S100P is a useful marker for differentiation of ovarian mucinous tumors.

The S100P protein stimulates cell proliferation and survival, thereby contributing to tumor progression. The purpose of this study was to evaluate S100P expression in the three subtypes of mucinous cystic tumors, cystadenomas, borderline tumors, and adenocarcinomas. The authors examined nuclear S100P expression in 60 mucinous ovarian tumor specimens, including 24 specimens of mucinous cystadenoma, 15 of borderline tumors, and 21 of adenocarcinomas. Immunohistochemistry revealed S100P expression followed one of three patterns: (1) Expressed in most nuclei of mucinous epithelial cells, (2) sporadic (spotted or patchy) expression, or (3) absent or rarely expressed in the nuclei of mucinous epithelial cells. Most adenomas showed the first expression pattern, and borderline tumors often showed a patchy expression pattern. Adenocarcinomas generally demonstrated absence of S100P expression. These data suggest that S100P is a useful histological marker to differentiate between benign, borderline, and malignant mucinous tumors of the ovary.

Cyclin D1 overexpression in thyroid papillary microcarcinoma: its association with tumour size and aberrant beta-catenin expression.

AIMS: Cyclin D1 is a target molecule transcriptionally activated by aberrant beta-catenin in Wnt signalling. Thyroid papillary microcarcinoma (PMC) may be considered a precursor of papillary thyroid cancer (PTC). Ki67 is widely used as a proliferation marker. The aim of this study was to determine whether cyclin D1 overexpression is involved in early thyroid carcinogenesis. METHODS AND RESULTS: Thirty-five cases of PMC were examined immunohistochemically, including 11 cases less than 5 mm (PMC < 5) and 24 cases more than 5 mm (PMC > 5), and 18 PTC cases (size 11-15 mm). Cyclin D1 expression was significantly lower in PMC < 5 than in PMC > 5, while there was no significant difference between PMC > 5 and PTC. Statistical analysis revealed significant correlations between cyclin D1 labelling index (LI) and Ki67 LI (P = 0.0272)/cytoplasmic beta-catenin expression (P < 0.001) in PMC and PTC. Four of five PMC > 5 cases with lymph node (LN) metastases displayed a high cyclin D1 LI and strong cytoplasmic beta-catenin expression. CONCLUSIONS: Cyclin D1 overexpression and correlation with aberrant beta-catenin expression were demonstrated in PMC. Cyclin D1 expression was significantly associated with tumour size and LN metastases in PMC. Cyclin D1 may be up-regulated at an early stage of thyroid carcinogenesis and promote tumour growth and metastatic potency in PMC through activation of the Wnt/beta-catenin pathway.

[Stenting for postoperative airway stenosis due to traumatic tracheobronchial rupture].

A 43-year-old man underwent repair for the broken trachea, left main bronchus and right main brouchus due to trauma. Twenty-seven months after the initial surgery, he developed dyspnea and required ventilatory support. Computed tomography showed severe stenosis of the left main bronchus, tracheomalasia and bronchomalasia of right main bronchus. A self-expandable metallic stent (SEMS) was placed in the bilateral main bronchus and T-tube in the trachea. SEMS developed granulatory and cicatricial stenosis of the airway, which caused severe dyspnea. Replacement of SEMS with Dumon stents was successfully done and dyspnea was disappeared. A silicon stent should be used for treating postreconstructive airway stenosis including tracheobronchomalasia.

[A case of lung cancer (small cell carcinoma) occurring esophago-pericardial fistula and purulent pericarditis].

A 72-year-old woman who had had an endoscopic sclerotherapy for esophageal varices presented with high fever and severe cough. Chest X-ray and CT demonstrated a pneumopericardium and pericardial effusion. Esophagoscopy and esophagography revealed an esophageal perforation into the pericardial cavity and into the lung. Consequently, drainage and irrigation of the pericardial cavity and mediastinum were done for MRSA infection. However, these procedures failed to reduce the inflammation, and she expired because of liver failure soon after placing a covered stent in the esophagus. Postmortem examination revealed small cell carcinoma in the left lung invading into the esophagus and pericardium.

Retrograde brain perfusion beyond the venous values. Hemodynamics and intracellular pH mapping.

