CD44 expression is related to poor prognosis of hypopharyngeal squamous cell carcinoma.

CONCLUSIONS: CD44 expression in hypopharyngeal squamous cell carcinomas (SCCs) is closely associated with poor prognosis for patients. CD44 may serve as a prognostic marker for hypopharyngeal SCCs. OBJECTIVES: CD44, an adhesion molecule binding to extracellular matrix, is believed to participate in the progression of malignancies. To clarify the role of CD44 in the progression of hypopharyngeal SCCs, we examined CD44 expression in relation to clinical parameters in hypopharyngeal SCCs. METHODS: Biopsy specimens of hypopharyngeal SCCs were collected from 40 untreated patients, and their CD44 expression was examined immunohistochemically. Hypopharyngeal SCCs were classified into two groups: CD44-low SCCs comprising < 50% CD44-positive tumor cells and CD44-high SCCs comprising ≥ 50% CD44-positive tumor cells. The relation between CD44 expression and various parameters (clinical T and N stages, distant metastasis, and pathological T and N stages) was analyzed by Fisher's exact test. The relation between CD44 expression and the 5-year disease-free survival (DFS) rate was also analyzed by log rank test. RESULTS: The CD44 expression in hypopharyngeal SCCs was related to pathological N stage, but not to clinical T and N stages and pathological T stage, of the patients. Distant metastasis during the follow-up occurred more frequently in patients with CD44-high SCCs than those with CD44-low SCCs. The 5-year DFS was significantly lower in the former than in the latter.

Congenital stenosis of the hepatic duct at the porta hepatis in children with choledochal cyst.

BACKGROUND: The intrahepatic gallstone is known as one of the complications of choledochal cyst. Stenosis of the hepatic duct may contribute to the formation of the stone. This report describes concurrent congenital stenosis of the hepatic duct identified during the primary operation of choledochal cyst. METHODS: Fourteen children were operated on for choledochal cyst. To identify the concurrent stenosis, cholangiography and inspection of the hepatic duct were performed during the operation. In those patients with identified membranous stenosis, the membrane was resected. In those with nonmembranous stenosis, the wide hilar hepaticojejunostomy was performed after hepatic duct plasty. RESULTS: Eleven sites of hepatic duct stenosis were identified, 8 membranous stenoses and 3 relative stenoses without membrane. The membranous stenoses were classified into 4 subtypes as follows: a small central opening, a marginal opening, 2 openings, and a bridgelike structure. At the primary surgery on choledochal cyst, those stenoses were released, and the formation of the gallstone has not been observed in 4 to 11 years in all cases.

Primary malignant melanoma of the larynx: a case report and literature review.

A 56-year-old Japanese man presented with hoarseness and left sided neck swelling in June 2003. Endoscopy showed an irregular tumor extending from the anterior commissure to the left ventricle with dark pigmentation. A biopsy showed malignant melanoma. A total laryngectomy with left radical neck dissection was performed in July 2003, followed by chemohormonal therapy and radiotherapy to the neck. Multiple bone metastases were diagnosed in May 2004, and the patient died with disseminated disease in April 2005, 21 months after initial treatment. The medical literature on laryngeal malignant melanoma was reviewed, and suggested a very poor prognosis despite therapy with surgery, radiotherapy, and chemotherapy.

Matrix metalloproteinase-9 expression in congenital diaphragmatic hernia during mechanical ventilation.

PURPOSE: Matrix metalloproteinase-9 (MMP-9) is detected in lung tissues subjected to ventilator-induced injury and is involved in the process of lung injury. We investigated the immunohistochemical expression of MMP-9 in the bilateral lungs of newborns with congenital diaphragmatic hernia (CDH) during mechanical ventilation and evaluated the degree of damage based on MMP-9 expression. METHODS: Lung tissue samples were obtained during autopsy from six newborns with CDH. Control lung tissue samples were obtained from two of these newborns; one who died of persistent pulmonary hypertension after being ventilated for 2 days, but whose bilateral lungs were not subjected to the compressions of herniation, and one who died of bilateral diaphragmatic hernias soon after birth, but was not subjected to artificial ventilation. The other four newborns with CDH had unilateral Bochdalek hernias. Immunohistochemical detection of MMP-9 expression was done using a wet autoclave antigen retrieval method on sections from formalin-fixed and paraffin-embedded lung tissue. RESULTS: The reaction and distribution of MMP-9 was strongly positive in the alveolar macrophages in thickened alveolar septi and ducts, and in the inflammatory cells around the parenchymal hemorrhage and intra-alveolar spaces. Only the four patients with unilateral Bochdalek hernia had widely positive MMP-9 immunoreactivity in the unaffected side, as well as the affected side. CONCLUSIONS: Based on MMP-9 expression, the lungs of newborns with CDH were damaged bilaterally during mechanical ventilation.

