[Show abstract][Hide abstract] ABSTRACT: Drug resistance and the transferability of resistance were examined in 218 Enterococcus faecium clinical isolates obtained from in-patients of a Japanese university hospital between 1990 and 1999. One hundred and sixty one isolates (73.9%) were drug-resistant and 127 (58.2%) isolates were resistant to two or more drugs. Vancomycin resistant E. faecium (VRE) was not isolated. The transferability of drug-resistance to an E. faecium strain was examined by broth or filter mating. Six (12.5%) of the 48 gentamicin resistance traits, and fifty (50%) of the 101 erythromycin resistance traits were transferred by filter mating. The gentamicin resistance traits of five isolates and the erythromycin resistance traits of four isolates were transferred to the recipient strains by both broth mating and filter mating at a frequency of about 10(-6) and 10(-5) per donor cell, respectively. The five gentamicin resistant strains were shown to harbor pMG1-like plasmids on the basis of their Southern hybridization with pMG1 (65.1 kbp, Gm(r)), which transfers efficiently between enterococci by broth mating. Each of the four erythromycin resistant transconjugants obtained by broth mating harbored a large conjugative plasmid (more than 100 kbp). The plasmids showed no homology with well-characterized enterococcal conjugative plasmids such as pAD1, pPD1, pAM(beta)1, pIP501 and pMG1 by Southern hybridization. Of the erythromycin resistance traits that transferred only by filter mating, it was found that the erythromycin resistance trait was conferred by a 47-kbp transposable element that transferred from the chromosome of the donor strain to different sites within the pheromone responsive plasmid pAD1 (60 kbp) of the recipient strain, suggesting that the erythromycin resistance trait was encoded on a conjugative transposon, which was named Tn950.
[Show abstract][Hide abstract] ABSTRACT: Transforming growth factor- (TGF-) regulates cell growth inhibition, and perturbations of TGF- signaling contribute to tumor development. The effects of TGF- growth inhibition are mediated by TGF--specific receptors, signal transducer Smad proteins, and various transcription factors. Although mutation of these genes is rare in esophageal cancer, alteration of the expression of these mediators correlates with tumor progression and poor prognosis. Consequently, esophageal cancer may have difficulty in the transmission of TGF- signaling and show loss of the growth inhibitory responses to TGF-. As well, the mechanisms of expression of TGF- signaling mediators appear to be regulated by ubiquitin-dependent degradation. In summary, modulation of the expression of TGF- signaling mediators is involved in the progression of esophageal cancer.
[Show abstract][Hide abstract] ABSTRACT: This report describes a rare case of a schwannoma that developed in the left breast of a 45-year-old woman without von Recklinghausen's disease. The patient complained of a mass growing slowly in her breast for more than 4 years. She did not have any pain and denied any discharge from her nipple. A physical examination revealed a 3.1 x 2.3-cm, elastic-soft, smooth, and mobile lump close to the nipple of the left breast. Mammography revealed a circumscribed, oval-shaped, and equal dense nodule without microcalcification. On ultrasonography the lesion was found to be a well-demarcated, hypoechoic mass including a large cystic area, which led to the suspicion of a phyllodes tumor. An excisional biopsy was performed. A microcopic examination revealed a structure with interlacing bundles of numerous elongated spindle-shaped cells with a typical palisading pattern. These findings were compatible with schwannoma. A review of the English literature yielded 21 proven cases of breast schwannoma. In this report, we describe another such case and review those documented in the literature.
Surgery Today 02/2005; 35(3):238-42. · 1.21 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Esophageal cancer is a common malignancy with a striking variation in geographical distribution; a reflection of exposure to specific environmental factors, which are still poorly defined. We discuss the recent progress made in the investigation of the molecular biology of esophageal cancer, addressing the topics of genetic alterations, methylation, overexpression of molecules thought to cause malignant transformation, carcinogenesis, invasion, and metastasis. We review six aspects of the research literature on esophageal cancer: epidemiology and etiology, epidermal growth factor receptor and related growth factor receptors, cell cycle regulatory proteins, transforming growth factor-beta/Smad proteins, mismatch repair genes, and other genes. This article provides a conceptual basis for evaluating studies on the molecular mechanism of esophageal carcinogenesis and for devising therapeutic and preventive strategies based on molecular biology. We hope that in the near future, the clinical outcome of patients with esophageal carcinoma will be improved by a better understanding of the basic mechanisms of carcinogenesis.
