The Impact of Rheumatoid Arthritis (RA) in Median Nerve Area in the Wrist Joint: A Case-Control Study.

Background Rheumatoid arthritis (RA) is one cause of carpal tunnel syndromes (CTS); due to increased intracarpal pressure in the rheumatoid wrist, synovial enlargement, joint erosions, and ligamentous laxity cause the compression of the median nerve (MN). Materials and methods A case-control study was conducted to assess the measurement of median nerve areas in RA using high-frequency ultrasound (US) and to correlate the measurement with the disease duration. Forty patients with rheumatoid arthritis (RA) and 40 with non-rheumatoid arthritis (RA) as a control group were referred to the radiology department of Yastabshiron Hospital, Khartoum, Sudan, from June to August 2022. After assessing the wrist joint by ultrasound scans, median nerve (MN) cross-sectional area (CSA) measurements were performed using a Fukuda Denshi ultrasound machine (Tokyo, Japan) with a linear-array high-frequency transducer (10 MHz), after receiving ethical approval from the research committee of the faculty of radiological science at University of Medical Sciences and Technology (UMST) and the study participants. Results The study demonstrated that the mean measurement of MN cross-sectional area (CSA) in RA patients was 13.60 mm2 for the right and 13.25 mm2 for the left MN. The study found that the MN CSA decreased by increasing the disease duration, with significant differences in the median nerve cross-sectional areas in RA and healthy control (p-value of <0.01). Conclusion The study concluded that rheumatoid arthritis (RA) had a greater influence on the median nerve cross-sectional areas. MN areas significantly decreased with increasing duration of diseases; the MN cross-sectional areas were more in RA than in the healthy control group.

Preoperative evaluation of cardiopulmonary reserve with the use of expired gas analysis during exercise testing in patients with squamous cell carcinoma of the thoracic esophagus.

OBJECTIVE: We evaluated the usefulness of analyzing expired gas during exercise testing for the prediction of postoperative cardiopulmonary complications in patients with esophageal carcinoma. BACKGROUND DATA: Radical esophagectomy with 3-field lymphadenectomy is performed in patients with thoracic esophageal carcinoma but has a high risk of postoperative complications. To reduce the surgical risk, we performed preoperative risk analysis using 8 factors. Although hospital mortality was decreased when this risk analysis was used, severe cardiopulmonary complications still occurred. METHODS: The study group consisted of 91 patients who had undergone curative esophagectomy with 3-field lymphadenectomy. The maximum oxygen uptake, anaerobic threshold, vital capacity, percent vital capacity, forced expiratory volume in 1 second, percent forced expiratory volume, V.(25)/HT, forced expired flow at 75% of forced vital capacity to height ratio (FEF(75%)/HT), forced expired flow at 50% to 75% of forced vital capacity ratio (FEF(50%)/FEF(75%)), percent diffusion capacity for carbon monoxide, and arterial oxygen tension were measured. Patients were divided into 2 groups on the basis of the presence or absence of postoperative cardiopulmonary complications. RESULTS: Only the maximum oxygen uptake was significantly different between the 2 groups. All patients were grouped according to the value of the maximum oxygen uptake, and the occurrence of postoperative cardiopulmonary complications was calculated for each group. A cardiopulmonary complication rate of 86% was found for patients with a maximum oxygen uptake of less than 699 mL. min(-1). m(-2); for those with a value of 700 to 799 mL. min(-1). m(-2), the complication rate was 44%. CONCLUSIONS: The maximum oxygen uptake obtained by expired gas analysis during exercise testing correlates with the postoperative cardiopulmonary complication rate. On the basis of these results, esophagectomy with 3-field lymphadenectomy can be safely performed in patients with a maximum oxygen uptake of at least 800 mL. min(-1). m(-2).

[Colorectal cancer in spouses of colorectal cancer patients].

