Recurrent nerve nodal involvement is associated with cervical nodal metastasis in thoracic esophageal carcinoma.

BACKGROUND: Because three-field dissection for esophageal carcinoma is one of the most invasive operations, this procedure should be selected only when strictly indicated; but there are no useful criteria for it. The goal of this study was to identify the useful clinicopathologic factors for indicating three-field dissection. STUDY DESIGN: In this study, we reviewed the survival of patients after three-field dissection and identified factors associated with metastases in cervical nodes (CN), especially internal jugular nodes and supraclavicular nodes. Eighty-six patients who underwent curative esophagectomy with three-field dissection for squamous cell carcinoma of the thoracic esophagus were enrolled in this study. Survival rates were compared with respect to the presence of nodal metastasis. The relationship between recurrent nerve nodal (RNN) involvement and CN metastasis (bilateral internal jugular nodes, supraclavicular nodes, or both) was examined. Clinicopathologic factors possibly influencing CN metastasis were studied by multivariate logistic regression analysis. RESULTS: The overall 5-year survival rate was 45.1%. The 5-year survival rate for patients without metastatic nodes was 67.5%, for patients with one to four metastatic nodes it was 53.1%, and for patients with five or more it was 9.1 %. The prognosis of those with five or more metastatic nodes was significantly poorer than those of the other two groups. In the positive-node group, the 5-year survival rate for patients with RNN metastasis was 21.7%, and for patients with negative RNN it was 47.0% (p = 0.2). In the positive-node group, the 5-year survival rate for patients with positive CN was 13.7% and for patients with negative CN it was 45.8% (p = 0.01). Fifty-six (88.9%) of 63 patients without RNN metastasis had no CN metastasis in contrast to 13 of 23 patients (56.5%) with RNN metastasis who had no CN metastasis (p = 0.001). The positive predictive value, negative predictive value, sensitivity, and specificity were 43.5%, 88.8%, 58.8%, and 81.2%, respectively. The number of metastatic nodes (5 or more versus 0-4) (odds ratio: 2.9, 95% Confidence Interval (CI) = 1.6-5.5, p = 0.0008) and RNN involvement (odds ratio: 4.5, 95% CI = 1.3-15.9, p = 0.02) were the significant factors associated with CN metastasis in the multivariate analysis. CONCLUSIONS: RNN involvement is associated with CN metastasis as is the number of metastatic nodes and may be an indicator for the selection of three-field dissection in thoracic esophageal carcinoma.

Predicting initial recurrence pattern of esophageal cancer after neoadjuvant chemotherapy.

BACKGROUND/AIMS: No report has reviewed which clinicopathological factors including 3-field dissection and the response to neoadjuvant chemotherapy can predict the recurrence pattern of an esophageal carcinoma. The aim of this study was to reveal clinicopathological predictors for the initial recurrence pattern of a thoracic esophageal carcinoma. METHODOLOGY: Sixteen parameters derived from 98 patients who underwent a curative esophagectomy with neoadjuvant chemotherapy for a squamous cell carcinoma of the thoracic esophagus were examined using univariate and multivariate logistic regression analyses. RESULTS: Thirty-seven (37.8%) of the 98 patients had recurrences (hematogenous; 16, lymphatic; 13, others; 8). Univariate analyses revealed that the completion of 3-field dissection was the only factor for suppressing the lymphatic recurrence (P = 0.009; odds ratio: 0.2). Multivariate analyses showed that the number of positive nodes was a significant predictor for recurrence including all modalities (P = 0.02; odds ratio: 1.2) and both the number of positive nodes (P = 0.04; odds ratio: 1.1) and the poor response to neoadjuvant chemotherapy (P = 0.02; odds ratio: 6.9) were significant predictors for the hematogenous recurrence. CONCLUSIONS: The number of positive nodes and the response to neoadjuvant chemotherapy could predict the hematogenous recurrence of esophageal carcinoma.

Use of digirad 2020tc Imager, a multi-crystal scintillation camera with solid-state detectors in one case for the imaging of autografts of parathyroid glands.

99mTc-methoxy-isobutyl-isonitrile (99mTc-MIBI) scintigraphy with Digirad 2020tc ImagerTM (2020tc), which was a multi-crystal scintillation camera with solid-state detectors was performed for patients with secondary hyperparathyroidism having autografts of parathyroid glands in the right arm. With the 2020tc camera, three abnormal accumulations were found in the right arm. The images obtained with this camera were superior in resolution to those obtained with a conventional NaI crystal gamma camera (ZLC7500, Siemens, Germany). The next day, resection of autografts of parathyroid glands was done. Four hyperplastic parathyroid glands were resected and all were hyperplastic in pathological findings.

[The developmental effects of an early intervention program for very low birthweight infants].