Surgery Today 02/2005; 35(1):7-18. · 1.21 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Laminin-5 gamma2 chain (LN-5 gamma2) is an extracellular matrix protein that plays an important role in cell migration and tumor invasion. We evaluated the association of LN-5 gamma2 and epidermal growth factor receptor (EGFR) expression in esophageal squamous cell carcinoma (SCC).
LN-5 gamma2 and EGFR expression was evaluated in 110 esophageal SCC patients by immunohistochemistry, and was confirmed using esophageal SCC cell lines by Western blot analysis.
LN-5 gamma2 expression in the invasive front of the tumor was correlated with the depth of invasion (p = 0.0001), lymph node metastasis (p = 0.0011) and pathological stage (p = 0.0001). The strong expression of EGFR was also correlated with lymph node metastasis (p = 0.0456) and the pathological stage (p = 0.0055). In patient survival, LN-5 gamma2 positivity and/or strong EGFR expression showed a significantly low survival rate as compared with those with lesser expression of LN-5 gamma2 and EGFR. Immunohistochemically, LN-5 gamma2 expression was significantly correlated with EGFR expression (p < 0.0001). Western blot analysis also confirmed the correlated expression of LN-5 gamma2 and EGFR in SCC cell lines except 2 of the 5 cell lines.
This study suggests that coexpression of LN-5 gamma2 and EGFR is closely related to the progression and poor prognosis of esophageal SCC.
[Show abstract][Hide abstract] ABSTRACT: Autosuture staplers have provided various operative and postoperative benefits in gastrointestinal surgery. We describe herein our technique of performing distal gastrectomy followed by side-to-end gastroduodenostomy. Eighteen consecutive patients with gastric cancer underwent distal gastrectomy by the staple technique. We propose a modification of the stapling technique to reduce the number of devices used. In our technique, side-to-end anastomosis is performed first, followed by gastric resection just distal to the anastomosis. By introducing the stapler through the area to be resected, we can eliminate the need to close the gastrostomy. Anastomotic stricture occurred in only 1 (5.5%) of 18 cases. There have been no other postoperative complications related to the anastomosis. We believe that our technique is superior in simplicity and security to the conventional techniques.
World Journal of Surgery 02/2005; 29(1):113-5. · 2.35 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: We aimed to clarify the morphogenesis of an anomalous ligamentum venosum terminating in the trunk of the superior left hepatic vein, because the ligamentum venosum ordinarily terminates into the root of the left hepatic vein or directly into the inferior vena cava.
We examined an anomalous ligamentum venosum found in the cadaveric liver of an 84-year-old Japanese woman.
The ligamentum venosum in this liver was not found in the usual course, the fissure for the ligamentum venosum. It lay on the posterior surface of the liver, connecting the left branch of the portal vein and the trunk of a small left hepatic vein. The small left hepatic vein draining the cranio-dorsal part of the lateral segment of the liver was revealed to be a superior left hepatic vein. This type of anomaly was found only in this 1 liver, among 125 cadaveric livers that were dissected.
Taking previous reports into consideration, the morphogenesis of the anomalous ligamentum venosum in the present case may be explained as being due to the persistence of the right half of the subdiaphragmatic anastomosis, which receives the blood from the ductus venosus in the embryonal period.
Journal of Hepato-Biliary-Pancreatic Surgery 02/2005; 12(4):310-3. · 1.60 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: RASSF1A is frequently inactivated by promoter methylation in human cancers. To understand the involvement of the RASSF1A gene in esophageal squamous cell cancer (ESCC), we investigated the methylation of the RASSF1A gene in primary ESCC to define the frequency of this epigenetic aberration and its clinicopathological significance. Methylation-specific polymerase chain reaction (MSP) was used to detect RASSF1A gene methylation in DNA from 55 cases of ESCC. Methylation of the RASSF1A gene was found in 13 of 55 (24%) cases of primary ESCC. No association was found between the promoter methylation of the RASSF1A gene in primary ESCC and age, gender, localization, invasion depth, or tumor stage. Association was found with tumor differentiation. There was no correlation with its prognosis. In conclusion, it was suggested that an inactivation of the RASSF1A gene due to promoter methylation was associated with de-differentiation of the tumor in ESCC.
