Studies on the Utility of Sequential Staining Technique using PCNA and AgNORs for Assessing the Degree of Malignancy of Gastric Carcinoma

In thirty cases of resected primary gastric carcinoma, the relative utility of argyrophilic nucleolar organizer regions (AgNORs) staining (single staining) and sequential staining technique using proliferating cell nuclear antigen (PCNA) and AgNORs was studied. The mean number of AgNORs in PCNA-positive cells was significantly larger than that in AgNORs single stained cells. For above two groups, correrating mean number of AgNORs with clinicopathological factors revealed a significant difference between stage I + II and stage III + IV. In lymph node metastasis, the depth of invasion and size, only sequential stain-positive cells showed significant difference. On the other hand, only that of sequential stain-negative cells, a significant difference was found with regard to liver metastasis. As for other assessment, the ratio of AgNORs area per nuclear area was investigated using an image analyzer (IBAS 2000 KONTRON). Comparison of the ratio of AgNORs area per nuclear area between PCNA-positive cells and AgNORs single stained cells revealed a significant difference in regard to lymph node metastasis. On the other hand, between the ratio of AgNORs area per nuclear area in PCNA-negative cells and that of AgNORs single stained cells, a significant difference was found in regard to liver metastasis. Thus, the evaluation using PCNA for classifying cells into proliferating cells and nonproliferating cells in combination with AgNORs staining provided information of greater values to the malignancy assessment of gastric carcinoma as compared with the standard AgNORs single staining

Intussusception secondary to endometriosis of the cecum

INTRODUCTION Intussusception in adults is a rare cause of bowel obstruction. Endometriosis of the bowel is also a rare entity that can be the cause of bowel obstruction. Here, we report a rare case of intussusception secondary to endometriosis of the cecum.PRESENTATION OF CASE A 40-year-old woman presented to the hospital with a one-week history of intermittent epigastric pain. On physical examination, there was a soft, round non-tender palpable mass in the right flank and abdominal computed tomography scan revealed an intussusception. We made the diagnosis of ileo-colic intussusception and performed ileocecal resection. The surgical specimen revealed a round submucosal cystic mass in the cecum and the histology showed endometriosis of the cecum.DISCUSSION Intussusception in adults is a rare entity present in just 1% of all patients with bowel obstruction, and 5% of all intussusceptions. In general, intussusception in adults has a pathologic lesion as the lead point and the lesion is a malignancy in 20-50% of the cases. Thus, the treatment of an intussusception in adults should be operative. Endometriosis of the bowel is a rare cause of intussusception. Small endometriosis lesions of the bowel are unlikely to cause symptoms; however, in patients presenting with bowel obstruction, urgent treatment is indicated.CONCLUSION Intussusception in an adult is a rare cause of bowel obstruction and intussusception caused by endometriosis is also rare. Although rare, the diagnosis of endometriosis as a cause of intussusception must be considered as part of the differential diagnosis

Acute inflammatory response to colorectal cancer resection according to different laparotomy incision lengths

The aim of this study was to clarify a correlation between acute inflammatory response to surgery and different laparotomy lengths in patients who underwent colorectal cancer resection via a single minimal laparotomy. Between April 2005 and May 2008, 131 consecutive patients (59 women, 72 men), who were scheduled to undergo elective surgery for resection of primary colorectal cancer using a single minimal skin incision, were enrolled in this study to investigate the correlation between postoperative acute inflammatory responses (as measured by serum C-reactive protein (CRP) levels and white blood cell count (WBC)) and different laparotomy lengths. According to the length of laparotomy, the patients were grouped into 3 categories, "small-incision" ( 7 cm), "medium-incision" (>7 and 14 cm), and "large-incision" (>14 cm) for comparison. Statistical analyses were conducted using the Kruskal-Wallis test with multiple comparison post-hoc and chi-square tests. The small-, medium-, and large-incision groups included 68 (51.9%), 42, (32.1%) and 21 (16.0%) patients, respectively. On the 1st postoperative day, median serum levels of CRP and WBC of the small-incision group were significantly lower than those of the medium-incision and large-incision groups (CRP, P=0.0051 and P=0.0015, respectively; WBC, P=0.049 and P =0.0007, respectively). In addition, the median serum levels of CRP and WBC on the 1st postoperative day were proportional to the length of laparotomy. These data suggested that the extent of acute inflammatory response may be proportional to length of laparotomy. In addition, only the use of small-incisions ( 7 cm) among the three investigated categories of laparotomy lengths may be a factor which is associated with statistical significance with minimal invasiveness of colorectal cancer resection

