Neurological deficit after simultaneous open abdominal aortic surgery and thoracic aortic endovascular therapy.

We examined a total of 12 cases; 8 cases were identified by searching the literature on Pubmed (excluding case reports published prior to 2000) and 4 cases were ones we personally encountered. We examined age, sex, history of smoking, and preoperative risk factors as preoperative factors, the access route and coverage of the descending aorta as perioperative factors, and complications and survival time as postoperative factors. Mean coverage of the thoracic aorta was 90.8 mm. In terms of perioperative deaths, 8.3% (1 patient) were due to coagulopathy. Perioperative complications occurred in 16.7% of cases (coagulopathy in 1 patient and paralysis in another). No patients experienced complications or underwent additional treatment during a mean follow-up of 22.9 months. This study suggested that simultaneous open abdominal aortic repair and thoracic aortic endovascular therapy is feasible and also involves few postoperative complications. Paraplegia and paralysis tended to occur less frequently than with two-stage surgery, but further study is needed to explain why this is true.

Elective Matsui-Kitamura stent graft repair for descending thoracic aortic aneurysm and chronic type-B aortic dissection.

BACKGROUND: The position of thoracic endovascular aortic repair (TEVAR) compared to open surgery of the thoracic aorta has changed. This study evaluates outcomes after TEVAR performed electively using our original Matsui-Kitamura stent graft (MKSG) to treat descending thoracic aortic aneurysms (dTAA) and chronic type-B aortic dissection (type-B AD), and elucidates the risk factors for postoperative spinal cord ischemia (SCI). METHODS: TEVAR was performed using an MKSG in 66 patients (age: 70.8+/-9.2 years). The underlying etiology was atherosclerotic change in 39 patients, chronic type-B aortic dissection in 23 patients, and other in 4 patients. RESULTS: No perioperative deaths occurred. Three patients showed temporary paralysis due to postoperative SCI. Abdominal aortic aneurysm (AAA) surgery was a risk factor for postoperative SCI (P=0.04). The 5-year survival rate was 81.2%. CONCLUSION: The present study demonstrated that TEVAR of patients with dTAA and chronic type-B AD using an MKSG can be performed with high technical success rates and low rates of severe acute complications. AAA surgery was a risk factor for postoperative SCI.

[Video-assisted thoracic surgery for clinical stage I lung cancer].

We evaluated our results of video-assisted thoracic surgery (VATS) performed for lung cancer over 8 years. Between April 2000 and October 2008, a total of 409 (60.9%) underwent VATS for lung cancer. Operative procedures as a radical operation were partial resection in 58 patients, segmentectomy in 64 patients, and lobectomy in 229 patients. There was 1 patient with operative death including hospital death due to pulmonary thromboembolism. In a median follow-up period of 21 months, the 5-year cause specific survival rate was 93.7%. According to operative procedures, the 5-year survival rate was 100% in patients underwent partial resection and segmentectomy, and 91.1% in patients underwent lobectomy. According to pathological stages, the 5-year survival rate was 98.8% in 289 patients with stage IA, 69.1% in 34 patients with stage IB, and 68.2% in 14 patients with stage IIIA. In conclusion, VATS lobectomy and VATS intentional limited resection can be performed with low mortality and good prognosis for clinical stage IA lung cancer patients.

Twisted ovarian tumor causing progressive hemothorax: a case report of porous diaphragm syndrome.

BACKGROUND: Porous diaphragm syndrome is caused by a defect in the diaphragm. The defect may induce pleural effusion in a patient with an ovarian tumor. CASE REPORT: A 59-year-old Japanese woman with an ovarian tumor and right hemothorax underwent thoracotomy and presented with a fenestra in the right diaphragm through which bloody fluids were flowing from the peritoneal cavity into the pleural space. Following suturing of the fenestra, laparotomy revealed intraabdominal bleeding due to torsion of an ovarian tumor. CONCLUSION: This is the first report in which the diaphragmatic defect was identified in a patient with an ovarian tumor and hemothorax. Porous diaphragm syndrome may be involved in the pathophysiology of right pleural effusion observed in other medical conditions such as Meigs' syndrome, ovarian hyperstimulated syndrome, and ovarian cancer.

[Quality of life of long-term survivors of surgically treated lung cancer].