Diseases of the Esophagus 02/2005; 18(4):253-6. · 2.06 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: We report a case of idiopathic omental bleeding in a 27-year-old man who was brought to our hospital after the sudden development of intermittent abdominal pain, nausea, and fainting. Computed tomography showed intra-abdominal fluid and emergency laparotomy revealed a hemorrhagic mass in the omental bursa, which was excised. The patient was successfully treated and a diagnosis of idiopathic omental bleeding was made.
Surgery Today 02/2005; 35(6):493-5. · 1.21 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: The purpose of the current study was to assess whether [18F]fluorodeoxyglucose positron emission tomography (FDG-PET) provides incremental value (e.g., additional information on lymph node involvement or the presence of distant metastases) compared with computed tomography (CT) in patients with esophageal carcinoma.
The authors examined 149 consecutive patients with thoracic esophageal carcinoma. Eighty-one patients underwent radical esophagectomy without pretreatment, 17 received chemoradiotherapy followed by surgery, 3 underwent endoscopic mucosal resection, and the remaining 48 patients received definitive radiotherapy and chemotherapy. The diagnostic accuracy of FDG-PET and CT was evaluated at the time of diagnosis.
The primary tumor was visualized using FDG-PET in 119 (80%) of 149 patients. Regarding lymph node metastases, FDG-PET had 32% sensitivity, 99% specificity, and 93% accuracy for individual lymph node group evaluation and 55% sensitivity, 90% specificity, and 72% accuracy for lymph node staging evaluation. PET exhibited incremental value over CT with regard to lymph node status in 14 of 98 patients who received surgery: 6 patients with negative CT findings were eventually shown to have lymph node metastases (i.e., they had positive PET findings and a positive reference standard [RS]); 6 patients with positive CT findings were shown not to have lymph node metastases (i.e., they had negative PET findings and a negative RS); and 2 patients were shown to have cervical lymph node metastases in addition to mediastinal or abdominal lymph node metastases. Among the remaining patients, PET showed incremental value over CT with regard to distant organ metastases in six patients. The overall incremental value of PET compared with CT with regard to staging accuracy was 14% (20 of 149 patients).
FDG-PET provided incremental value over CT in the initial staging of esophageal carcinoma. At present, combined PET-CT may be the most effective method available for the preoperative staging of esophageal tumors.
Cancer 02/2005; 103(1):148-56. · 4.90 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Positron emission tomography (PET), a functional imaging modality, has provided the transition between the research environment and the clinical environment over the last 10 years. Its primary use is in the field of oncology, where it is being increasingly used in the management of several tumor types including esophageal cancer. 18F-Fluorodeoxyglucose PET (FDG-PET) scans may also be used to distinguish between benign and malignant tumors, to identify different stages of tumor spread, to assess for tumor recurrence, and monitor the response to therapy of malignant diseases. This review aims to outline the current and future roles of PET scanning in the field of esophageal cancer.
