The purpose of this case report is to determine the unique pathogenesis of a "spared flow tract" through a thick mural thrombus of an aortic aneurysm mimicking the penetrating or dissecting tract of an impending or acute rupture of an abdominal aortic aneurysm (AAA) and to discuss its clinical importance. Three blood flow tracts (i.e., spared flow tracts) penetrating to aortic major branches (inferior mesenteric arteries in two and left renal artery in one) through thick mural thrombi of three aortic aneurysms were found on thin section spiral CT scans. Histopathological examination revealed that the tracts were formed by thrombi and partially covered with endothelial cells. In conclusion, spared flow tracts may be pathways continuing to the aortic major branches through thick mural thrombi of aortic aneurysms and are spared from thrombogenesis because of relatively high blood flows. Their pathogenesis is definitely different from penetrating or dissecting tracts within mural thrombi of ruptured AAAs. Spared flow tracts should not be misinterpreted as penetrating or dissecting tracts of impending or acute rupture.

Acute Disease↗

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Complications of endovascular repair for thoracic and abdominal aortic aneurysm: an imaging spectrum.

Endovascular stent-graft implantation is an alternative to conventional open surgery for the treatment of aortic aneurysm. Forty-nine consecutive patients with aortic aneurysm (thoracic, n = 17; infrarenal, n = 32) were treated with endovascular stent-graft implantation. Complications occurred in 25 patients (two patients had two complications): endoleak (n = 13), graft thrombosis (n = 5), graft kinking (n = 2), pseudoaneurysm caused by graft infection (n = 1), graft occlusion (n = 1), shower embolism (n = 1), perforation of mural thrombus by means of inadvertent penetration of delivery system (n = 1), colon necrosis (n = 1), aortic dissection (n = 1), and hematoma at the arteriotomy site (n = 1). Imaging findings were analyzed for spiral computed tomography, plain abdominal radiography, transesophageal echocardiography, and digital subtraction angiography. Since some of these complications are fatal, radiologists need to instantly and accurately recognize them. Awareness and understanding of possible complications should help ensure a safe, successful procedure.

Aged↗

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Angiogenesis induced by the implantation of self-bone marrow cells: a new material for therapeutic angiogenesis.

Bone marrow, contains various primitive cells that are thought to secrete several angiogenic growth factors and may also differentiate into endothelial cells. The present study was conducted to investigate the possibility that bone marrow cells could be a novel material to induce angiogenesis. The expression of vascular endothelial growth factor (VEGF) and basic fibroblast growth factor (bFGF) in rat bone marrow cells was examined by immunohistochemistry. The production of VEGF was compared in tissue culture supernatant under the conditions of normoxia and hypoxia. The process of angiogenesis that occurred following the implantation of bone marrow cells was determined using a rat cornea model. VEGF- and bFGF-positive cells were found in rat bone marrow. The production of VEGF from bone marrow cells was significantly more enhanced by hypoxic conditions than by normoxic conditions. The rat cornea model showed that bone marrow cell implantation created new vessels. The implantation of self-bone marrow cells is a novel and simple method of inducing angiogenesis.

Animals↗

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The long-term evaluation of pulmonary toxicity following isolated lung perfusion with melphalan in the rat.

The present study was conducted to evaluate the long-term pulmonary toxicity of isolated lung perfusion (ILP) with melphalan in the rat model. F344 rats were treated by ILP with 1 mg of melphalan or buffered hespan (BHE). The rats in the melphalan group were sacrificed randomly 30, 60, 90, 120, 150, and 180 days after the perfusion. Pulmonary toxicity was evaluated by pathological analysis. In the melphalan group, light and electron microscopic findings revealed perivascular and peribronchial edema, and septal thickening with cellular infiltration of the interstitial space 30 days after the perfusion, but all of these changes had disappeared by 60 days. Azan stain showed a slight increase of the connective tissue at the alveolar wall in the melphalan group, but no progressive pulmonary interstitial fibrosis was observed after 180 days. Transmission electron microscopy showed minimal proliferation of the type II pneumocytes of normal appearance in the melphalan group. In conclusion, the long-term pulmonary toxicity of ILP with melphalan is acceptable; however clinical trials of this therapy need to be conducted.

Animals↗

PubMedDate not supplied

A case of MALT (mucosa-associated lymphoid tissue) lymphoma occurring in the rectum.