Quality of life (QOL) of long-term survivors (more than 3 years after surgery) of primary non-small cell lung cancer was studied. QOL was analyzed using European Organization for Research and Treatment of Cancer Quality of Life Questionnaire, 30-Item version 3.0 (QLQ-C30) and Hospital Anxiety and Depression Scale (HADS). Sixty of 91 patients (66%) participated in this study 87 +/- 5 (38-172) months postoperatively. In QLQ-C30, calculated scores of physical (84.0 +/- 2.4), role (81.3 +/- 3.6), cognitive (79.7 +/- 2.6), emotional (86.8 +/- 1.9), and social (91.0 +/- 1.9) functioning, and global QOL (72.6 +/- 2.9) were obtained. Calculated HADS A (anxiety) was 3.3 +/- 0.3 and HADS D (depression) was 4.0 +/- 0.4. Postoperative follow-up duration was correlated with financial impact only. QOL of long-term survivors was influenced by gender histology, marital status, employment status, and academic carrier.

Experimental study of aortic anastomosis using a circular stapling device in the porcine model.

OBJECTIVES: The aim of this study was to assess the strength (pressure resistance) and histological findings of aortic anastomoses performed using a circular stapling device. MATERIALS AND METHODS: A circular stapling device was used for anastomosing a porcine aorta and a Dacron graft. The maximum pressure resistance of the anastomotic site of a porcine aortic specimen and a Dacron graft was examined (n=10). A porcine aorta with Dacron graft was anastomosed to a beating heart, and pressure overload was induced by adrenaline (n=5). Specimens of the anastomotic sites were harvested after 14 days and examined histologically. RESULTS: The maximum pressure resistance of the anastomotic site was 427.3+/-34.4 (375-511) mmHg. No anastomotic sites leaked as a result of pressure overloading at 227.6+/-21.1 (201-260) mmHg. Histologically, good incorporation and cell coverage were observed, and the inner surfaces of the anastomotic sites were smooth and without stenoses. CONCLUSIONS: Aortic anastomosis using a circular stapling device is feasible and worthy of further investigation.

Inorganic polyphosphate stimulates lon-mediated proteolysis of nucleoid proteins in Escherichia coli.

Inorganic polyphosphate (polyP) accumulates in response to amino acid starvation in Escherichia coli. Previously, we found that the complex formation of Lon with polyP stimulates proteolysis of free ribosomal proteins. In the current studies, we examined the effects of polyP on the degradation of major nucleoid proteins. Fusions of green fluorescent protein with HimA, Fis, HupA, and HupB were clearly associated with polyP in vivo. Lon degraded His-tagged HimA protein only in the presence of polyP in vitro as well as in vivo. Whereas, when HimA and HimD formed a heterodimer, Lon could not degrade it even in the presence of polyP. In addition, Lon degraded His-tagged Fis protein in the presence of polyP. However, in vivo, Lon did not efficiently degrade the Fis protein even when cells accumulated polyP in response to amino acid starvation. It appears that this is due to tighter binding of Fis to DNA than to polyP and resistance of the DNA-Fis to Lon-mediated proteolysis. Indeed, we found that at least a five-fold excess of polyP was necessary to displace DNA from the DNA-Fis complex. Furthermore, Lon degraded His-tagged HupA protein efficiently in the presence of polyP. We also showed that degradation of the translational initiation factor InfC depends on polyP.

Establishment of an immortalised human ovarian surface epithelial cell line without chromosomal instability.

Epithelial ovarian carcinoma is thought to derive from ovarian surface epithelium (OSE). The black box of the early molecular changes in ovarian carcinogenesis is being interpreted by the development of experimental systems employing immortalised human OSE cells. However, the existing cell lines of the OSE cells have limited utility due to chromosomal instability. Our goal was to establish new immortalised human OSE cells that retain the original characteristics of the primary cells without chromosomal alterations. Using primary human OSE cells obtained from a postmenopausal patient with endometrial cancer, five cell lines ('HOSE1' lines) were newly established by infection with retroviral expression vectors containing type 16 human papillomavirus (HPV-16) E6, E7, a variant E6 (E6delta151), and Bmi1 polycomb gene, in combination with telomerase reverse transcriptase (hTERT). Consequently, five HOSE1s cell lines, HOSE1s-E6/hTERT, -E7/hTERT, -E6/E7/hTERT, -E6delta151/E7/hTERT, and -E6delta151/Bmi1/hTERT, grew beyond the population doubling number of 200. These cell lines, except for HOSE1-E6/hTERT, essentially showed the original features of the primary human OSE cells. Of them, HOSE1-E7/hTERT preserved diploidy in a kariotype analysis, and did not show transformed phenotypes in anchorage-independent growth and tumour formation. Thus, HOSE1-E7/hTERT may provide a novel model system with which to investigate the mechanisms of early molecular changes.