[Show abstract][Hide abstract] ABSTRACT: BACKGROUND: Obesity is reported to increase the risk of colorectal cancer. We investigated whether it was associated with mortality or morbidity after colorectal-cancer surgery. METHODS: 70 colorectal-cancer patients who underwent elective surgery were investigated in this study. The intra-abdominal fat (IAF) and subcutaneous fat (SCF) areas were quantified by CT scan preoperatively. We investigated whether body mass index (BMI), IAF, or SCF were associated with postoperative mortality or morbidity. RESULTS: The mortality rate was 0%. 11 (16%) of 70 patients had medical complications (pneumonia, 9; arrhythmia, 2) and 16 (23%) had surgery-related complications (wound infection, 12; anastomotic leakage, 5) postoperatively. There was no significant difference in the postoperative medical or surgery-related morbidity rate between the IAF+ (males, 160 cm2; females, 120 cm2) and IAF– groups. The surgery-related morbidity rate was significantly higher in the SCF+ group (male, 180 cm2; female, 250 cm2) than in the SCF– group and multilogistic regression analysis confirmed that diabetes mellitus and SCF were significant for surgery-related morbidity. CONCLUSIONS: Subcutaneous fat accumulation is significantly associated with postoperative surgery-related morbidity after colorectal-cancer surgery.GRUNDLAGEN: Fettleibigkeit soll das Risiko von kolorektalem Karzinom erhhen. Ein etwaiger Zusammenhang mit postoperativer Mortalitt oder Morbiditt bei kolorektalen Eingriffen wurde untersucht. METHODIK: Zu der Untersuchung wurden 70 an kolorektalem Karzinom erkrankte und operierte Patienten herangezogen. Properativ wurde das Fett im Inneren der Bauchhhle (IAF) und das subkutane Fett (SCF) mittels Computertomographie quantifiziert. Dann wurde untersucht, ob ein Zusammenhang zwischen Body-Mass-Index (BMI), IAF oder SCF und der postoperativen Mortalitts- oder Morbidittsrate bestand. ERGEBNISSE: Die Mortalittsrate betrug 0 %. Postoperativ hatten 11 (16 %) der 70 Patienten medizinische Komplikationen (Pneumonitis, 9; Arrhythmie, 2) und 16 (23 %) hatten chirurgische Komplikationen (Wundinfektion, 12; Anastomoseninsuffizienz, 5). Ein signifikanter Unterschied in der postoperativen, auf medizinische oder chirurgische Faktoren zurckzufhrenden Morbidittsrate zwischen der IAF+- (Mnner, 160 cm2; Frauen, 120 cm2) und der IAF–-Gruppe bestand nicht. Die chirurgische Morbidittsrate in der SCF+-Gruppe (Mnner, 180 cm2; Frauen, 250 cm2) war bedeutend hher als in der SCF–-Gruppe, und eine multilogistische Regressionsanalyse besttigte, dass Diabetes mellitus und SCF bei der auf chirurgischen Eingriff zurckzufhrenden Morbiditt eine bedeutende Rolle spielten. SCHLUSSFOLGERUNGEN: Subkutane Fettablagerung ist an der auf chirurgischen Eingriff zurckzufhrenden Morbiditt nach einem operativen Eingriff bei kolorektalem Karzinom mageblich beteiligt.
European Surgery 01/2005; 37(2):94-98. · 0.26 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Serum p53 antibodies (p53-Ab) have been detected in some cancers. The possible correlation between serum p53-Ab levels in drainage blood from the azygos vein in patients with esophageal carcinoma and prognosis was investigated.
Serum p53-Ab levels were examined in both the peripheral and azygos veins of 57 patients, and in the peripheral vein of 17 healthy volunteers. Serum p53-Ab levels were measured using an enzyme-linked immunosorbent assay.
The positive rate of serum p53-Ab in the peripheral vein of the patients was 31.6%, significantly higher than that of the normal volunteers. There were no significant correlations between the clinicopathological features and the serum p53-Ab in either the peripheral or azygos veins. Serum p53-Ab levels in either vein did not correlate with prognosis in the univariate survival analysis, although the levels in the two veins were significantly correlated.
Serum p53-Ab levels in the azygos vein did not reflect the tumor status or prognosis more directly or accurately than those in the peripheral vein, since levels in the two veins were similar. Therefore, measurement of serum p53-Ab in the azygos vein does not appear to be necessary.
Anticancer research 01/2005; 25(5):3231-5. · 1.87 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Ets-1 protein is a transcription factor that has been implicated in both tumor invasion and neovascularization. The purpose of this study was to investigate the clinical significance of Ets-1 expression in gastric cancer.
We examined the expression of Ets-1 protein by immunohistochemical staining in tissues obtained from 124 primary gastric cancers. Ets-1 expression was detected by automated immunodetection (Ventana Medical Systems Inc., Tucon, AZ, USA).
