Incidence of and risk factors for lymphocele formation after lateral pelvic lymph node dissection for rectal cancer: a retrospective study.

AIM: Pelvic lymphocele is a common complication that develops after pelvic lymph node dissection. The incidence of pelvic lymphocele formation has been reported to be 10.5-51% after gynaecological or urological procedures. However, no evidence has been reported thus far with regard to the development of pelvic lymphocele following lateral pelvic lymph node dissection (LPND) for low rectal cancer. The aim of this study was to investigate the incidence of and risk factors for lymphocele formation after LPND for low rectal cancer and to examine its clinical management. METHOD: We retrospectively analysed the incidence of and risk factors for pelvic lymphocele formation after LPND for rectal cancer in our hospital between January 2012 and December 2017. We also compared the size of the lymphocele between asymptomatic and symptomatic patients by using CT volumetry and examined its clinical management. RESULTS: A total of 30 out of 98 patients (30.8%) developed pelvic lymphocele after rectal LPND. The number of resected nodes was significantly higher in patients with a pelvic lymphocele (P < 0.01). The median volume was significantly higher in patients with symptomatic pelvic lymphocele (P = 0.011). Among the nine symptomatic patients, two underwent CT-guided drainage, one underwent transurethral ureteral stent placement and one underwent laparoscopic marsupialization. CONCLUSION: It is essential to keep in mind the possibility of pelvic lymphocele formation during follow-up of patients who undergo LPND, and to consider an appropriate treatment when these patients are symptomatic.

Increased Survival Benefit of Adjuvant Intra-arterial Infusion Chemotherapy in HCC Patients with Portal Vein Infiltration after Hepatectomy.

BACKGROUND: The role of adjuvant hepatic intra-arterial infusion chemotherapy (HAI) is considered to be a promising option. METHODS: We examined treatment effects of adjuvant HAI using cisplatin in 37 hepatocellular carcinoma (HCC) patients with portal vein infiltration (PVI) who underwent hepatectomy in comparison with those in 85 patients who did not. RESULTS: PVI in 89 patients. Increased levels of aspartate transaminase, tumor markers, size and microvessel tumor infiltration (MVI) or cirrhosis, poorly differentiation, non-adjuvant HAI was associated with lower overall survival (p = 0.09). Poor differentiation, MVI and HAI were independently risk factors associated with tumor-free and overall survivals by the multivariate analysis (p < 0.05). Adjuvant HAI tended to show longer survivals in comparison with no-HAI (p = 0.08) and the multivariate analysis revealed significant efficacy of HAI for better prognosis. CONCLUSION: Adjuvant HAI showed effectiveness on prolonging tumor-free and patient survival in HCC with PVI and is a promising option in the daily clinical practice.

Obstruction is associated with perineural invasion in T3/T4 colon cancer.

AIM: Perineural invasion (PNI) is a risk factor for recurrence and metastasis and consequently leads to decreased survival in patients with various malignancies. Recent studies showed that stent placement in obstructive colon cancer increases the frequency of PNI. We hypothesized that mechanical stress including obstruction itself may be associated with PNI. METHOD: We retrospectively reviewed 496 patients with pathological T3 or T4 colon cancer who did not receive preoperative treatment. Data were collected from medical charts and pathological findings. The relationships between PNI and other clinicopathological factors were analysed using univariate and multivariate analyses. RESULTS: PNI was observed in 239 (48%) patients. Obstruction was markedly more frequent in PNI-positive cancer (39%) than in PNI-negative cancer (24%, P = 0.0003). Multivariate analyses identified obstruction as one of the significant factors associated with PNI (OR 1.68, P = 0.028). Moreover, in 414 patients without distant metastasis who underwent complete resection, PNI was an independent factor associated with poor recurrence-free survival (hazard ratio 2.35, P = 0.003). The coexistence of PNI and obstruction resulted in greater decreases in recurrence-free survival than PNI-negative and/or non-obstructive cases. CONCLUSION: Our results suggest that obstruction is associated with PNI and consequently contributes to an increased postoperative recurrence in colon cancer.

Influenza A virus infection of vascular endothelial cells induces GSK-3ß-mediated ß-catenin degradation in adherens junctions, with a resultant increase in membrane permeability.

