1 or milder grade 1 symptoms, and peripheral nerve damage. No adverse reactions such as myocardial disorders or congestive heart failure were noted. Grade 3 and grade 2 neutropenia occurred in 1 and 6 patients, respectively, and 4 patients were admitted for treatment of this. In conclusion, the short premedication was useful, and this was thought to make it possible to conduct ambulatory treatment with TXL + THP in some patients. The response rate of 27.3%, however, was not satisfactory. It will be necessary to clarify the characteristics of this therapy by administering it to a wider spectrum of patients.