A case of mucosa-associated lymphoid tissue (MALT) lymphoma of the rectum is reported. A 64 year-old woman was referred to us for the evaluation of occult blood in the stool. A hard mass was palpable on digital examination. Biopsy specimens revealed a histologic picture compatible with MALT lymphoma. Abdominoperineal excision of the rectum was carried out. Chemotherapy was not performed, and the post-operative course was uneventful, with no evidence of recurrence for 2 years and 11 months. Surgical resection is an effective therapy for MALT lymphoma of the rectum.

Female↗

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Detection of 20q13 gain by dual-color FISH in breast cancers.

An increase in the 20q13 copy number has been reported in a wide range of solid tumors including breast cancers. However, the biological significance of this 20q13 gain has not yet been defined. We examined the 20q13 gain in breast cancer cells by dual-color FISH using two different DNA probes specific for the region of 20q13 and chromosome 20 centromere to investigate the relationship between 20q13 gain and the clinicopathological features of breast cancers. DNA measurement by LSC revealed DNA diploidy in 14 tumors and DNA aneuploidy in 24 tumors. Although the modal number of chromosome 20 was 2 in most of the tumors, the average fraction of cells with the modal chromosomal number was significantly different in the diploid and aneuploid tumors (p < 0.01). A gain in the 20q13 copy number was detected in 9 of 38 breast cancers, 2 of which showed a high-level gain. The gain in 20q13 was associated with negative expression for the progesterone receptor, but it was not linked to estrogen receptor expression. A 20q13 gain tended to be seen in DNA aneuploid and/or scirrhous carcinomas, but the increase in the 20q13 copy number did not affect either the nodal state or the disease stage in this series.

Adult↗

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Laparoscopic surgery in infants with intra-abdominal cysts: two case reports.

OBJECTIVES: We report two cases of infants found to have congenital omental cystic lesion with torsion and ovarian cyst treated by laparoscopy-assisted surgery (LAS). METHODS: A laparoscope was inserted by an open method. The intra-abdominal pressure was maintained at 8 mm Hg. We diagnosed the cystic lesions with torsion. At aspirator was used to aspirate the cystic content and remove the cyst. RESULTS: No intra- or postoperative complications were encountered. Oral intake was commenced on postoperative day 2 in both patients. The cosmetic results following LAS were excellent. CONCLUSIONS: We conclude that LAS is suitable for the management of omental cystic lesions with torsion and ovarian cyst in nursing infants. An aspirator is useful in preventing spillage of cystic contents in patients with intra-abdominal cystic lesion.

Cysts↗

PubMedDate not supplied

Randomized controlled trial of 5-fluorouracil (5-FU) infusion combined with 1-hexylcarbamoyl-5-fluorouracil (HCFU) oral administration and HCFU alone as postoperative adjuvant chemotherapy for colorectal cancer.

BACKGROUND: Although surgical resectability is an important prognostic factor, recurrences are commonly noted in advanced colorectal cancer patients, even after apparently curative surgery. Because such recurrences cannot be cured, better adjuvant chemotherapies are urgently required. PATIENTS AND METHODS: We studied the effect of postoperative chemotherapy using 1-hexylcarbamoyl-5-fluorouracil (HCFU) oral administration with or without 5-fluorouracil (5-FU) infusion for curatively resected Stage II and III colorectal cancer. This study was prospectively randomized and controlled and 303 (95.6%) of 316 patients were determined to be candidates for statistical assessment. Group A received oral HCFU, 300 mg daily for 52 weeks beginning 2 weeks after surgery. Group B also received 5-FU intravenous injection, 333 mg/m2 body surface area/24 hours continuously for 72 hours beginning on postoperative day 0 and 6. RESULTS: There were no differences in overall 5-year survival or disease-free survival between Groups A and B. Group B had better 5-year disease-free survival (47.6%) than Group A (42.9%) (p = 0.062) and significantly prolonged interval from surgery to recurrence (p = 0.003) for patients with lymph node metastasis. In contrast, group B had significantly shortened 5-year disease-free survival (p = 0.010) and increased recurrence rate in patients without lymph node metastasis. CONCLUSION: Inductive therapy with 5-FU in combination with oral HCFU is beneficial as adjuvant chemotherapy for advanced colorectal cancer with lymph node metastasis.

Administration, Oral↗

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Mitral insufficiency in an incomplete form of Marfan syndrome corrected with valve replacement.