Married couples share home environments and life style for years. In the case of colorectal cancer, an association with insulin resistance was reported. We determined the presence of the insulin-resistance syndrome (IRS, 1 or more of the following: body mass index of > 25 kg/m2, diabetes, or hyperlipidemia) in 84 colorectal cancer patients, of whom 61 patients (73%) had IRS. The incidence of the distal colorectal cancer, which has been declining in the United States, was significantly higher in the IRS group than in the non-IRS group (75.4 vs 52.2%, p = 0.0400). Some mechanisms may promote the progression of mucosal lesions to invasive cancers in the distal colorectum. There were no significant differences with respect to the age (64.6 +/- 9.4 vs 64.3 +/- 11.3 yr, p = 0.8298), height (159 +/- 9 vs 157 +/- 8 cm, p = 0.1375), and body mass index (22.2 +/- 3.6 vs 22.4 +/- 2.7 kg/m2, p = 0.6364) between the patients and their spouses. In 84 couples in whom colorectal cancer develops at least in one may then not illustrate the nursery rhyme: "Jack Sprat could eat no fat, His wife could eat no lean...". The spouses had been married for an average of 38 years, and in 30 spouses who had been followed in a colorectal cancer screening, 5 developed colorectal cancer. To diminish the incidence of colorectal cancer in Japan, we might advise screening colonoscopy to the spouses of colorectal cancer patients, or déjà vu all over again?

Lumbar paraspinal myonecrosis after abdominal vascular surgery: a case report.

STUDY DESIGN: Case report. OBJECTIVES: Lumbar paraspinal myonecrosis after abdominal vascular surgery. SUMMARY OF BACKGROUND DATA: Lumbar paraspinal myonecrosis does not appear to have been reported previously. METHODS: A patient who had severe back pain after abdominal vascular surgery was observed with computed tomographic scans and histologic examination of a specimen obtained in open biopsy. RESULTS: Computed tomographic scans of the lumbar region demonstrated muscle swelling of the unilateral paraspinal compartment. Histologic examinations of affected muscle revealed fresh ischemic necrosis. A compartmental syndrome was considered from the patient's clinical presentation and radiographic and histologic features. An accompanying secondary infection led to an extensive abscess in the paraspinal compartment. The patient resumed active daily life after aggressive débridements of infected and necrotic muscles. CONCLUSIONS: A compartmental syndrome in the paraspinal muscle should be kept in mind as a potential cause of acute back pain especially after abdominal vascular surgery.

Nerve root pressure in lumbar disc herniation.

STUDY DESIGN: The contact pressure between the nerve root and lumbar disc herniation was measured and compared with clinical features. OBJECTIVE: To assess levels of actual compression to the nerve root in clinical cases. SUMMARY OF BACKGROUND DATA: Actual levels of pressure to the nerve root of lumbar disc herniation in clinical cases is unknown. METHODS: The study was performed on 34 patients who had lumbar disc herniation. All of them had been treated by open discectomy. After laminotomy, nerve root pressure was measured by inserting a transducer between the nerve root and the disc herniation. The magnitude of pressure was compared with clinical features. RESULTS: Nerve root pressures before discectomy were varied from 7 mm Hg to 256 mm Hg (mean, 53 mm Hg). After discectomy, the contact pressure was 0 mm Hg in all cases. There were no significant correlations between the magnitude of nerve root pressure and limits to the degree of straight leg raising, duration of symptoms, and age of the patients. However, the magnitude of the pressure in patients with neurologic deficits and trunk list was significantly higher than in the absence of these findings. CONCLUSIONS: The contact pressure exerted by lumbar disc herniation on the nerve roots was recorded during surgical intervention, and the mean pressure was 53 mm Hg. The magnitude of nerve root pressure was not correlated with the degree of straight leg raising, but with the severity of neurologic deficits.

Identification of positive and negative regulator elements for the tissue inhibitor of metalloproteinase 1 gene.

We have identified an IL-10 inducible enhancer (HTE) (5'-CACGATGACTCATCACTGTTGAAAGACA-3') (-864 to -836 bp) and associated silencer element (HTS) (5'-CCACTGGCCCATCGTATAT-3') (-1284 to -1266 bp) in the 5' promoter region of the human tissue inhibitor of metalloproteinase-1 (TIMP-1) gene. Chloramphenicol acetyl transferase (CAT), electrophoretic migration shift assays (EMSAs), and DNase footprinting revealed that IL-10 (15 ng/ml for 1-2 h) induced the HTE enhancer. In comparison, phorbol ester stimulated the HTS silencer and blocked IL-10's effects in a dose-dependent, orientation- and position-independent fashion, suggesting that HTS is a true silencer element. EMSAs combined with deletion and mutation analysis of the HTE and HTS elements confirmed these observations. Finally, Northern blot, Western blot, immunoprecipitation, and ELISA analysis showed that IL-10 (15 ng/ml) induced TIMP-1 expression (approximately 10-fold by 18 h), whereas PMA (100 ng/ml) inhibited the stimulatory effects of IL-10 on TIMP-1 expression. The data indicate that HTE and HTS function as positive and negative regulatory elements that control human TIMP-1 expression.