Beta-synuclein gene alterations in dementia with Lewy bodies.

OBJECTIVE: To determine whether mutations in the genes for alpha-synuclein or beta-synuclein are responsible for dementia with Lewy bodies (DLB), a disorder closely related to Parkinson disease (PD). METHODS: The authors ascertained 33 sporadic cases of DLB and 10 kindreds segregating DLB. DNA samples from the 43 index cases were screened for alterations in the genes for alpha-synuclein and beta-synuclein, as alpha-synuclein alterations cause PD and beta-synuclein may modulate alpha-synuclein aggregation and neurotoxicity. RESULTS: Two amino acid alterations were identified in unrelated DLB index cases: a valine to methionine substitution at codon 70 (V70M) and a proline to histidine substitution at codon 123 (P123H), both in the beta-synuclein gene. These amino acid substitutions occur at conserved residues in highly conserved regions of the beta-synuclein protein. Screening of at least 660 chromosomes from control subjects matched to the patients' population groups failed to identify another V70M or P123H allele. Cosegregation analysis of an extended pedigree segregating the P123H beta-synuclein alteration suggested that it is a dominant trait with reduced penetrance or a risk factor polymorphism. Histopathology and immunohistochemistry analysis of index case brain sections revealed widespread Lewy body pathology and alpha-synuclein aggregation without evidence of beta-synuclein aggregation. CONCLUSION: Mutations in the beta-synuclein gene may predispose to DLB.

Clear cell sarcoma arising in the retroperitoneum.

Clear cell sarcoma is a rare soft-tissue neoplasm, arising most commonly in the tendons and aponeuroses of young adults. We report here the first female case of clear cell sarcoma arising in the retroperitoneum with clinical features similar to those of malignant ovarian tumors. Aspects of clinical presentation, histopathologic evaluation, and treatment are described.

Analysis of prognostic factors in newly diagnosed patients with acute promyelocytic leukemia: the APL92 study of the Japan Adult Leukemia Study Group (JALSG).

All-trans-retinoic acid (ATRA) has been incorporated in front-line therapy for newly diagnosed acute promyelocytic leukemia (APL). We conducted a multicenter study of differentiation therapy with ATRA alone or in combination with chemotherapy followed by intensive postremission chemotherapy in patients with APL (the JALSG APL92 study), and analyzed prognostic factors to increase the cure rate in our subsequent trial. From 1992 to 1997, adult patients with newly diagnosed APL received oral ATRA 45 mg/m2 daily alone until complete remission (CR) if initial leukocyte counts were < 3.0x10(9)/l, and ATRA daily plus daunorubicin (DNR) 40 mg/m2x3 days plus enocitabine (BHAC) 200 mg/m2x5 days if leukocyte counts were > or =3.0 x 10(9)/l. If peripheral blasts exceeded 1.0x10(9)/l during therapy, DNRx3 days plus BHACx5 days was added. After CR was achieved, three courses of consolidation and six courses of maintenance/intensification chemotherapy were administered. Of 376 patients enrolled, 369 were evaluable (median age 46 years, range 15-86 years; median leukocyte counts 2.0x10(9)/l), and 333 (90%) achieved CR (94% of patients treated with ATRA alone, 88% with ATRA plus later chemotherapy, 89% with ATRA plus initial chemotherapy, and 86% with ATRA plus initial and later chemotherapy). At a median follow-up of 45 months, the predicted 6-year overall and event-free survival (EFS) rates for all patients were 65% and 52%, respectively. Favorable prognostic factors for CR were younger age, no or mild purpura, high serum total protein level, low lactate dehydrogenase level, and no or mild disseminated intravascular coagulation (DIC). Favorable prognostic factors for EFS were leukocyte counts < 10.0x10(9)/l, mild DIC, and no sepsis during induction therapy. In the JALSG APL97 study, we intensified chemotherapy for patients with leukocyte counts > or =3.0x10(9)/l, and are randomly testing whether further chemotherapy is required for APL patients with negative PCR for PML/retinoic acid receptor alpha in the maintenance phase.