A 14-year-old boy with an incomplete form of the Marfan syndrome developed an acute episode of severe congestive heart failure following exertion. The preoperative studies indicated a mitral insufficiency, and a floppy, thickened mitral valve was removed and replaced with a Starr-Edwards prosthesis. Microscopically, the valve showed increase in collagen with central myxomatous transformation. Seven months postoperatively the patient is doing well and has no symptoms of heart failure.

Adolescent↗

PubMedDate not supplied

Digitonin enhances the anti-tumor effect of cisplatin against methylcholanthrene-induced rat sarcoma cells in vitro.

BACKGROUND: This study was designed to evaluate cellular uptake and cytotoxicity of cisplatin in methylcholanthrene (MCA)-induced rat sarcoma cells when used in combination with a detergent, digitonin. MATERIALS AND METHODS: In the cellular intake study, after MCA sarcoma cells (10(7)) were treated with cisplatin alone (50 micrograms/ml) and with cisplatin (50 micrograms/ml) in combination with digitonin at 20 microM and 50 microM, the cells were washed twice with PBS and the platinum levels were measured by flameless atomic spectrometry. For the anti-tumor effect MCA sarcoma cells (10(3)) were seeded in cell culture dishes and loaded for 10 minutes with PBS, digitonin (5 microM), cisplatin (5 micrograms/ml) or a combination of cisplatin (5 micrograms/ml) and digitonin (5 microM). The cells were then washed and incubated for 72 hours. Bromodeoxyuridine uptake was measured with an ELISA system for determining viable cells counts. RESULTS: Cell platinum levels were significantly elevated in proportion to the increase of digitonin (p < 0.0001). The number of viable cells was significantly decreased with, the combined cisplatin (5 micrograms/ml)--digitonin (5 microM) treatment (p < 0.0001 CONCLUSION: Digitonin enhances the antitumor effect of cisplatin against methylcholanthrene-induced rat sarcoma in vitro.

Animals↗

PubMedDate not supplied

Increasing drug concentration in a rat lung tumor model by combining isolated lung perfusion with hypertensive chemotherapy.

Isolated left lung perfusion (ILP) with cisplatin was performed in Fisher 344 rats. Before perfusion, bolus injection with endothelin was given via the pulmonary artery. The vasoconstrictive potency was estimated by monitoring the perfusion pressure. The toxicity was estimated by tracking body weight change, survival rate after right pneumonectomy, arterial blood gas analysis and histological findings. To observe the pharmacokinetic changes, a solitary Methylcholanthrene-induced sarcoma model was established in a rat lung and the total platinum concentration in perfused lung and tumor tissues was measured. Perfusion pressure was increased significantly in a dose-dependent manner. Pulmonary toxicity from ILP with cisplatin was limited by the use of endothelin. Significantly higher levels of total platinum were obtained in tumors but not in normal lung tissues by endothelin injection before ILP than by ILP alone. The combination of ILP and hypertensive chemotherapy should be one of the available treatments for unresectable pulmonary carcinoma.

Animals↗

PubMedDate not supplied

Post-operative adjuvant chemotherapy for colorectal cancer with 5-fluorouracil (5-FU) infusion combined with 1-hexylcarbamoyl-5-fluorouracil (HCFU) oral administration after curative resection.

BACKGROUND: Although surgical resectability is an important prognostic factor, recurrences are commonly noted in advanced colorectal cancer patients, even after apparently curative surgery. Since such recurrences cannot be cured, better adjuvant chemotherapies are urgently required. PATIENTS AND METHODS: We studied the effect of post-operative chemotherapy using oral administration of 1-hexylcarbamoyl-5-fluorouracil (HCFU) with 5-fluorouracil (5-FU) infusion for curatively-resected Stage IIIa and IIIb colorectal cancers. This study was prospectively randomized and controlled and 314 (97.8%) out of 321 patients were determined to be candidates for statistical assessment. Group A and Group B received 5-FU intravenous injection at, respectively, 333 mg/m2 and 1000 mg/m2 body surface area/24 hours continuously for 72 hours beginning on post-operative day 0 and day 6, with oral HCFU 300 mg daily for 52 weeks beginning 2 weeks after surgery. RESULTS: There were no differences in overall 5-year survival or disease-free survival between Group A and Group B. A retrospective subset analysis. however, suggested that the protocol of Group B tended to yield better 5-year survival (68.3%) for rectal cancer than that of Group A (58.8%). CONCLUSION: Inductive therapy with high-dose 5-FU in combination with oral HCFU appears to be beneficial as adjuvant chemotherapy for advanced rectal cancer with lymph node metastasis.

Administration, Oral↗