Specific transcription factors prognostic for prostate cancer progression.

We have previously identified (M. Wang et al., Oncol. Res., in press, 1998) an enhancer element [human tissue inhibitor of metalloproteinase-1 enhancer-1 (HTE)] for the human tissue inhibitor of metalloproteinase-1 promoter that binds a novel zinc finger, cysteine-rich transcription factor (CRTF). In this study, we have used electrophoretic mobility shift assays to examine the relative level of expression of CRTF, jun/fos, and IFN-gamma responsive signal transducer activators of transcription (STATs) that bind specific HTE, activator protein, and IFN-gamma (Fcy and interferon regulatory factor) response motifs in tumor lines and human prostate tissue [i.e., normal (n = 3); benign prostatic hyperplasia (BPH; n = 12); high grade prostate intraepithelial neoplasia (PIN; n = 10); and prostate cancer adenocarcinoma (PCA; n = 61) plus seminal vesicle (n = 10) tissues]. The data showed that CRTF was overexpressed in PCA (Gleason's score, 10>8>6>5>4) compared with BPH, PIN, seminal vesicle, and normal tissues. To a much lesser degree, jun/fos and STAT 1 were also elevated in PCA compared to BPH, PIN, and normal tissues. In addition, blinded studies showed that CRTF and jun/fos were present at low levels in organ-confined specimens but at significantly elevated levels (P < 0.001) in samples exhibiting capsular penetration and localized spread, which indicated that CRTF and perhaps jun/fos were markers for cancer progression.

Biochemical and pharmacological characterization of FK706, a novel elastase inhibitor.

FK706, sodium 2-[4-[[(S)-1-[[(S)-2-[[(RS)-3, 3, 3-trifluoro-1-isopropyl-2-oxopropyl]aminocarbonyl]pyrrolidin -1-yl]carbonyl]-2-methylpropyl] aminocarbonyl] benzoylamino] acetate, C26H32F3N4NaO7, is a synthetic water-soluble inhibitor of human neutrophil elastase. This compound demonstrated a competitive and slow-binding inhibition of human neutrophil elastase with a Ki of 4.2 nM. In studies using synthetic substrates, FK706 inhibited human neutrophil elastase activity and porcine pancreatic elastase activity with respective IC50 values of 83 and 100 nM. FK706, however, inhibited more weakly, (IC50 values > 340 microM) other serine proteinases such as human pancreatic alpha-chymotrypsin, human pancreatic trypsin and human leukocyte cathepsin G. FK706 also effectively inhibited the hydrolysis of bovine neck ligament elastin (2 mg/ml final concentration) by human neutrophil elastase (4 microg/ml final concentration) with an IC50 value of 230 nM. FK706 protected animals against human neutrophil elastase (50 microg/animal)-induced lung hemorrhage with ED50 values of 2.4 microg/animal by intratracheal administration and 36.5 mg/kg by intravenous administration, respectively. Subcutaneous administration of FK706 significantly suppressed human neutrophil elastase (20 microg/paw)-induced paw edema in mice in a dose-dependent manner (47% inhibition at a dose of 100 mg/kg). These results suggest that FK706 would be a useful tool for investigating the role of human neutrophil elastase in inflammatory disorders associated with an excess of elastase, such as pulmonary emphysema, adult respiratory distress syndrome, septic shock, cystic fibrosis, chronic bronchitis and rheumatoid arthritis.

Impact on outcome of additional microvascular anastomosis--supercharge--on colon interposition for esophageal replacement: comparative and multivariate analysis.