Multiorgan failure with vascular hyperpermeability is the final outcome in the progression of seasonal influenza virus pneumonia and influenza-associated encephalopathy, and it is also common in infection with highly pathogenic avian influenza virus. However, the precise molecular mechanism by which influenza virus infection causes vascular endothelial cell hyperpermeability remains poorly defined. We investigated the mechanisms of hyperpermeability of human umbilical vein endothelial cells infected with influenza A virus (IAV)/Puerto Rico/8/34 (PR8) (H1N1). The levels of ß-catenin, a key regulatory component of the vascular endothelial-cadherin cell adhesion complex, were markedly decreased during infection for 28 h, with increments of vascular hyperpermeability measured by transendothelial electrical resistance. Lactacystin (at 2 µM), a proteasome inhibitor, inhibited the decrease in ß-catenin levels. Since the N-terminal phosphorylation of ß-catenin by glycogen synthase kinase (GSK)-3ß is the initiation step of proteasome-dependent degradation, we examined the effects of GSK-3ß suppression by RNA interference in endothelial cells. IAV-infection-induced ß-catenin degradation was significantly inhibited in GSK-3ß-knockdown cells, and transfection of cells with recombinant ß-catenin significantly suppressed IAV-induced hyperpermeability. These findings suggest that IAV infection induces GSK-3ß-mediated ß-catenin degradation in the adherens junctional complexes and induces vascular hyperpermeability. The in vitro findings of ß-catenin degradation and activation of GSK-3ß after IAV infection were confirmed in lungs of mice infected with IAV PR8 during the course of infection from day 0 to day 6. These results suggest that GSK-3ß-mediated ß-catenin degradation in adherens junctions is one of the key mechanisms of vascular hyperpermeability in severe influenza.

Abundant daily non-sedentary activity is associated with reduced prevalence of metabolic syndrome and insulin resistance.

BACKGROUND: Non-exercise activity thermogenesis has recently drawn attention because of its potential to prevent weight gain. AIM: This study evaluated the relationships between the duration of daily non-sedentary activities and the prevalence of metabolic syndrome and insulin resistance (IR) in the Japanese population. MATERIAL/SUBJECTS AND METHODS: A total of 518 eligible subjects (380 men and 138 women) who attended the Tokushima Prefectural General Health Checkup Center and participated in the baseline survey of a cohort study conducted in Tokushima Prefecture, Japan were analyzed. Information about lifestyle characteristics including leisure-time exercise and daily non-exercise activities was obtained from a questionnaire. Logistic and multiple linear regression analyses were performed to evaluate the associations between the duration of daily non-exercise non-sedentary activities (beyond sitting) and prevalence of metabolic syndrome (and its components) and IR. RESULTS: Subjects with longer duration of daily non-sedentary activities had significantly lower adjusted odds ratios for metabolic syndrome (p for trend =0.024), abdominal obesity (p for trend =0.023), and low HDLcholesterol levels (p for trend =0.002), after adjustment for sex, age, and other probable covariates including leisure-time exercise. Longer duration of daily non-sedentary activities was further associated with lower homeostasis model of assessment- IR (HOMA-IR) values (p for trend =0.009). CONCLUSIONS: Our results suggest that abundant daily non-sedentary activity might be associated with a lower prevalence of metabolic syndrome, especially for the components of central obesity and low HDL-cholesterol levels, and with a lower prevalence of IR, independent of leisure-time exercise.

Circulating profiles of osteoprotegerin and soluble receptor activator of nuclear factor kappaB ligand in post-menopausal women.

OBJECTIVE: The aim of this study was to elucidate the detail profiles of circulating osteoprotegerin (OPG) and soluble receptor activator of nuclear factor kappaB ligand (sRANKL) in post-menopausal women. METHODS: Eighty Japanese post-menopausal women were enrolled in this cross-sectional study. Circulating OPG and free fraction of sRANKL (free sRANKL), PTH, calcium and phosphorus, age, years since menopause, body mass index, bone mineral density of the vertebral bodies (LBMD) and bone turnover markers were determined in each subject. RESULTS: In rank order correlation analysis, serum OPG concentrations had a significant positive correlation with age (r=0.291, p=0.024) and a marginal significant negative correlation with LBMD (r=-0.247, p=0.062). However they did not have correlations with LBMD or other parameters after adjustment for age. Serum free sRANKL concentrations had a significant positive correlation with age (r=0.332, p=0.010) and a significant negative correlation with LBMD (r=-0.608, p<0.001). This correlation with LBMD persisted after adjustment for age. In a multiple regression analysis with a stepwise model, the main determinants of LBMD were age and serum free sRANKL (p=0.015 and p=0.006, respectively). CONCLUSIONS: We found the increase in circulating OPG and sRANKL with age and a robust negative correlation between circulating free sRANKL and LBMD after adjustment for age. The increase in circulating free sRANKL may reflect directly or indirectly the conditions coexistent with bone loss in post-menopausal women.

