Infrequent RAS mutation is not associated with specific histological phenotype in gliomas

BACKGROUND: Mutations in driver genes such as IDH and BRAF have been identified in gliomas. Meanwhile, dysregulations in the p53, RB1, and MAPK and/or PI3K pathways are involved in the molecular pathogenesis of glioblastoma. RAS family genes activate MAPK through activation of RAF and PI3K to promote cell proliferation. RAS mutations are a well-known driver of mutation in many types of cancers, but knowledge of their significance for glioma is insufficient. The purpose of this study was to reveal the frequency and the clinical phenotype of RAS mutant in gliomas. METHODS: This study analysed RAS mutations and their clinical significance in 242 gliomas that were stored as unfixed or cryopreserved specimens removed at Kyoto University and Osaka National Hospital between May 2006 and October 2017. The hot spots mutation of IDH1/2, H3F3A, HIST1H3B, and TERT promoter and exon 2 and exon 3 of KRAS, HRAS, and NRAS were analysed with Sanger sequencing method, and 1p/19q codeletion was analysed with multiplex ligation-dependent probe amplification. DNA methylation array was performed in some RAS mutant tumours to improve accuracy of diagnosis. RESULTS: RAS mutations were identified in four gliomas with three KRAS mutations and one NRAS mutation in one anaplastic oligodendroglioma, two anaplastic astrocytomas (IDH wild-type in each), and one ganglioglioma. RAS-mutant gliomas were identified with various types of glioma histology. CONCLUSION: RAS mutation appears infrequent, and it is not associated with any specific histological phenotype of glioma

Pacemaker-induced Superior Vena Cava Syndrome : Report of One Case and Review of the Literature

A 76-year-old man developed superior vena cava syndrome (SVCS) 20 months after the implantation of a dual chamber pacemaker, and was successfully treated with thrombolytic therapy followed by long-term anticoagulant therapy. The face and neck were markedly swollen, and superficial veins in the neck, upper arms and upper chest were prominently distended. Venography from bilateral cubital veins revealed a severe stenosis of the distal segment of the superior vena cava without the development of collateral channels. After an initial treatment with urokinase for 5 days followed by warfarin for 16 months, the symptoms and signs of the SVCS disappeared, and the digital subtraction angiography revealed a marked regression of the thrombotic stenosis. In view of the expected increase in the insertion of multiple leads in cases of dual chamber pacemakers or including fractured lead retention, more attention should be paid to the risk of the development of the SVCS in these cases

Usefulness and limitation of laparoscopic assisted hepatic resections: a preliminary report

Background/Aims: We preliminarily examined the characteristics of patients who underwent laparoscopic assisted hepatic resection (LAPH) to clarify its advantages and limitations of this procedure. Methodology: We examined the demographics, surgical records and outcome in 9 patients undergoing LAPH between 2001 and 2007 by comparing results in 15 patients (control group) who did not undergo laparoscopy before 2000. Results: By comparing the control group, patient demographics were not different. Four patients underwent left lateral sectionectomy and others underwent partial hepatectomy. One patient needed combined resection of abdominal wall and left lateral sector because of direct invasion from a liver tumor. There was no remarkable morbidity or mortality in all patients. Mean operation time in the LAPH group was significantly longer than that in the control group (356+/-68 vs. 276+A59 minutes) (p=O.015), particularly in patients undergoing partial resection. Blood loss was not different between groups. Days of use of pain reliever and hospital stay in the LAPH group was significantly shorter than that in the control group (pO.OOl). These tendencies were similar in each operative procedure. Conclusions: LAPH can be safely performed even in patients with chronic liver injury and recovery of patients from operation was faster than that by conventional hepatectomy