We assessed the efficacy of an early intervention program (EIP) designed to promote the neonatal behavioral organization and developmental progress in infants born prematurely. The study subjects consisted of 48 very low birthweight infants (< or = 1,500 gms) who received care in NICU of Nagasaki University Hospital, Nagasaki, Japan. During 1993-1996, the experimental group (n = 30) received the NBAS (Neonatal Behavioral Assessment Scale) based intervention combined with a therapeutic program (EIP), for 44 weeks starting from 38 weeks of postmenstrual age. The control group (historical control, n = 18) received the standard medical-nursing care without EIP during 1990-1992. Developmental outcome was assessed in both groups using the NBAS examination after EIP at 44 weeks of postmenstrual age, and the Bayley Scales at 12 months corrected age. Multivariate analyses were performed to adjust for baseline variables that might be associated with the developmental outcome: sex, appropriate or light for dates infant, birthweight, gestational age, Apgar score at 1 minute, duration of intubation, and NBAS cluster score before EIP. In the NBAS examination after EIP, the experimental group achieved significantly higher scores in orientation, motor performance, state range and state regulation tasks than the control group. Furthermore, the experimental group showed significantly higher Bayley Mental and Psychomotor Developmental Indices compared with the control group. These results suggested that EIP was effective in promoting the neonatal neurobehavioral development of very low birthweight infants.

[Diagnosis of incompetent perforators in primary varicose veins by high resolution ultrasonography].

The purpose of this study is to investigate morphological changes of incompetent perforators in primary varicose vein, and to elucidate diagnostic accuracy of high resolution ultrasonography regarding the incompetent perforators. The subjects were 42 lower limbs in 28 patients. Sixteen lower limbs had stasis symptoms and 26 had stasis dermal findings. Perforators were diagnosed when they penetrated the strong echo from the fascia. Their diameter was measured and their subfascial draining veins were identified. By operation, their penetrating portions on the fascia were confirmed and bleed back test was performed. They were divided into 8 types according to their draining veins. Eighty-nine perforators were detected and of them were major 3 types. The incompetent perforators arose at 3mm in diameter, and the all perforators more than 7mm became incompetent. The diagnostic accuracy of ultrasonography regarding their positions was 92%. However, the diagnostic accuracy of ultrasonography regarding their incompetency was 65% in total accuracy, when 4mm in diameter was used as a cut-off line. The positions of perforators were accurately detected using ultrasonography, but their competency was not precisely evaluated by diameter measurement. Therefore, this method was available for marking the precise position of incompetent perforators preoperatively.

[Diagnosis of deep vein thrombosis by high resolution ultrasonography].

Using high resolution ultrasonography (US), diagnostic accuracy of thrombi in each venous segment of lower limbs and qualitative evaluation of thrombi in deep vein thrombosis (DVT) were investigated. The subjects were 106 lower limbs in 81 patients. The thrombi in common femoral vein (CFV), were diagnosed by compression technique and, were qualitatively analysed by echogenicity and consistency. Venography was performed in 18 limbs and histologic tests of thrombi were made in 6 limbs. The total accuracy of US was 100% for diagnosis of DVT, but was 83% for diagnosis of its extent. The total accuracy of US in each segment was greater than 90%, but the sensitivity of iliac veins was less than 90%. The thrombi in CFV were divided into 3 types and 8 sub-types. Type A was homogenous, type B was heterogenous, and type C was contracted echo. The types of us were consistent with results of histologic tests. We concluded that high resolution US is available for screening test for diagnosis of DVT and that qualitative evaluation of thrombi by US is a useful clinical test for selection of more adequate treatments.

Gradient-index rod lens with a high acceptance angle for color use by Na(+) for Li(+) exchange.

The relationship between the characteristics of gradient-index rod lenses obtained by ion exchange and their mother glass compositions is studied. It is observed that Li(2)O content, R(2)O (Li(2)O + Na(2)O) content, and the Li(2)O/Na(2)O ratio are important factors in attaining a high acceptance angle and a small field curvature. Thus the gradient-index lens array is fabricated by the use of a newly developed glass composition and its optical performance; the modulation transfer function, luminous intensity, and chromatic aberration are precisely evaluated. The array is found to have a sufficiently high performance to be applicable for color use.

Expression of heat shock proteins in developing and degenerating rat testes.

In the testis, several types of heat shock proteins (HSPs) have been identified and characterized, although the cellular basis of the HSPs remains elusive. In the present study, alterations in the cellular localization of HSPs, including HSP 25, 60, 70, and 90, were studied during the developing and degenerating periods in the rat testis using immunohistochemistry and Western blotting. HSP25 was expressed in neither germ cells nor somatic cells on all days examined. In contrast, HSP 60 was expressed in Leydig cells during neonatal and prepuberty periods, and only in spermatogonia and primary spermatocytes after puberty. HSPs 70 and 90 were expressed in germ cells, Sertoli cells, and Leydig cells during neonatal and early developing testes, and in spermatocytes and round spermatids after puberty. Besides, there was faint expression of HSP 90 protein in spermatogonia in this period. In the degenerative condition, all HSP proteins were markedly expressed in germ cells after surgery. It would appear that HSPs play roles in unique homeostasis in testes.

[MRI of anterior cruciate ligament autografts].