A case of pediatric ovarian dysgerminoma associated with high serum levels and positive immunohistochemical staining of neuron-specific enolase.

A 5-year-old girl presented with a painful abdominal mass. Abdominal magnetic resonance imaging (MRI) showed 3 separate masses. Tumor markers including lactate dehydrogenase (LDH), cancer antigen-125 (CA-125), beta-subunit of human chorionic gonadotropin (beta-hCG) and neuron-specific enolase (NSE) were elevated. At operation, the main tumor arose from the left ovary and was associated with torsion, whereas the other lesions were lymph node metastases. A salpingo-oophorectomy was performed. Histopathologic examination indicated that the tumor was a dysgerminoma. Immunohistochemicallly, the cells were positive for NSE and placental alkaline phosphatase (PALP) but were negative for CA-125, beta-hCG, S-100, glial fibrillary acidic protein, and vimentin. The elevated serum levels of tumor markers improved dramatically after the operation and chemotherapy.

Clinical significance of measurement of resting energy expenditure in childhood.

1. Biliary atresia (BA), as a common disease in Japan, and cystic fibrosis (CF), as an extremely uncommon disease in Japan, were selected to assess the clinical significance of measurement of energy expenditure (EE). 2. Energy expenditure was significantly higher in children with BA than in normal children. 3. Measurement of EE in BA lead to clues to resolving its mechanism by novel assessment of interleukin-6 and leptin. 4. Energy expenditure in children with CF is also higher, but this has been addressed by nutritional intervention with additional calories. 5. Individualization of EE measurement is necessary in the analysis of pathological mechanisms and nutritional management of patients with both common and uncommon diseases.

Accuracy of flow and sensors of indirect calorimetry for neonates and infants: using mass spectrometry and a pneumotachogram.

1. The accuracy of measurements of flow rate and concentrations of O2 and CO2 in expiratory gas by indirect calorimetry (IC) using paediatric and adult circuits were assessed by mass spectrometry and a pneumotachogram, which have been proven as the most reliable instruments for these purposes. 2. In the paediatric circuit, all measurements were demonstrated to be reliable: error rates for flow rate, O2 concentration and CO2 concentration were +3.13, +2.66 and -6.63%, respectively. All were within the 10%, which is acceptable as a biological error. 3. However, in the adult circuit of IC, all measurements were reliable except for measurements of CO2 concentration: error rates for flow rate, O2 concentration and CO2 concentration were +2.82, +1.64 and +11.42%, respectively. 4. A fluctuation phenomenon of expiratory gas concentration was observed only in IC. Mass spectrometry did not show this phenomenon. This phenomenon seems to be derived from the IC machine itself.

Accuracy of flow and sensors of indirect calorimetry for neonates and infants: Using mass spectrometry and a pneumotachogram.

1. The accuracy of measurements of flow rate and concentrations of O2 and CO2 in expiratory gas by indirect calorimetry (IC) using paediatric and adult circuits were assessed by mass spectrometry and a pneumotachogram, which have been proven as the most reliable instruments for these purposes. 2. In the paediatric circuit, all measurements were demonstrated to be reliable: error rates for flow rate, O2 concentration and CO2 concentration were +3.13, +2.66 and -6.63%, respectively. All were within the 10%, which is acceptable as a biological error. 3. However, in the adult circuit of IC, all measurements were reliable except for measurements of CO2 concentration: error rates for flow rate, O2 concentration and CO2 concentration were +2.82, +1.64 and +11.42%, respectively. 4. A fluctuation phenomenon of expiratory gas concentration was observed only in IC. Mass spectrometry did not show this phenomenon. This phenomenon seems to be derived from the IC machine itself.

CLINICAL SIGNIFICANCE OF MEASUREMENT OF RESTING ENERGY EXPENDITURE IN CHILDHOOD.

1. Biliary atresia (BA), as a common disease in Japan, and cystic fibrosis (CF), as an extremely uncommon disease in Japan, were selected to assess the clinical significance of measurement of energy expenditure (EE). 2. Energy expenditure was significantly higher in children with BA than in normal children. 3. Measurement of EE in BA lead to clues to resolving its mechanism by novel assessment of interleukin-6 and leptin. 4. Energy expenditure in children with CF is also higher, but this has been addressed by nutritional intervention with additional calories. 5. Individualization of EE measurement is necessary in the analysis of pathological mechanisms and nutritional management of patients with both common and uncommon diseases.