Treatment with cytosine arabinoside and granulocyte colony-stimulating factor in patients with myelodysplastic syndrome and its leukemic phase.

Twenty-one patients with myelodysplastic syndrome (MDS) or overt leukemia resulting from MDS were treated with recombinant human granulocyte colony-stimulating factor (rhG-CSF) and cytosine arabinoside (Ara-C). Ara-C was administered in a dose of 20 mg/m2 every 12 h for 5 days and after 2 days 125 micrograms of rhG-CSF was administered for 10 days. After recovery of the leukocyte count the therapy was repeated, doubling the dose of Ara-C serially when possible. Of 13 patients with MDS, four achieved complete remission (CR), two good response (GR), two minor response (MR), and five no response (NR). Of eight patients with overt leukemia from MDS, only one with hyperplastic bone marrow achieved a partial response (PR) and the remaining seven achieved NR. The efficacy of the combination of rhG-CSF and Ara-C in the treatment of MDS and its leukemic phase is discussed, including at which time rhG-CSF should be administered: before, after or concomitantly with Ara-C. Multicenter randomized studies are needed in the evaluation of this combination therapy.

Outcomes for patients undergoing one or more total hip and knee arthroplasties.

Either total hip arthroplasty (THA), total knee arthroplasty (TKA) or both were performed in 105 patients from 1981 to 1994. These patients were experiencing severe joint destruction in the lower extremities due to rheumatoid arthritis (RA). These patients were followed for more than 2 years after their last operation. Eighty-six patients were alive and 19 patients had died at the time of follow-up. The 86 living patients were divided into four groups based on the number of replaced joints. Their pre- and postoperative conditions, including such factors as pain, mobility and disability for the quality of life (QOL), were compared. All of the four groups showed some reduction in pain and disability, and an improvement in ambulation after the operations. The 19 deceased patients were classified into two groups, one including those with multiple (three or four) arthroplasties and the other, those with only a small number (one or two). The mean age at death was lower (55.7+/-6.2 years) in patients with multiple arthroplasties than that (69.1+/-7.5 years) in patients with only a small number of arthroplasties. Secondary diseases from RA, such as amyloidosis, spinal injury and pulmonary fibrosis, were found to be the primary cause of death in patients with multiple arthroplasties. The most important finding in this study is that although RA patients with multiple arthroplasties in the lower extremities improved their QOL, they were still afflicted with secondary diseases derived from RA and experienced complications that could shorten their lifespan.

Detection of factor V Leiden in Thai patients with venous thrombosis.

The molecular defect underlying activated protein C resistance (APC-R) is caused by a G to A point mutation in the codon for arginine 506 in the factor V gene (factor V Leiden) which is a major risk factor for venous thrombosis, especially in Caucasian populations. This study is an analysis of the Thai population to determine the prevalence of the factor V Leiden mutation. Twenty-seven patients with apparent venous thrombosis were divided into two groups according to APC-R test. Thirteen patients were diagnosed as positive for n-APC-SR, ratio < 0.8 and fourteen patients were diagnosed as negative for n-APC-SR, ratio > 0.8. Two of thirteen APC-R positive patients and one of fourteen APC-R negative patients were found to have the heterozygous allele for the factor V Leiden mutation but the homozygous allele was not detected in these groups of patients. Neither the heterozygous nor homozygous Leiden mutation was detected in 200 healthy volunteer blood donors. In conclusion, our findings indicate that factor V Leiden mutation is related to venous thrombosis in Thai people. Moreover, a further study of other mutations at the activated protein C cleavage sites of factor V and factor VIII is recommended.

Which type of underlying disease facilitates cytomegalovirus infection? Comparison of benign disease, hematopoietic malignancy, and post-bone-marrow or renal transplantation status by using the first standardized objective PCR test for cytomegalovirus detection.