The purpose of this study was to assess the usefulness of MRI in the evaluation of autografts after anterior cruciate ligament reconstruction. The subjects were 110 patients with anterior cruciate ligament reconstruction using patellar tendon autografts who underwent clinical examination, MRI, and arthroscopy of the knee. T1- and T2-weighted MR images were obtained in sagittal plane. Clinical findings were categorized into three groups: normal, borderline, and abnormal. The MRI appearances of the autografts were categorized into three types: straight continuous band (type I), interrupted band (type II) and generalized increased intensity band (type III). The clinical findings and MRI findings were compared with arthroscopic findings. Ninety-six percent of the type I showed no autograft tear on arthroscopy. In comparison with the clinical findings, MRI was found to be well correlated with arthroscopic findings. In conclusion, if the clinical findings are normal, patients are to be followed-up without MRI and arthroscopy. However, if clinical findings are either borderline or abnormal, MRI should be performed prior to arthroscopy.

A solitary renal mass as the only manifest lesion of a B-cell lymphoma.

A patient with a solitary renal mass as the only manifest lesion of B-cell lymphoma was reported. The surgical specimen revealed that the lesion was histologically limited to the renal parenchyma. Liver dysfunction prevented him from receiving systemic chemotherapy. Mediastinal and mesenteric lymph node involvements developed 6 months later. Fortunately, the patient survived without recurrence for 18 months after the surgical removal of these tumors and intensive chemotherapy. Systemic chemotherapy is recommended on patients with renal lymphoma even if the tumor seems to be limited to the organ.

Involvement of Fas in the apoptosis of mouse germ cells induced by experimental cryptorchidism.

The role of Fas in the apoptosis of testicular germ cells was investigated in BALB/c mice and Fas-deficient lpr/lpr mice. Spontaneous apoptosis of germ cells was observed in the testes of 40-day-old BALB/c mice, and experimentally induced cryptorchidism increased this apoptosis to such an extent that there was a decrease in the weight of the testis. Flow cytometry and immunohistochemistry using a Fas-specific monoclonal antibody demonstrated expression of Fas on germ cells including spermatogonia, spermatocytes, and spermatids. Furthermore, analysis by flow cytometry suggested that Fas expression on germ cells was increased following cryptorchidism. However, spontaneous and cryptorchidism-induced apoptosis of germ cells were also observed in 40-day-old Fas-deficient lpr/lpr mice. Moreover, testis weight also decreased following cryptorchidism in the mutant mice. The present results may indicate that the expression of Fas on germ cells does not correlate with spontaneous apoptosis or apoptosis induced by cryptorchidism. However, on the contrary, this study shows that Fas are partly involved in cryptorchidism-induced apoptosis, because the decrease in testis weight of lpr/lpr mice was less than that in BALB/c mice.

[Relationship between redistribution rate (RD rate) of 123I-IMP SPECT and prognosis by Barthel index in cerebral infarction].

A comparative study of RD rate and the Barthel index was performed in 26 patients who had cerebral infarction. On 123I-IMP SPECT, the RD rate was calculated as follows, RD rate = (I-II)/I x 100(%). (I = (B-A)/B, where A is the mean count of the low density area (LDA) on brain CT on the early image and B the mean count of the opposite portion of LDA on the early image. II = (B'-A')/B', where A' is the mean count of the LDA on the delayed image and B' is the mean count of the opposite portion of the LDA on the delayed image. delta Barthel index (delta B. I.) was defined as follows: delta B. I. = B. I. (post-rehabilitation)-B. I. (pre-rehabilitation). In the group with B. I. (pre rehabilitation) < 85, the RD rate and delta B. I. were well correlated. In the group with B. I. (pre-rehabilitation) > or = 85, the RD rate and delta B. I. were not correlated. This result suggests that the RD rate might be useful in predicting prognosis and selecting the principle of therapy.

Redistribution in I-123 N-isopropyl-p iodoamphetamine single-photon emission computed tomography in cerebrovascular disease and the effects of rehabilitation.

We performed N-isopropyl-p (I-123) iodoamphetamine (IMP) single-photon emission computed tomography (SPECT) on 28 patients with severe cerebrovascular disease before rehabilitation, and compared the degree of redistribution and the assessment of activities of daily living (ADL). We calculated a redistribution (RD) ratio in the central and peripheral parts of the lesions: RD ratio (c) and RD ratio (p). We classified the patients into four groups based on the degree of redistribution: complete: both RD ratio (c) and (p) > or = 75; peripheral: RD ratio (c) < 75, RD ratio (p) > or = 75; incomplete: both RD ratio (c) and (p) < 75 and at least one of RD ratio (c) or (p) > or = 25; no redistribution: both RD ratio (c) and (p) < 25. We assessed the ADL using the modified Barthel index (BI). deltaBI was defined as BI after rehabilitation-BI before rehabilitation (BIpost-BIpre). The deltaBI of the four groups were as follows: complete-redistribution group (40.8 +/- 22.8), peripheral-redistribution group (40.0 +/- 15.8), incomplete-redistribution group (27.2 +/- 22.6), no-redistribution group (8.8 +/- 12.3). The deltaBI of the complete and peripheral redistribution groups were significantly higher than that of the no-redistribution group. However, deltaBI was almost the same in the complete- and peripheral-redistribution groups. This suggests that the effect of rehabilitation might be closely related to the viability of the peripheral part of the lesion.