Inguinal hernias appearing after lateral lymph node dissection via extraperitoneal approach for advanced lower rectal cancer.

PURPOSE: Lateral lymph node dissection (LLND) is performed for advanced lower rectal cancer (ALRC) in Japan. The LLND in laparotomy is performed via the extraperitoneal approach, which is similar to radical retropubic prostatectomy (RRP). Inguinal hernias (IHs) appearing after RRP are common. However, there are few reports about IHs appearing after LLND. METHODS: In part A, we retrospectively investigated 108 patients who underwent LLND for ALRC between January 2004 and December 2014. In part B, we compared 13 patients who underwent IH repair after LLND and 57 patients who underwent IH repair after RRP in the same period. RESULTS: In part A, the incidence of IHs after LLND was 7% (8/108). All eight patients who developed IHs were male, and their median age was 60 years. More than 80% of IHs observed were the unilateral lateral type. In part B, the interval between the previous operation and IH occurrence was 4.9 years on average. Furthermore, 2 out of the 13 patients developed additional IHs occurring on the opposite side within 2 years. CONCLUSIONS: The characteristics associated with developing IHs after LLND were similar to those after RRP. Any pelvic operation via the extraperitoneal approach has a risk of IHs, and surgeons should pay attention to IHs after surgery.

Determination of full-energy peak and total efficiency functions for Ge-detectors by iteration calculation using a mixed radionuclide source.

Empirical calibrations of full-energy peak and total efficiency curves for well-type and coaxial p-type germanium detectors were carried out using several combinations of practical nuclides. As a result, reliable efficiency functions of both types of detectors were successfully obtained using a home-made program coded with Visual Basic for Applications (VBA) and the "Solver" add-in in Excel™. We also examined the applicability of our advanced program to volumetric sources using squared-to-linear curve technique.

Absolute peak-efficiency calibration of a well-type germanium detector using multiple gamma-emitting nuclides with the "Solver" add-in in Excel™.

When calibrating absolute peak efficiency and total efficiency functions for high efficient germanium detectors, single gamma-emitting nuclides are used in general to avoid coincidence summing effects. As another approach, Blaauw developed calibration technique using multiple gamma-emitting nuclides with least-square technique (Blaauw, 1993; Blaauw and Gelsema, 2003). In the present study, we tried to calibrate efficiency functions of a well-type germanium detector based on Blaauw's approach using a home-made iteration calculation algorithm with the "Solver" add-in in Excel™.

Activity measurement of (68)Ge-(68)Ga by use of 4π(ß(+)+γ) integral counting method.

A 4π(ß(+)+γ) integral counting method using 4πß-4πγ detector configuration composed of a large well type NaI(Tl) scintillation detector and stacked plastic scintillators positioned in the center of the well and coupled with a slender PMT was adopted for activity measurement of (68)Ge-(68)Ga. Several source preparation schemes were studied to reduce the activity loss due to volatility. The possible contribution of EC events were rejected with pulse-height discrimination. Owing to the high counting efficiencies in both channels and the multiplicity of photons and ß-particles emitted, the 4π(ß(+)+γ) integral counting system gives a count rate very nearly equal to the positron emission rate. The activity can be determined simply from this value divided by the positron emission branching ratio. The remaining overall inefficiency was evaluated by the EGS5 code.

Practical correction method for impurities on activity measurements using isotope calibrators.

Radioactive impurities might cause significant error in the activity determination of a target nuclide using ionization chambers. In the present study, an impurity correction technique for (201)Tl sources was performed by applying two different responses of an IG12A20 and IG11N20 ionization chamber. This technique can be extended to another method in which an attenuation filter made of tin was used to obtain different responses of an argon filled IG12A20. The results obtained with these techniques were very consistent with each other and with the reference value within their uncertainty after making the impurity correction. Examples of (64)Cu activity determination were also shown.

Response of Ge photon detectors to beta-rays and possible reduction of photopeak areas due to beta-gamma coincidence summing effects.