The impact on the outcome of an additional microvascular anastomosis--supercharge--on colon interposition for esophageal replacement was retrospectively evaluated by comparing it with colon interposition without supercharge. A series of 53 patients had undergone colon interposition for esophageal replacement at Kurume University Hospital from 1981 to 1996. The postoperative courses and the morbidity and mortality rates were compared between the 24 patients who underwent colon interposition without supercharge from 1981 to 1988 and the other 29 patients who underwent colon interposition with supercharge from 1989 to 1996. Risk factors for leakage of the esophagocolostomy and for hospital mortality after colon interposition were evaluated by multivariate analysis. Colon interposition with supercharge required a longer operation time but resulted in a lower incidence of necrosis in the colon graft and leakage in the esophagocolostomy (Odds ratio = 34), a shorter duration until peroral intake, and a shorter hospital stay compared to colonic interposition without supercharge. The addition of supercharge to colon interposition for esophageal replacement has been an effective option that has prevented serious complications caused by graft ischemia.

Phenotypes of human esophageal squamous cell carcinoma based on matrix metalloproteinase production.

We investigated the effects of epidermal growth factor (EGF) and transforming growth factor-beta (TGF-beta) on cell growth and on regulation of matrix metalloproteinases (MMPs) in four cell lines of human esophageal squamous cell carcinomas (TE8, TE9, TE10, and TE11). EGF stimulated the production of proforms of gelatinase B (MMP-9) by three cell lines that could synthesize EGF by themselves, with TE9 being the exception. Particularly, both the production of MMP-9 and DNA synthesis in TE10 were stimulated significantly by EGF. TGF-beta slightly stimulated DNA synthesis in two cell lines, TE9 and TE11, and TGF-beta secretion by TE9 was detected. The production of proforms of gelatinases A (MMP-2) and MMP-9 was gradually induced by TGF-beta in a concentration-dependent manner in all the cell lines except for TE9. Flow cytometric analysis revealed that all the lines expressed both EGF- and TGF-beta-receptors. In conclusion, our present results indicate that at least there are possibly two distinct phenotypes in human esophageal squamous cell carcinoma: one (TE10) depends on autocrine EGF production that enhances DNA synthesis and MMP-9 production; and the other (TE9) on autocrine TGF-beta that stimulates DNA synthesis but not in relation to gelatinase production.

The significance of epidermal growth factor receptor and matrix metalloproteinase-3 in squamous cell carcinoma of the oral cavity.

Surgical specimens from 65 patients with squamous cell carcinoma (SCC) of the oral cavity were examined immunohistochemically. The clinicopathological significance of the expression of epidermal growth factor receptor (EGFR) and matrix metalloproteinase-3 (MMP-3) was assessed. Among the 65 tumours, 20(30.8%) and 37(56.9%) tested positively for EGFR and MMP-3, respectively. A positive correlation between the expression of EGFR and MMP-3 was found. The expression of EGFR in oral SCCs was associated with an advanced T stage of the primary tumour, an advanced pathological stage, and a high incidence of neck metastasis. In addition, MMP-3 was primarily expressed at the advancing front of cancer with a diffuse invasive mode. Thus, overexpression of MMP-3 was associated with an advanced pathological stage, a diffuse invasive mode, and a high incidence of neck metastasis. The analysis of MMP-3 expression is useful to evaluate the pathological status of tumours. Because EGFR-overexpressed tumour should produce larger amounts of MMP-3 in vivo, a close examination of oral SCC for expression of EGFR and MMP-3 should be helpful to predict their malignant potential.

Changes in epidural pressure during walking in patients with lumbar spinal stenosis.