All immunocompromised hosts, such as infants, the elderly, patients with advanced cancer, and patients being treated with immunosuppressants, etc., are said to be more susceptible to cytomegalovirus (CMV) infection or CMV disease. However, we questioned the validity of this conclusion and attempted to detect CMV viremia in the plasma of subjects by using the AMPLICOR CMV test (Roche Diagnostics Systems, Branchburg, NJ), the first standardized PCR kit for CMV infection. One hundred healthy volunteers whose CMV IgG titer was < 4 and 100 healthy volunteers whose IgG titer for CMV was > or = 4 were studied. None of the subjects in either healthy group was positive for CMV viremia. Patients who were suspected of CMV infection were divided into four groups and tested: [1] 104 patients with benign disease, only one of whom was positive for CMV [2] 99 patients with hematopoietic malignancy who had not undergone bone marrow transplantation and all of whom were negative for CMV infection [3] 120 post-bone-marrow transplantation, 28 of whom were CMV positive, [4] 37 post-renal transplantation patients, 19 of whom were CMV positive. A statistically significant difference in CMV positivity was found by the non-parametric Kruskal-Wallis test (p < 0.0001) among the four disease group. CMV infection has been said to occur in all types of immunocompromised patients, however, based on our findings, we conclude that CMV infection tends to occur in post-transplantation status and does not tend to occur in patients with hematopoietic malignancy if they have not undergone transplantation.

[A clinical evaluation of the new laboratory method that diagnoses bacterial infection, using silkworm larvae plasma].

Based upon the phenomenon that the peptidoglycan, a common component of Gram positive and negative bacteria, reacts specifically with silkworm larvae plasma (SLP), a new laboratory method named "SLP test" was developed to measure the reaction products in plasma quantitatively as SLP. This SLP test seems to be able to diagnose both Gram positive and negative bacterial infection. So we evaluated its usefulness in diagnosing clinical infectious diseases. This study included 14 patients with result to positive bacterial blood culture, 22 patients with bacterial local infection, 7 patients without any evidence of bacterial infection, and 19 healthy volunteers. It seemed that the cut-off value of this SLP test should be set at 0.6 ng/ml. The sensitivity and specificity of this SLP test were 57.1%, 100%, respectively. A significant difference was not detected statistically between SLP values of patients with Gram positive and Gram negative bacterial infectious diseases. So the SLP test did not appeared specific to either Gram positive or Gram negative bacteria. This test may become a new method diagnosing bacterial infectious disease.

Successful treatment for active cytomegalovirus infection by cytomegalovirus antibody-enriched immunoglobulin in a renal transplant recipient.

Active cytomegalovirus (CMV) infection was treated successfully by only CMV antibody-enriched immunoglobulin (CMV-IG) in a renal transplant recipient. CMV-IG was injected at 86 mg/kg i.v. twice a day for a total of 16 days (4 plus 12 days, interrupted by a pause of 4 days), followed by weekly i.v. injection of 86 mg/kg (7 weeks). Active CMV infection was diagnosed on the basis of DNAemia in plasma, by a newly developed CMV polymerase chain reaction (PCR) test (AMPLICOR CMV). The disappearance of CMV from plasma was confirmed by this PCR test. It seems that single CMV-IG therapy is worth consideration for the treatment of CMV infection.

Evaluation of a new laboratory test measuring plasma (1-->3)-beta-D-glucan in the diagnosis of Candida deep mycosis: comparison with a serologic test.

We evaluated the effectiveness of the newly developed WAKO beta-glucan test which measures plasma (1-->3)-beta-D-glucan concentrations in the diagnosis of Candida deep mycosis. This test was compared to the Cand-Tec test. The WAKO beta-glucan test and Cand-Tec test were performed on 212 plasma specimens which were taken at 212 instances from 62 immunocompromised patients with serious diseases; i.e. hematopoietic malignancy, solid malignant tumor, etc. The sensitivities and specificities for the WAKO beta-glucan test were 84.8 and 85.9%, respectively, and 60.9 and 80.0% for the Cand-Tec test.

[Treatment of hepatosplenic candidiasis with liposomal amphotericin B in a patient with acute leukemia; a case report of the experience of use of liposomal amphotericin B].

We report a 26-year-old male patient with acute myelocytic leukemia and hepatosplenic candidiasis during his clinical course. His hepatosplenic candidiasis was refractoty to itraconazole and fluconazol. He developed serious side-effect such as renal dysfunction, when conventional amphotericin B was given. Then he was treated with liposomal amphotericin B (Abelcet). This therapy was safe and effective for him. He was able to be treated with 3075 mg of a liposomal amphotericin B. This was ten times as much as the dose of conventional amphotericin B which was given earlier until amphotericin B was stopped because of renal dysfunction. Liposomal amphotericin B seems to be a safe and effective therapy for systemic fungal infectin and should be considered more in Japan.