Ets-1 was not expressed in normal gastric epithelium. Ets-1 staining was defined as positive in 51.6% (64 of 124) of gastric cancer cases. There were no significant differences in age, gender, or histopathological grading. With regard to clinicopathological characteristics, significant differences were observed in the depth of tumor invasion, lymph node and distant metastases, increased tumor stage, and histological lymphatic and venous invasion. Patients with Ets-1 expression demonstrated poorer survival rates than patients without Ets-1 expression, as determined by the log-rank test (p=0.017), but multivariable analysis showed that the expression of Ets-1 was not an independent prognostic indicator (p=0.370).
Ets-1 expression in gastric cancers is correlated with histological prognostic indicators and is a useful marker for predicting the outcome for patients with gastric cancer.
[Show abstract][Hide abstract] ABSTRACT: The purpose of this study was to determine whether the loss of KAI1 expression was related to the clinicopathologic features of patients with gastric cancer.
The expression of KAI1 protein was investigated retrospectively in 174 patients with gastric cancer. Immunohistochemical staining of the paraffin sections was performed using polyclonal antibody to KAI1.
KAI1 was consistently and highly expressed in normal gastric epithelium, while 47 (27%) of 174 patient samples had KAI1-positive expression in the primary gastric carcinoma. There were no significant differences of age, gender, and tumor location. With regard to the clinicopathological characteristics, significant differences were observed in histological types (p<0.001), increased tumor stage (p<0.001), lymph node (p<0.001) and distant metastasis (p<0.001). KAI1-negative patients had a worse prognosis than that of positive patients in overall survival, but loss of KAI1 expression was not an independent prognostic indicator (p=0.779) by multivariable analysis.
Loss of KAI1 of expression is likely to predict metastasis and poor clinical outcome in gastric cancer patients. For the purpose of predicting the prognosis of gastric cancer patients, it is important to discriminate whether the carcinoma cells have loss of KAI1 expression.
[Show abstract][Hide abstract] ABSTRACT: Positron emission tomography (PET) with 18-F-fluorodeoxyglucose (FDG) has already proved useful in assessing the extension of esophageal carcinomas, detecting tumor recurrence and monitoring responses to therapy. This study aimed to elucidate the potential role of FDG-PET compared with technetium-99m methylene diphosphonate (Tc-99m MDP) bone scintigraphy in the evaluation of bony metastasis in esophageal carcinoma patients.
Forty-four patients with thoracic esophageal carcinomas, who underwent FDG-PET together with bone scintigraphy within 1 month between January 2000 and September 2003, were included in this study.
Of the 44 patients, 13 had 31 bone metastases and, of these, 6 were diagnosed pretreatment and 7 had recurrence after esophagectomy surgery. Of the 31 metastases, 9 were in the vertebral column, 11 in the thoracic cage (including the ribs, clavicle, sternum and scapula), 9 in the pelvic bones and 2 in the long bones of the extremities. In evaluating the detection of bony metastasis, FDG-PET showed 92% sensitivity, 94% specificity and 93% accuracy, compared with 77%, 84% and 82%o, respectively, for bone scintigraphy. Although the sensitivity, specificity and accuracy of PET were slightly higher than those of bone scintigraphy, these differences were not statistically significant according to the McNemar's test. Three patients with false-negative findings on their bone scans had positive findings with PET; all of these lesions were osteolytic metastases.
FDG-PET scans were superior to bone scintigraphy in detecting bony metastases of esophageal carcinomas. Therefore, FDG-PET can be used for the detection and follow-up of bone tumors when Tc-99m MDP bone scintigraphy gives negative findings.
Anticancer research 01/2005; 25(6C):4439-44. · 1.87 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: We have been investigating various molecules correlated with the malignancy of esophageal squamous cell carcinoma and, in the present study, we examined the correlation of four of them (KAI1, FAK, EphA2, Ki-67 labeling index) with the prognosis of affected patients. Furthermore, the use of biopsy samples was studied to evaluate whether the grade of tumor malignancy can be determined before treatment in a clinical setting.