Twenty-one dogs (group 1) had retrograde brain perfusion for 90 minutes through the sagittal sinus and superior vena cava with pressure-regulated cardiopulmonary bypass, and 10 dogs (group 2) had 60 minutes of circulatory arrest with an additional 30-minute evaluation of brain slices, both at 20 degrees C. In group 1, cerebral blood flow determined by laser flowmetry was 8.98 +/- 2.02 ml/100 gm/min with a driving pressure of 29.69 +/- 9.92 mm Hg during the retrograde perfusion, whereas it was 0.85 ml/100 gm/min during solitary perfusion through the superior vena cava. Retrograde cerebral vascular resistance was slightly higher than the antegrade resistance. Neutral red stain was given intraperitoneally as an intracellular pH indicator. Regional intracellular pH was calculated from photoabsorption at 440 and 535 nm with the use of color transparency photographs of the brain and spinal cord slices taken after retrograde cerebral perfusion in group 1 and after circulatory arrest in group 2. The pH mapping showed that the retrograde brain perfusion maintained the pH within 6.77 to 7.14, whereas the cerebral pH decreased to 6.24 to 6.43 at 60 minutes of circulatory arrest and further decreased to 5.81 to 6.22 at 90 minutes. The pH after the retrograde brain perfusion was significantly higher than the pH after circulatory arrest in the entire brain and the spinal cord. We conclude that the brain is protected when perfused retrogradely beyond the venous valves with a driving pressure above 20 mm Hg.

[A case of tricuspid atresia treated with fenestrated total cavopulmonary connection at late infantile stage].

A one-year-old girl with tricuspid atresia (TA) underwent fenestrated totalcavopulmonary connection (TCPC) after pulmonary artery banding. Under cardiopulmonary bypass, an fenestrated intraatrial cavocaval channel was constructed with a prosthetic graft of polytrafluorothylene. The SVC was transsected and each end of SVC was anastomosed to the pulmonary artery in a end-to-side fashion. She did not need "high CVP management" nor "low HR management" in the post operative course. We suggest that fenestrated TCPC may be indicated for the patients of TA at late infantile stage.

[A case of pulmonary arteriovenous fistula failed in transcatheter embolization and followed by emergency operation].

We reported a 55-year-old male case with pulmonary arteriovenous fistula. The lesion existed in right S9b and was about 6 cm in diameter. The afferent artery and the efferent vein, both were more than 10 mm in diameter, were shown on the chest CT and DSA film. At first transcatheter embolization with steel coils and Histoacryl was tried. Though we succeeded in embolization of the afferent artery, embolization of the fistula was failed because of reflux from the drainage vein. And a coil, a fragment of Histoacryl dropped and floated in the fistula. With concerning about the risk of embolization of the other organ with these materials, we performed the enucleation of the fistula at the next day. Although transcatheter embolization is useful in treating pulmonary arteriovenous fistula, in the case of wide communication with large drainage vein such as our case, it seems to be risky.

[A case of bilateral synchronous renal cell carcinoma treated with partial nephrectomy with temporary occlusion of the segmental renal artery (segmental nephrectomy)].

We present a case of bilateral synchronous renal cell carcinoma. A 57-year-old man visited our hospital with a complaint of fever up. On ultrasonography and computerized tomography scan, a round tumor about 2.5 cm in diameter in the posterior portion of the right kidney and another tumor about 7 cm in diameter arising from the upper pole of the left kidney. Selective renal arteriogram showed that the inferior branch of the posterior segmental artery supplied blood to the right renal tumor. Left partial nephrectomy with temporary occlusion of the main renal artery and posterior segmental nephrectomy of the right kidney were performed at the same time. In patients with cancer confined to the posterior segment of the kidney, segmental nephrectomy can be performed while allowing unimpaired perfusion to the remainder of the kidney from the main renal artery.

[Epidemiologic study on urolithiasis in Mie prefecture. 2. Present status in 1988].

To determine the current status of urolithiasis in 1988, in comparison with that in 1985, we analyzed the 1937 patients of urolithiasis at 17 departments of urology in Mie Prefecture and 2 departments of urology in Wakayama Prefecture. The ratio of male to female patients was 2.6 to 1.0. Geographically, the number of urolithiasis patients was most frequently distributed in Matsusaka City. The frequency of urolithiasis in the urban area was almost the same as that in the rural area. Most of the stones (96.3%) were in the upper urinary tract. The frequency of lower urinary tract calculi tended to be high in southern Mie Prefecture. The ratio of the upper urinary tract calculi to the lower urinary tract calculi in the urban area was higher than in the rural area. The age distribution in males was in the forties, while that in females was in the fifties. The average age was 46.4 years old. The surgical treatment was performed in 671 patients (34.6%) and the extracorporeal shock wave lithotripsy (ESWL) was the most frequent mode of treatment (85.0%), followed by cysto-lithotripsy (4.2%) and percutaneous nephro-uretero-lithotripsy (2.4%). The most frequent component of the urinary tract calculi was calcium oxalate and/or calcium phosphate (81.7%). The stone patient increased in the number during the summer season (July, August and September). In conclusion, in 1988 when the ESWL treatment started in Mie Prefecture, the epidemiologic features of urolithiasis was characterized as follows: the number of patients increased and the broad application of the ESWL treatment resulted in the decreased number of patients with spontaneous discharge and the increased number of patients with recurrent stones and with bilateral or multiple complex stones.