Disconnectivity between Dorsal Raphe Nucleus and Posterior Cingulate Cortex in Later Life Depression

The dorsal raphe nucleus (DRN) has been repeatedly implicated as having a significant relationship with depression, along with its serotoninergic innervation. However, functional connectivity of the DRN in depression is not well understood. The current study aimed to isolate functional connectivity of the DRN distinct in later life depression (LLD) compared to a healthy age-matched population. Resting state functional magnetic resonance imaging (rsfMRI) data from 95 participants (33 LLD and 62 healthy) were collected to examine functional connectivity from the DRN to the whole brain in voxel-wise fashion. The posterior cingulate cortex (PCC) bilaterally showed significantly smaller connectivity in the LLD group than the control group. The DRN to PCC connectivity did not show any association with the depressive status. The findings implicate that the LLD involves disruption of serotoninergic input to the PCC, which has been suggested to be a part of the reduced default mode network in depression

An Investigation of Early Death Following the Operation for Lung Cancer

In our clinic 212 patients with primary lung cancer had undergone lung resection during 12 years from April 1977 to March 1989. The authors reviewed 41 patients who died within a year after operation. Twenty-eight deaths were from cnacer ; 13 from other causes. We inquired, from the view-point of operative indication and postoperative measurement, what points should be payed attention to in order that the operation performed may indeed benefit the treatment for lung cancer. Conclusions are that the following measures are essential to take precaution against the early death after operation : (1) strict preoperative assessment of the stage of cancer ; (2) avoiding reduction surgery-absolutely non-curative resection ; (3) keeping the blood volume transfused during and after operation as minimum as possible ; (4) preventing atelectasis immediately after operation ; (5) and preventing postoperative aspiration and alimentary tract bleeding

Surgery for Gastric Cancer in Younger Patients

Twenty-five patients with gastric cancer were clinically evaluated in terms of a clinicopathological pattern in younger patients. 1) Female was more predominant than male. 2) The main tumor location was the cardia and the gross appearance was Borrmann IV of undifferentiated carcinoma in the majority. 3) Less hepatic metastases were seen in younger patients, whereas, the common extension in younger patients was peritoneal dissemination and serosal invasion. 4) The surgical outcome was satisfactory as far as a curative operation be performed. On the contrary, the result of non-curative operation was extremely pessimistic. Recently great strides in the surgical outcome of gastric cancer have been achieved in combination with adjuvant therapy of immunochemotherapy. Improvement of surgical outcome is attributable to the standarized operative procedure with reasonable node dissection. It is common that carcinomas in various organs affect older patients, not usually younger ones. The purpose of this study is to clarify the clinicopathologic features of gastric cancer in younger patients on the basis of our result of clinical experience

Surgery for Diverticular Disease of the Colon

Surgery for complications of colonic diverticulum was evaluated on the basis of a result of clinical experience for the 15 patients. 1) Average age was 48.9 years, and right-side oriented lesions were more often seen in younger patients. The men and women ratio was 1.5 to 1.0. 2) The reasons for surgery were disticulitis in 7 (46.7%), perforation in 3 (20.0%) and abscess and fistula formation in 2 (13.3%), respectively. 3) Complications on the left side were much more severe than those on the right side and also seen more often in older patients

Malignant Potential in the Analysis of DNA Ploidy Pattern in Patients with Colorectal Cancer

Recently the measurement of cellular DNA content has been focused on knowing the extent of cancer extension and biological behaviour of the tumor cells as well as on producting occurrence of recurrence and the survival time in patients with carcinomas of various organs. And also it is well known that tumor markers such as CEA, CA19-9 and CA72-2 are of great value in predicting recurrence in the follow-up study. It is common that colorectal cancers show well differentiated carcinoma which demonstrates relatively fair prognosis. However, some revealed aggressive and rapid extension of carcinoma, indicating a poor prognosis. The purpose of this study is to certify the significance of the measurement of cellular DNA content for assessing biologic behavior of colorectal cancer in comparison with clinicopathologic factors which have been used for assessment of their prognosis. Development of flow cytometer enabled us to measure the nuclear DNA content with ease, speed and producibility. Furthermore, prevalence of flow cytometric technique makes it possible to know more accurate outcome. When assessed biologically aggressive behavior of tumor cells, potent chemotherapy and extensive surgery are mandatory for improvement of the outcome. It is necessary to search for the method of the accurate assessment of the outcome for patients with carcinomas. The purpose of this study is to clarify the validity of nuclear DNA measurement for assessment of the prognosis in patients with colorectal cancer in comparison with clinicopathologic factors