An anti-platelet activating factor antibody and its effects on platelet aggregation.

Production of antibodies against platelet activating factor (PAF) has been difficult, probably because of the low antigenicity of PAF, a low-molecular-weight phospholipid. We therefore used colloidal gold as a hapten carrier to produce anti-PAF polyclonal and monoclonal antibodies. Both antibodies reacted with PAF, lyso PAF, and L-alpha-lysophosphatidyl choline palmitoyl (lyso PCP), but they did not react phosphorylcholine chloride (PCC). Their affinities were higher for PAF than for lyso PAF and lyso PCP. When the antibodies were tested on PAF-induced platelet aggregation, they suppressed aggregation in a dose-dependent manner.

Therapy with mitoxantrone, ifosfamide, vindesine, and prednisolone for malignant lymphoma with adjustable doses and timing of courses.

Thirty-seven patients with malignant lymphoma were treated with mitoxantrone, ifosfamide, vindesine, and prednisolone. The time among courses was not fixed, being decided by the time for recovery from the leukopenia caused by the treatment. The drug dose was adjusted after the initial course. Of the 12 patients treated for the first time, eight had a complete remission and two had a partial response. Of the 18 patients who relapsed after another drug regimen, six had a complete remission and seven had a partial response. The SD of the leukocyte nadirs decreased after the first course, and time needed for recovery from leukopenia tended to shorten during treatment. Side effects seemed mild, and we can use many drugs safely in a short term without long drug-free intervals. Response rates were satisfactory, compared with other report, so this method of timing the start of courses with adjustment of the dose seems useful.

Clinical study of malignant lymphoma of head and neck in the nasal cavity and Waldyer's ring.

Clinical outcome of fifty-one cases of non-Hodgkin's lymphoma limited to the head and neck were studied for differences with involvement of one of two sites: Waldyer's ring, and the nasal cavity and paranasal sinuses taken together. The median survival for patients with involvement of Waldyer's ring was 58.6 months, and for the other group, 10.3 months. The patients with involvement of the nasal cavity and paranasal sinuses responded poorly to treatment and the lymphoma rapidly progressed. In these patients, the lymphomas were not of the diffuse small cell type, which has a relatively good prognosis: but T cell type. The poor outcome with involvement of the nasal cavity and paranasal sinuses may be due to histological and immunological factors, and to inadequate therapy. Early combination chemotherapy might give better results for this group.

Evaluation of serum sialyl Lewisx-i in hematologic disorders.

Sialyl Lewisx-i (SLX) was found in more than 40% of patients with acute leukemia or chronic myelogenous leukemia, and in about 20% of those with myelodysplastic syndrome or malignant lymphoma. This tumor marker was absent in all patients with polycythemia vera, essential thrombocythemia, primary myelofibrosis, chronic lymphatic leukemia, multiple myeloma, and those with acute leukemia or malignant lymphoma in remission. The marker was found in 8% and of the patients with idiopathic thrombocytopenic purpura and 33% of those with autoimmune hemolytic anemia but in no patient with aplastic anemia or megaloblastic anemia. Immunostaining with SLX antibody showed that tumor cells of the patients with high levels of serum SLX were producing the SLX antigen. The detection of this marker in the serum is thought to be useful not only in the diagnosis but also in the observation of the recurrence of the diseases.

Evaluation of 117 patients with non-Hodgkin's lymphoma in the past ten years at our department.

We did a retrospective statistical study of 117 patients with non-Hodgkin's lymphoma admitted to our hospital from January 1979 to December 1988. Five-year survival was 83% for patients in stage I at diagnosis, which was significantly better than the 55% in stage II, 37% in stage III, and 34% in stage IV. Five-year survival was 74% for patients with B-cell lymphoma (74%), which was significantly better than with the 32% for T-cell lymphoma. For patients in stage I or II, five-year survival was 46% for those with nasal lymphoma, which was significantly worse than the 72% with nodal lymphoma and the 82% for those with Waldeyer's lymphoma. Sixty-eight patients were treated initially with radiation only. The relapse frequency was 20% in stage I and 40% in stage II. All of the relapses occurred outside the irradiated area treated on the other side of the diaphragm. Of all 48 patients with combination chemotherapy such as vincristine, cyclophosphamide, predonisolone, and Adriamycin (VEPA), mitoxantrone, cyclophosphamide, vincristine, and predonisolone (MCOP), and mitoxantrone, ifosfamide, vindesine, and predonisolone (MIFP), 33 (69%) achieved complete remission.