STUDY DESIGN: This study was done to assess the pathophysiology of neurogenic intermittent claudication by measuring the epidural pressure at walking. OBJECTIVES: Changes in epidural pressure during walking in patients with neurogenic intermittent claudication and in normal individuals were analyzed. SUMMARY OF BACKGROUND DATA: Neurogenic intermittent claudication may be caused by compression of the nerve roots or may be a result of nerve root ischemia. The exact pathogenesis of neurogenic intermittent claudication is uncertain. METHODS: Local epidural pressure changes at the stenotic level during walking were analyzed in 12 patients with lumber spinal stenosis and seven normal individuals. a flexible pressure transducer was inserted into the epidural space and placed at the L4-L5 level. The epidural pressure was monitored continuously during walking. The pattern of the pressure change was assessed by gait analysis using a foot switch. RESULTS: The pressure was changed during walking. The pressure had a wave pattern of increase and decrease, and this pattern was repeated during walking. Intermittent pressure increase was seen about 90 times per minute while walking at a velocity of 2 km/h. An increase in epidural pressure occurred at the double-supporting phase in each gait cycle. CONCLUSIONS: The pressure was high in spinal stenosis and low in normal individuals. The increase of epidural pressure at simple walking was higher than walking with lumbar flexion. Intermittent compression to the nerve roots during walking may be a cause of neurogenic intermittent claudication.

Mortality and morbidity rates, postoperative course, quality of life, and prognosis after extended radical lymphadenectomy for esophageal cancer. Comparison of three-field lymphadenectomy with two-field lymphadenectomy.

PURPOSE: The authors evaluated the efficacy of extended radical (three-field) lymphadenectomy for esophageal cancer compared with less radical (two-field) lymphadenectomy. STUDY SUBJECTS AND ANALYTIC METHODS: The mortality and morbidity rates, postoperative courses, and survival rates were compared between 63 patients who underwent three-field lymph node dissection and 65 who underwent two-field lymph node dissection at Kurume University Hospital from 1986 to 1991. Long-term quality of life after surgery was compared between 37 patients who underwent three-field dissection and 35 who underwent two-field dissection from 1980 to 1991. RESULTS: Three-field dissection resulted in better survival for patients with positive lymph node metastasis from a carcinoma in the upper thoracic or midthoracic esophagus compared with two-field dissection. The mortality rates, postoperative courses and quality of life were the same for both procedures. CONCLUSIONS: Three-field dissection is preferred for upper thoracic or midthoracic esophageal cancer because of improved survival, acceptable mortality and morbidity rates, and good postoperative course and quality of life.

Production of granulocyte colony-stimulating factor by malignant mesothelioma.

We present the case of a male patient, aged 45 yrs, with malignant mesothelioma producing granulocyte colony-stimulating factor (G-CSF). The diagnosis was established by histopathological examination of the autopsied pleural tissues. Production of G-CSF was confirmed by immunoperoxidase staining, using a specific monoclonal antibody against recombinant G-CSF (rhG-CSF).

Rearrangement of esophageal-carcinoma cells and stromal fibroblasts in a multicellular spheroid.

Using a thermo-responsive polymer, a collagen-conjugated poly-N-isopropyl acrylamide (PNIPAAm) as a substratum, we developed hetero-multicellular spheroids (MCS) composed of esophageal squamous carcinoma cells (TE10) and esophageal fibroblasts isolated from esophageal carcinoma tissue. PNIPAAm is insoluble in water above the lower critical solution temperature (LCST; about 32 degrees C) and becomes reversibly solubilized below the LCST. Taking advantage of this conversion, we prepared three types of hetero-MCS as follows: F/T-multicellular spheroids made by seeding of TE10 onto a preprepared monolayer of fibroblasts; T/F-multicellular spheroids made by seeding of fibroblasts onto a preprepared monolayer of TE10; Mixed-multicellular spheroid made from a monolayer of mixed fibroblasts and TE10. Histolo,oical and immunohistochemical examinations revealed that fibroblasts and TE10 cells were intermingled in 5-day-old multicellular spheroids but were divided into three zones in 1- or 2 week-cultured spheroids: into an external zone composed almost entirely of TE10 cells that were positive for epithelial membrane antigen (EMA), an intermediate zone composed of fibroblasts that were positive for vimentin, and a necrotic zone showing variable evidence of cell injury. This distribution was observed in all three types of the spheroids described above. These findings indicate that TE10 cells are able to migrate and cover the surface to make organizing spheroid, thus mimicking in vivo structures. We conclude that the three-dimensional culture system using a thermo-responsive polymer, which enables coculturing with different types of cells as a heteromilticellular spheroid, is a useful model to examine the interaction between carcinoma cells and their stroma cells as it occurs in vivo.

