Standard and limitation of intraoperative monitoring of the visual evoked potential

Visual evoked potential (VEP) has been installed as one of the intraoperative visual function monitoring. It remains unclear, however, whether intraoperative VEP monitoring facilitates as a real time visual function monitoring with satisfactory effectiveness and sensitivity. To evaluate this, relationships between VEP waveform changes and postoperative visual function were analysed retrospectively. Intraoperative VEP monitoring was carried out for 106 sides (eyes) in 53 surgeries, including two intraorbital, 36 parasellar and 15 cortical lesions in Shinshu University Hospital under total intravenous anaesthesia. Red light flash stimulation was provided to each eye independently. VEP recording and postoperative visual function were analysed. In 103 out of 106 sides (97%), steady VEP monitoring was recorded. Stable VEP was acquired from eyes having corrected visual acuity greater than 0.4. VEP was not recorded in one side with corrected visual acuity of 0.3 and two sides in whom sevoflurane was used incidentally for anaesthesia. Transient VEP decrease was observed in three sides, but visual function was preserved. Permanent VEP decrease was seen in seven sides, which presented visual impairment postoperatively. In one side, visual acuity improved but minor visual field defect was encountered postoperatively, though VEP unchanged throughout the surgery. Intraoperative monitoring of VEP predicts postoperative visual function: reversible change in VEP means visual function to be preserved. Visual field defect without decrease in the visual acuity may not be predicted by VEP monitoring. Intraoperative VEP monitoring will be mandatory for surgeries harbouring a risk of visual impairment.ArticleACTA NEUROCHIRURGICA. 152(4):643-648 (2010)journal articl

Mucinous Carcinoma of the Breast: Clinicopathological Features and Long-term Prognosis in Comparison with Invasive Ductal Cancer; A Single Hospital’s 30+-Year Experience

Mucinous carcinoma (MC) of the breast is a rare and special type of malignancy, with a substantial amount of extracellular mucin. We compared the clinicopathological features and the long-term survival of MC patients with those of invasive ductal carcinoma-no special type (IDC-NST) patients, and we examined prognostic factors of MC. A total of 116 patients with mucinous carcinoma and 3,258 patients with IDC-NST who underwent surgery at our hospital (1977-2008) were enrolled. The 10-year overall survival rate and breast cancer-specific survival rate (BSS) of the MC patients (88.3%, 93.7%) were both significantly higher than those of IDC-NST patients (81.6%, 85.0%) (p=0.015, p=0.005, respectively). A Cox regression analysis demonstrated that MC tended to be an independent prognostic factor (hazard ratio 0.44, p=0.098). The BSS of the MC patients with positive lymph node (LN) metastasis was significantly poorer than that of the patients without it, by univariate analysis (p=0.002). The tumor size in the MC patients with positive LN metastasis (mean 3.2 cm) was significantly larger than that in the patients without it (mean 1.9 cm) (p=0.0004). Although a Cox regression analysis revealed no independent factor, MC patients with positive LN metastasis should be treated for advanced invasive ductal breast cancer

ASTE CO(3-2) Observations of the Barred Spiral Galaxy M 83: I. Correlation between CO(3-2)/CO(1-0) Ratios and Star Formation Efficiencies

We present CO(J=3-2) emission observations with the Atacama Submillimeter Telescope Experiment (ASTE) toward the 5' x 5' (or 6.6 x 6.6 kpc at the distance D = 4.5 Mpc) region of the nearby barred spiral galaxy M 83. We successfully resolved the major structures, i.e., the nuclear starburst region, bar, and inner spiral arms in CO(J=3-2) emission at a resolution of 22'' (or 480 pc), showing a good spatial coincidence between CO(J=3-2) and 6 cm continuum emissions. We found a global CO(J=3-2) luminosity L'_CO(3-2) of 5.1 x 10^8 K km s^-1 pc^2 within the observed region. We also found L'_CO(3-2) in the disk region (0.5 < r < 3.5 kpc) of 4.2 x 10^8 K km s^-1 pc^2, indicating that CO(J=3-2) emission in the disk region significantly contributes to the global L'_CO(3-2). From a comparison of a CO(J=3-2) data with CO(J=1-0) intensities measured with Nobeyama 45-m telescope, we found that the radial profile of CO(J=3-2)/CO(J=1-0) integrated intensity ratio R_3-2/1-0 is almost unity in the central region (r < 0.25 kpc), whereas it drops to a constant value, 0.6--0.7, in the disk region. The radial profile of star formation efficiencies (SFEs), determined from 6 cm radio continuum and CO(J=1-0) emission, shows the same trend as that of R_3-2/1-0. At the bar-end (r ~ 2.4 kpc), the amounts of molecular gas and the massive stars are enhanced when compared with other disk regions, whereas there is no excess of R_3-2/1-0 and SFE in that region. This means that a simple summation of the star forming regions at the bar-end and the disk cannot reproduce the nuclear starburst of M 83, implying that the spatial variation of the dense gas fraction traced by R_3-2/1-0 governs the spatial variation of SFE in M 83.Comment: 13 pages, 11 figures, PASJ in press, version with high resolution figures is available via http://www.nro.nao.ac.jp/~z5001km/m83-aste.pd