Tissue specimens that had been surgically removed from 91 patients with thoracic esophageal cancer and 247 biopsy samples were examined. The malignancy index (MI) was defined in terms of the KAI1, FAK and EphA2 scores and the Ki-67 labeling index, and the reliability and utility of the correlation between MI and prognosis was evaluated. Results: The mean 5-year survival rate of patients with MI=0 was 100%, while that of patients with MI=1, 2 and 3 was 70%, 48% and 10%, respectively. Patients with MI=4 all died, with the exception of one who has been observed for 3 years. The rate of concordance between the biopsy samples and surgical specimens was 79.4% for KAI1, 88.2% for FAK and 73.5% for EphA2, and the rates of concordance for 1, 2, 3, 4, 5, 6, 7 and 8 biopsy samples were 66.7%, 64.1%, 74.5%, 90.7%, 91.7%, 83.3%, 100% and 100%, respectively.
It may be feasible to evaluate the malignancy of tumor cells and to predict patient outcome by using multiple marker molecules. It is anticipated that such data will accelerate the development of "tailor-made" therapy.
Anticancer research 01/2005; 25(6B):4005-11. · 1.87 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Mucosa-associated lymphoid tissue lymphoma of the extrahepatic bile duct has not yet been reported. Much more common than this is secondary involvement of the extrahepatic bile duct in cases of disseminated lymphoma. A 59-year-old man manifesting jaundice was referred to our hospital. PTC revealed an extrahepatic bile duct stenosis from the hilum to the lower part of the choledochus. On the operative specimen, we examined L26/CD20, Bcl-2, UCHL-1/CD45RO, cyclin D1 and p53. Histologically, follicular colonization, centrocyte-like cells and lymphoepithelial lesion was observed. Tumor cells were positive for L26/CD20 and Bcl-2 and were negative for intracytoplasmic immunoglobulins, UCHL-1/CD45RO, cyclin D1 and p53. Pathological diagnosis was mucosa-associated lymphoid tissue lymphoma of the extrahepatic bile duct. The authors present herein the first case of mucosa-associated lymphoid tissue lymphoma of the extrahepatic bile duct. It was very difficult to distinguish from hilar cholangiocarcinoma clinically. Only incomplete stenosis of the bile duct and 18-F fluoro-2-deoxyglucose positron emission tomography (FDG-PET) could suggest this unusual clinical entity.
[Show abstract][Hide abstract] ABSTRACT: The sensitivity of tumors to chemotherapy and radiotherapy differs from one case to another and may be influenced by the expression of biological molecules. The presence of six potential predictive markers in esophageal squamous cell carcinoma (ESCC) was investigated and the data obtained were related to the response of the tumors to chemo-radiotherapy and radiotherapy.
Biopsy specimens were obtained from 61 patients with ESCC before treatment with chemo-radiotherapy (31 patients) or radiotherapy (30 patients). External radiotherapy was delivered by a two-field technique to a total of 60-70 Gray. Concurrent chemotherapy consisted of cisplatin or nedaplatin and 5-fluorouracil administered intravenously. The patients were examined before and after treatment by endoscopy, esophagography and computed tomography. The clinical response was classified as effective (> 50% decrease in primary lesion), or ineffective. Immunohistochemical staining for p53, p21, bax, bcl2, heat-shock protein (Hsp) 27 and Hsp70 was performed on the biopsy specimens before therapy.
The primary tumor response was effective in 73.8% (45/61) and ineffective in 26.2% (16/61) of patients. Tumors with p53-positive expression were less sensitive than p53-negative tumors (p = 0.033). p21-positive patients (p = 0.027), and Hsp27-negative (p = 0.0057) and Hsp70-negative patients (p = 0.010) were all good responders. Neither bcl2 nor bax expression was related to the efficacy of therapy. Multivariate analysis revealed that Hsp27 was the most reliable predictor of the effect of chemo-radiotherapy and radiotherapy among the four potential markers. p53-negative and Hsp70-negative patients had a more favorable prognosis than p53- and Hsp70-positive patients (p = 0.039, p = 0.038, respectively).
Expression of Hsp27 was a good predictor of the response of ESCC to chemo-radiotherapy and radiotherapy.
Anticancer research 01/2005; 25(4):2749-55. · 1.87 Impact Factor