Role of inorganic polyphosphate in promoting ribosomal protein degradation by the Lon protease in E. coli.

Inorganic polyphosphate (polyP), a polymer of hundreds of phosphate (Pi) residues, accumulates in Escherichia coli in response to stresses, including amino acid starvation. Here we show that the adenosine 5'-triphosphate-dependent protease Lon formed a complex with polyP and degraded most of the ribosomal proteins, including S2, L9, and L13. Purified S2 also bound to polyP and formed a complex with Lon in the presence of polyP. Thus, polyP may promote ribosomal protein degradation by the Lon protease, thereby supplying the amino acids needed to respond to starvation.

Characterization and tumorigenicity of human ovarian surface epithelial cells immortalized by SV40 large T antigen.

OBJECTIVES: Epithelial ovarian cancers are considered to arise from neoplastic transformation of the ovarian surface epithelium (OSE). However, the earliest events in ovarian carcinogenesis have not been clearly defined because patients are often diagnosed in the advanced stages and useful in vivo and in vitro experimental systems using human OSE cells are lacking. We aimed to improve the availability of experimental models for the study of human ovarian carcinogenesis. METHODS: Subcultured human OSE cells were transfected with SV40 large T antigen. Resulting OSE cell lines were characterized using immunocytochemistry and tested tumorigenicity. RESULTS: Six immortalized OSE cell lines were obtained. All cell lines essentially retained the original morphological features of normal OSE cells and showed higher proliferation rates and saturation density. Although they were all nontumorigenic in athymic mice, OSE2b-2 sv cells, which were selected in soft agar from colonies of an SV40 large T antigen-expressing transfectant, OSE2b sv, produced tumors on the peritoneal surface, mesothelium, and diaphragm and induced ascites after being injected intraperitoneally. Solid tumors also grew when mice were inoculated subcutaneously. The tumor cells were formed in a solid sheet arrangement and no evidence of glandular or squamous differentiation was present. They were weakly immunostained with an antibody against cytokeratin, and intercellular junctions resembling attachment devices were ultrastructurally present between cells. The tumors were histologically diagnosed as undifferentiated carcinomas. CONCLUSIONS: The established cell lines may provide a model system to investigate the mechanisms of cytogenic and molecular changes from normal OSE cells through the various steps of transformation.

Intrathoracic aneurysm of the innominate and right subclavian arteries: report of a case.

Aneurysms of the innominate and subclavian arteries are uncommon but associated with high mortality rates. We report herein the case of a 45-year-old man who presented with facial anhidrosis that developed several years after blunt thoracic trauma, in whom an aneurysm involving the innominate and subclavian arteries was revealed by preoperative examinations. Resection of the aneurysm and reconstruction from the ascending aorta to both the subclavian and common carotid arteries using a bifurcated graft was successfully performed without brain perfusion. Although the left posterior cerebral artery, which was not manipulated during surgery, became occluded, it was recanalized by thrombolysis. The patient was discharged in good health and has remained well since.

Terahertz radiation from a shallow incidence-angle InAs emitter in a magnetic field irradiated with femtosecond laser pulses.

The optimized incidence angle and magnetic field direction geometry of an InAs terahertz radiation emitter irradiated with femtosecond laser pulses in a magnetic field is reported. The optimum geometric layout is the magnetic field direction parallel to the semiconductor surface and at an incidence angle that is slightly larger than the Brewster angle. Additionally, we also observed a center frequency shift of terahertz radiation spectrum by changing the incidence angle of the excitation laser.

[Qualitative features of confabulation in a case with basal forebrain amnesia].