In the use of photon detectors having sensitivity to ß-rays or internal conversion electrons (CEs), ß-γ and/or X-CE coincidence summing may arise. In particular, an n-type germanium detector has a thin dead layer and window, causing considerably higher sensitivity to ß-rays and/or CEs especially when sources are located at a small source-to-detector distance. In the present research, reduction of the photopeak area due to ß-γ or X-CE coincidence summing has been studied for three germanium detectors.

A simple method for activity determination of ¹³4Cs and ¹³7Cs in foodstuffs using NaI(Tl) scintillation spectrometer.

A simplified peak fitting technique for the analysis of the overlapped pulse-height spectra of (134)Cs and (137)Cs γ-rays obtained with a NaI(Tl) scintillation spectrometer was studied. In this analysis, nearly an upper half of 662 keV (137)Cs peak data was employed for fitting of the Gaussian peak using the least squares algorithm. Consistent results were obtained as compared with the reference value of test samples mixed with (134)Cs and (137)Cs standard solutions.

Development of certified matrix reference materials for quality assurance of screening ¹³4Cs and ¹³7Cs in food.

A certified reference material using activated alumina powder certified for activity of (134)Cs and (137)Cs was developed. The results of the verification and the certification are described. The certified reference material can be used for quality assurance of screening activity measurements of (134)Cs and (137)Cs in food/foodstuffs. Commercially available equipments were experimentally tested using the CRM and another CRM including (40)K. The results of these tests are also shown.

An evaluation of polyvinylidene film dressing for treatment of pressure ulcers in older people.

OBJECTIVE: To compare the effectiveness of polyvinylidene (PVL) food wrap as a dressing material versus conventional ointments and gauze dressings for pressure ulcers in patients aged 60 years or over. METHODS: A prospective open controlled trial was conducted. The severity of pressure ulcers in both groups was evaluated using the DESIGN system. Scores were compared at baseline, four, eight and 12 weeks. RESULTS: Twenty-five patients were treated with the PVL film (test) dressings and 24 with the conventional treatment (control). The test group showed greater improvement in DESIGN scores than the control group throughout the observation period, and the difference reached statistical significance at 12 weeks (p < 0.05). The incidences of local wound infection in the two groups were not statistically different (p > 0.999). CONCLUSION: The PVL film dressing was more effective than conventional treatment in the management of severe pressure ulcers.

Frequency of early and late-onset dementias in a Japanese memory disorders clinic.

The aim of this study was to compare the diagnostic profiles of patients with early (age<65 years) and late (age>or=65 years) onset of dementia in a memory disorders clinic in Japan. A total of 512 consecutive memory clinic patients were evaluated using clinical information and results of examinations. Diagnosis of dementia was made according to DSM-III-R, and that of subtypes according to standard diagnostic criteria. A total of 464 patients met the criteria for dementia. Amongst late-onset patients (n=430), Alzheimer's disease (AD) (48.1%) was the most frequent cause of dementia, followed by AD with cerebrovascular disease (CVD) (31.4%), vascular dementia (VaD) (9.1%), dementia with Lewy bodies (DLB) (3.7%), frontotemporal lobar degeneration (FTLD) (1.6%), and others (5.8%). On the contrary, amongst early onset patients (n=34), the most common dementia diagnosis was AD (38.2%), followed by VaD (23.5%), FTLD (14.7%), AD with CVD (5.9%), DLB (2.9%), and others (17.6%). FTLD and VaD were significantly more common in the early onset group. All patients, but one, with DLB and Parkinson's disease dementia were late-onset. The relative frequencies of AD, VaD, and DLB in our series are consistent with epidemiologic findings in several Western countries; however, the frequency of FTLD is not consistent with the previous findings presenting high frequency in late-onset patients in some Western countries.

Fatal hypothermia related vacuolation of hormone-producing cells in the anterior pituitary.