Expression of epidermal growth-factor (EGF), matrix metalloproteinase-9 (mmp-9) and proliferating cell nuclear antigen (pcna) in esophageal cancer.

Expression of human epidermal growth factor (EGF) and matrix metalloproteinase-9 (MMP-9/gelatinase B) was examined immunohistochemically in 62 cases of surgically resected esophageal carcinomas, and the correlation between EGF expression and the proliferative activity of the tumors was studied by analysing the number of proliferating cell nuclear antigen (PCNA)-positive cells. Expression of EGF and MMP-9 was observed in 16 (38.1%) and 18 (42.9%) of the 42 superficial carcinomas and 8 (40%) and 14 (70%) of the 20 advanced carcinomas, respectively. The differences in the MMP-9 expression between the superficial carcinomas and the advanced carcinomas was significant (p<0.05). The synchronous expression of EGF and MMP-9 was observed in 15 (24.2%) of 62 carcinomas, i.e. 62.5% of the 24 EGF-positive tumors expressed MMP-9, but there was no statistically significant correlation between the expression of EGF and MMP-9. The relationships between EGF expression and tumor proliferative activity and prognostic factors were investigated. The PCNA grades were significantly higher in tumors with EGF-positive than those with EGF-negative expression (p<0.05) and the EGF expression showed a good correlation between the expression of MMP-9 and vascular invasion (p<0.01). The expression of MMP-9 was stronger in the advanced than the superficial carcinomas and there was a good correlation with vascular invasion (p<0.01). In a follow-up study of 55 patients, those with tumor that expressed MMP-9 or had a high PCNA grade showed a poor prognosis. Taken together, these observations suggest that both EGF and MMP-9 participate in the invasive phenotype in human esophageal carcinoma, but the expression of EGF is not directly related to the expression of MMP-9. Additional growth factors and cytokines may be involved in regulation of MMP-9 expression in this carcinoma.

[A case of superficial spreading esophageal cancer with a long sclerosis of the esophageal wall and dysphagia].

This report describes a rare case of superficial spreading esophageal carcinoma with a long sclerosis of the esophageal wall and dysphagia. The patient was a 64-year-old male with dysphagia. An esophagogram showed a long sclerosis from the upper-third to the lower-third of the esophagus. An esophagoscopy revealed a small ulcerative tumor (approximately 3 cm in size) at the level of 33 cm from the incisor teeth, and intraepithelial spread, 16 cm in length. However, esophageal stricture was not found in preoperative examinations. Histopathologically, most of the cancerous lesions were mucosal cancers with severe lymphocyte infiltration and the marked thickening of muscularis mucosa. These findings suggest the possibility that the sclerosis of the esophageal wall and esophageal dysfunction may be caused by these pathological changes.

Lymph node metastasis and recurrence in patients with a carcinoma of the thoracic esophagus who underwent three-field dissection.

The indication, efficacy, and extent of extended lymphadenectomy for a carcinoma in the thoracic esophagus remain controversial and under clinical investigation. Here we report the frequency and mode of lymph node metastasis at operation and of lymph node recurrence after operation in 70 patients who underwent three-field dissection and 75.7% of whom suffered from metastasis or recurrence in the lymph nodes (metastasis in 71.4% and recurrence in 21.4%). Metastasis or recurrence in the cervical and cervicothoracic nodes were found in 18.6% and 41.4%, respectively. The frequency of cervical and cervicothoracic lymph node metastasis or recurrence was, respectively, 40.0% and 90.0% for a carcinoma in the upper thoracic esophagus, 21.6% and 37.8% for a carcinoma in the middle thoracic esophagus, and 4.3% and 26.1% for a carcinoma in the lower thoracic esophagus. Lymph node metastasis at operation was most frequently found in the right recurrent nerve nodes, right paracardiac nodes, periesophageal nodes, and lesser curvature nodes, whereas lymph node recurrence after operation was found in the left upper recurrent nerve nodes and the right supraclavicular, celiac, and abdominal paraaortic nodes. Metastasis or recurrence was rarely found in the internal jugular, pretracheal, greater curvature, common hepatic, or splenic nodes. This finding suggests the need for recurrent nerve node dissection for all cases and for three-field dissection for a carcinoma in the upper or middle thoracic esophagus.