We investigated qualitative features of confabulation in a case with basal forebrain amnesia. A 66-year-old, right-handed woman with a 8th-grade education, was admitted to the Rehabilitation Department of Tohoku University Hospital, Japan, for evaluation and therapy of amnesia. Her previous medical history included hypertension. Nine months before admission, she went to a hospital because of headache and blurred vision. She was diagnosed as suffering from a suprasellar arachnoid cyst and unruptured aneurysm at the anterior communicating artery. Five months later, resection of the cyst and clipping of the aneurysm was performed. After the operation, she became disoriented and amnesic with marked confabulation. On admission to our hospital 3 months later, she was alert and cooperative. Detailed neuropsychological assessment was performed during the next two months. She remained clinically stable throughout her hospitalization. Neurological examination showed no abnormalities. Brain magnetic resonance images revealed lesions in the bilateral orbito-frontal cortices and basal forebrain. Measurement of blood flow with 123I-IMP single photon emission computed tomography showed hypoperfusion in the bilateral frontotemporal regions. We performed systematic investigations to clarify the qualitative features of her confabulations. Her confabulations included many facts she had experienced before, but they were out of context. Each fact was recalled in isolation or associated with erroneous places, persons or times. Her confabulations were never fantastic or momentary in nature, but were consisted with isolated facts. Experimental investigation revealed that she could recognize individual facts (a person, a place, a task and time) in each episode. However, she could not integrate individual facts into an episode. We propose calling this type of confabulation "mosaic confabulation".

Laparoscopic diagnosis and clinical course of chronic schistosomiasis japonica.

Laparoscopic findings of nine patients with chronic schistosomiasis japonica were analyzed and compared to hepatic ultrasonograms, computed tomography (CT) scans and histological findings from the same patients. In all nine patients laparoscopy revealed yellowish, small speckles, approximately 50 microm in diameter, sparse or clustered over the liver surface, which were later found to represent subcapsular calcified ova of Schistosoma japonicum. While the liver surface was almost smooth in mild schistosomiasis, multiple whitish markings and irregular, relatively wide, groove-like septums were seen in more advanced cases. In severe schistosomiasis block-like formations of variable size, separated by groove-like depressions, made the liver surface appear like a tortoise shell. In moderate or severe schistosomiasis ultrasonography revealed spotted high echoes and CT scans demonstrated network patterns and lineal calcified spots. The liver surface of chronic schistosomiasis japonica without re-infection appeared stable without change over time but with a tendency to improve. Hepatocellular carcinoma was initially recorded in two of the nine patients and follow-up revealed a further two with the same diagnosis. However, all these four cases also had chronic hepatitis C (HCV). Hepatocellular carcinoma was not detected in patients without viral hepatitis, indicating that hepatic viral infection is more important than schistosomiasis in promoting the development of hepatocellular carcinoma.

Dynamic contrast-enhanced MR imaging of uterine cervical cancer: pharmacokinetic analysis with histopathologic correlation and its importance in predicting the outcome of radiation therapy.

PURPOSE: To investigate the histopathologic bases of different enhancement patterns on dynamic contrast material-enhanced magnetic resonance (MR) images of cervical cancer and to assess their importance in predicting the outcome of patients after radiation therapy. MATERIALS AND METHODS: Dynamic enhanced MR imaging and pharmacokinetic analyses were performed in 26 patients with cervical cancer who subsequently underwent hysterectomy and in 36 patients with cervical cancer who received radiation therapy. Histopathologic findings and clinical outcomes were correlated with results of dynamic MR imaging and pharmacokinetic analysis. RESULTS: On dynamic MR images of the surgical patients, areas with intense homogeneous enhancement showed increased permeability (k = 27.4 x 10(-3)) compared with areas with poor enhancement (k = 19.0 x 10(-3)). Well-enhanced areas were predominantly composed of cancer cell fascicles, whereas poorly enhanced areas were composed of fibrous tissue with scattered cancer cells. Radiation therapy was more effective in tumors with higher tissue permeability (k = 31.3 x 10(-3)) on dynamic MR images than in those with lower tissue permeability (k = 18.3 x 10(-3)). CONCLUSION: Areas of increased contrast enhancement are mainly composed of abundant cancer cell fascicles, whereas poorly perfused areas are composed of fibrous tissue with scattered cancer cells. Radiation therapy is more effective in well-enhanced tumors, resulting in improved local control.

[Icteric-type hepatoma with liver cirrhosis successfully treated with hepatectomy after biliary drainage: case report].

A 67-year-old man with liver cirrhosis and an icteric-type hepatoma involving the left main portal vein underwent left hepatic lobectomy after percutaneous transhepatic biliary drainage. Surgery was successful because of effective biliary drainage and meticulous assessment of liver function tests, including 99mTC-galactosyl human serum albumin scintiphotography.