We found small cytoplasmic vacuoles in the hormone-producing cells of anterior pituitary in hypothermic death. The vacuoles were found in approximately 40% of anterior pituitary cells both in males and females that had died from cold (n=31) while the detection rate was lower than 1% (P <0.001) in the other causes of death (n=180: fire death, n=25; fatal injury, n=24; asphyxia, n=24; poisoning, n=8; natural diseases, n=103). The detection rate in hypothermic death was the highest in ACTH cells (about 65%), followed by gonadotrophs (about 43%), and the lowest in TSH cells (about 16%) (P <0.001). These findings suggest that the cytoplasmic vacuoles in the anterior pituitary cells may be the most closely related to cold exposure among the above-mentioned cause of death, providing a supplementary evidence for determining the causes of death.

Negligent homicide by traumatic asphyxia.

We presented an unusual case of negligent homicide by thorax compression, which is the expanded concept of traumatic asphyxia. A 58-year-old man was restrained in the prone position by six prison officers. They were ordered by their superiors to continue restraining him for about 15 min and the victim died. At the forensic autopsy, typical findings of thorax compression with intramuscular hemorrhages on the back and multiple fractures of the ribs were observed. No evidence of neck compression/smothering or other fatal issues likely to occur by chest compression was found. The reconstruction of the scene corresponded exactly with the localization of the injuries found in the victim. This is the first case of death by pure thorax compression without other fatal factors during intentional restraint, in which the force causing the chest compression was distinctly determined by the autopsy and reconstruction.

Lead content of brain tissue in diffuse neurofibrillary tangles with calcification (DNTC): the possibility of lead neurotoxicity.

Diffuse neurofibrillary tangles with calcification (DNTC) is a form of presenile dementia, characterized pathologically by fronto-temporal atrophy with neurofibrillary tangles (NFTs), neuropil threads and Fahr-type calcification, in which no senile plaques are observed. As already noted, chronic exposure to lead (Pb) might be one of the etiological factors of Fahr-type calcification. Until now, there have been no reports in which Pb concentration has been quantified in DNTC brains. We examined the concentration of Pb in fresh-frozen brain tissue and in 10% formalin-fixed brain tissue from six cases of DNTC, four cases of Alzheimer's disease, and in nine non-demented elderly controls by flameless atomic absorption spectrometry, and demonstrated a high concentration of Pb in DNTC brains. Although it remains unclear how these findings are related to the formation of NFTs, they suggest that Pb neurotoxicity may be involved in the pathogenesis of DNTC.

Distribution of basal ganglia lesions in generalized variant of Pick's disease: a clinicopathological study of four autopsy cases.

We investigated four Japanese autopsy cases of the generalized variant of Pick's disease ("basophilic inclusion body disease") both clinically and pathologically, and examined the degree and distribution of the basal ganglia lesions, including the amygdala, striatum, pallidum, and substantia nigra. The lesions in the amygdala, striatum, and pallidum were classified into three categories (slight, moderate, and severe). The lesions in the substantia nigra were qualitatively judged, compared with normal controls. Extrapyramidal signs, not noticed in the generalized variant of Pick's disease, were evident in all four cases, in addition to dementia. The degree and distribution of basal ganglia lesions in all four cases were uniform: the caudate nucleus showed severe lesions, the amygdala and putamen severe to moderate lesions, and the pallidum moderate to slight lesions. The substantia nigra in all our cases showed prominent neuronal loss, probably being one of the lesions responsible for extrapyramidal signs. In the generalized variant of Pick's disease, the degree and distribution of the alterations within the basal ganglia differs from those reported in Pick's disease with Pick bodies (PDPB) and corticobasal degeneration (CBD). In PDPB, severe lesions are present in the amygdala with relative sparing of the substantia nigra, compatible with rare extrapyramidal signs in PDPB, while in CBD, severe lesions are found in the pallidum and substantia nigra. These clinicopathological findings may contribute not only to the elucidation of clinicopathological hallmarks, but also to the progress of neuroimaging, in the generalized variant of Pick's disease.

A case of tuberculous peritonitis monitored by gallium-67 scintigraphy.