Diminished Gastric Resection Preserves Better Quality of Life in Patients with Early Gastric Cancer

Using the Postgastrectomy Syndrome Assessment Scale (PGSAS)-45, we compared the surgical outcomes and the quality of life (QOL) between patients undergoing limited gastrectomies and those undergoing conventional gastrectomies. In Oomoto Hospital between January 2004 and December 2013, a total of 124 patients who met the eligibility criteria were enrolled. Using the main outcome measures of PGSAS-45, we compared 4 types of limited gastrectomy procedures (1/2 distal gastrectomy [1/2DG] in 21 patients; pylorus-preserving gastrectomy [PPG] in 15 patients; segmental gastrectomy [SG] in 26 patients; and local resection [LR] in 13 patients) with conventional gastrectomy (total gastrectomy [TG] in 24 patients and 2/3 or more distal gastrectomy [WDG] in 25 patients). The TG group showed the worst QOL in almost all items of the main outcome measures. The 1/2DG, PPG, and SG groups showed better QOL than the WDG group in many of the main outcome measures, including the body weight ratio, total symptom score, ingested amount of food per meal, and the dissatisfaction for daily life subscale. The LR group showed a better intake of food than the 1/2DG, PPG, and SG groups. The body weight ratio of the LR group was better than that of the SG group. Diminished gastric resection preserved better QOL in patients with early gastric cancer

Gliosarcoma arising from a fibrillary astrocytoma

We report a 67-year-old woman who was diagnosed with a gliosarcoma at a second operation after diagnosis of a fibrillary astrocytoma 5 months previously. Initially, she underwent a CT-guided stereotactic biopsy. Histological examination showed fibrillary astrocytoma (World Health Organization [WHO] grade II). Loss of heterozygosity (LOH) on 1 p, 10q, and 19q was not detected. She received chemotherapy, but no radiotherapy. Five months after the biopsy, MRI revealed rapid tumor growth. Tissue obtained from partial removal of the tumor revealed gliosarcoma (WHO grade IV), and LOH on 10q and 19q was detected. The history, histopathology, and genetic alterations of this patient are discussed.ArticleJOURNAL OF CLINICAL NEUROSCIENCE. 18(9):1251-1254 (2011)journal articl

Dense Molecular Clumps associated with the LMC Supergiant Shells LMC 4 \& LMC 5

We investigate the effects of Supergiant Shells (SGSs) and their interaction on dense molecular clumps by observing the Large Magellanic Cloud (LMC) star forming regions N48 and N49, which are located between two SGSs, LMC 4 and LMC 5. $^{12}$CO ($J$=3-2, 1-0) and $^{13}$CO ($J$=1-0) observations with the ASTE and Mopra telescopes have been carried out towards these regions. A clumpy distribution of dense molecular clumps is revealed with 7 pc spatial resolution. Large velocity gradient analysis shows that the molecular hydrogen densities ($n({\rm H}_2)$) of the clumps are distributed from low to high density ($10^3$-$10^5$ cm$^{-3}$) and their kinetic temperatures ($T_{\rm kin}$) are typically high (greater than $50$ K). These clumps seem to be in the early stages of star formation, as also indicated from the distribution of H$\alpha$, young stellar object candidates, and IR emission. We found that the N48 region is located in the high column density HI envelope at the interface of the two SGSs and the star formation is relatively evolved, whereas the N49 region is associated with LMC 5 alone and the star formation is quiet. The clumps in the N48 region typically show high $n({\rm H}_2)$ and $T_{\rm kin}$, which are as dense and warm as the clumps in LMC massive cluster-forming areas (30 Dor, N159). These results suggest that the large-scale structure of the SGSs, especially the interaction of two SGSs, works efficiently on the formation of dense molecular clumps and stars.Comment: 26 pages, 7 tables, 16 figure