An 18-year-old man was admitted to our hospital for further examination of fever of unknown origin and ascites. Ga-67 scintigraphy revealed diffuse increased uptake throughout the abdomen. He was diagnosed with tuberculous peritonitis and began the treatment for tuberculosis (rifampicin, 450 mg/day orally and isoniazid, 300 mg/day orally, and 0.75 g of streptomycin by intramuscular injection 2 times a week). One year after starting the treatment, Ga-67 scintigraphy revealed accumulation of radioactivity in the upper abdomen, but the diffuse accumulation in the abdomen decreased. A specimen obtained by tumor biopsy under ultrasonic guidance revealed a tuberculous granuloma. Percutaneous injection was performed in the tumor with 1.0 g of streptomycin. On Ga-67 scintigraphy performed 2 weeks after the injection of streptomycin, the accumulation of radioactivity in the upper abdomen had disappeared. These findings suggest that Ga-67 scintigraphy is useful for diagnosis and observation during treatment of tuberculous peritonitis.

Mesenteric desmoid with uptake on gallium-67 citrate scintigraphy.

A 72-year-old man was hospitalized for further evaluation of a space-occupying lesion in the abdomen. Magnetic resonance imaging revealed a tumor 40 mm in diameter in the abdomen. Anterior Ga-67 citrate scintigraphy revealed a region of accumulation of radioactivity in the abdomen corresponding to the tumor. Mesenteric desmoid was diagnosed on the basis of histological findings for the excised tumor. These finding suggested that mesenteric desmoid may be one of the tumors which show high uptake of Ga-67.

A case of glucagonoma with high uptake on F-18 fluorodeoxyglucose positron emission tomography.

Glucagonomas are relatively rare, and can be difficult to differentiate from other pancreatic tumors. A 62-year-old woman who had suffered from diabetes mellitus was hospitalized for further evaluation of a space-occupying lesion in the head of the pancreas and tumors in the liver. F-18 fluorodeoxyglucose positron emission tomography revealed accumulation of isotope corresponding to a tumor of the pancreas with a standardized uptake value of 4.3, and tumors in the liver with standardized uptake values of 2.4 and 2.8. The serum glucagon level was high (1,170 pg/ml) and the secretin tolerance test was negative. She was diagnosed with glucagonoma with a high serum glucagon level and clinical findings. It is suggested that glucagonoma may be one of the tumors which show high uptake of F-18 fluorodeoxyglucose.

Accessory spleen in the pelvis diagnosed by Tc-99m phytate scintigraphy.

We report a 58-year-old woman with an accessory spleen in the left side of the pelvis. She visited our outpatient clinic complaining of lower abdominal discomfort. Abdominal ultrasonography revealed a tumor 4 cm in diameter in the left side of the pelvis. Color Doppler ultrasonography demonstrated plentiful pulsating blood flow. Magnetic resonance angiography revealed that the blood supply for the tumor was from a branch of the splenic artery. Scintigraphy with Tc-99m phytate revealed accumulation of radioactivity concordant with a mass in the left side of the pelvis, and the spleen was normally visualized. These findings suggested that this tumor was an accessory spleen, and the patient underwent no further invasive procedures.

Human identification from forensic materials by amplification of a human-specific sequence in the myoglobin gene.

We developed a method for human identification of forensic biological materials by PCR-based detection of a human-specific sequence in exon 3 of the myoglobin gene. This human-specific DNA sequence was deduced from differences in the amino acid sequences of myoglobins between humans and other animal species. The new method enabled amplification of the target DNA fragment from 30 samples of human DNA, and the amplified sequences were identical with that already reported. Using this method, we were able to distinguish human samples from those of 21 kinds of animals: the crab-eating monkey, horse, cow, sheep, goat, pig, wild boar, dog, raccoon dog, cat, rabbit, guinea pig, hamster, rat, mouse, whale, chicken, pigeon, turtle, frog, and tuna. However, we were unable to distinguish between human and gorilla samples. This method enabled us to detect the target sequence from 25 pg of human DNA, and the target DNA fragment from blood stored at 37 degrees C for 6 months, and from bloodstains heated at 150 degrees C for 4 h or stored at room temperature for 26 years. Herein we also report a practical application of the method for human identification of a bone fragment.