[A case of disease-free, long survival in a patient with mixed adenoneuroendocrine carcinoma of the gallbladder treated with induction CDDP/CPT-11 chemotherapy and resection].

A 57-year-old woman with a complaint of a right upper quadrant mass was referred to our hospital. Multimodal studies such as PET-CT revealed large hepatic tumors and swollen para-aortic lymph nodes, the origin of which was unclear. Pathological analysis of a biopsy specimen obtained from the liver tumor led to a diagnosis of neuroendocrine carcinoma. After 4 CDDP/CPT-11 chemotherapy treatment courses, remarkable shrinkage of liver tumors and disappearance of the swollen lymph nodes were achieved. Subsequently, liver tumor and extrahepatic bile duct resection and lymphatic dissection were performed. Pathological analysis of the resected specimens revealed that the liver tumors and metastatic lymph nodes originated from the gallbladder, leading to a diagnosis of mixed adenoneuroendocrine carcinoma. After 5 courses of adjuvant chemotherapy using the same regimen, the patient has remained disease free for 24 months since the initialdiagnosis.

[Two cases of long-term survival of metastatic colorectal cancer following treatment with polysaccharide K and mFOLFOX6 therapy].

Protein-bound polysaccharide K (PSK) has been used as a chemoimmunotherapy agent for the treatment of colorectal cancer. Recently, PSK was reported to be able to decrease some adverse effects of FOLFOX therapy, including neutropenia and peripheral neurotoxicity. Here, we report 2 patients with metastatic colorectal cancer, who unexpectedly were able to receive many courses of PSK+mFOLFOX6 therapy for a prolonged period. We speculate that FOLFOX therapy may achieve long-term tumor control with the aid of PSK without serious side effects for metastatic colorectal cancer patients.

Effects of gentian violet on refractory discharging ears infected with methicillin-resistant Staphylococcus aureus.

OBJECTIVE: To test the efficacy of topical treatment with gentian violet on methicillin-resistant Staphylococcus aureus (MRSA). STUDY DESIGN: Retrospective study. SETTING: Territorial referral centre. PATIENTS: Patients with discharging ears infected with MRSA alone or MRSA and Pseudomonas aeruginosa (PA). INTERVENTION: One percent gentian violet was applied. MAIN OUTCOME: Remission of discharge. RESULTS: Remission was obtained in 44 of 46 ears infected with MRSA, whereas remission was obtained in only 3 of 6 ears infected with MRSA and PA. The minimum inhibitory concentrations (MICs) of gentian violet for MRSA strains sensitive to topical application of gentian violet and strains resistant to this treatment were 0.03 microg/mL and 0.5%, respectively. The MIC for PA resistant to topical gentian violet treatment was higher than 32 microg/mL. CONCLUSIONS: Topical application of gentian violet is a useful option for the treatment of refractory discharging ears infected with MRSA. However, great care must be taken if there is any chance of the gentian violet reaching the middle ear.

Neuropathological features of the brain in acardius acormus.

Acardia is the most severe complication in monozygotic twinning. Acardius acormus is an uncommon phenotype among acardias. We report on an acardius acormus using thorough gross and light microscopic examination of the brain. Neuropathological examination revealed a severely disorganized cerebral cortex, agenesis of cerebellum and brain stem, and undeveloped basal ganglia and thalamus. In particular, the cerebral cortex was characterized by no clear lamination, almost complete loss of neurons, extensive gliosis, angiogenesis and focal mineralization. Neurohistology of the acardius acormus clearly demonstrated two types of lesions: developmental arrest of the brain and hypoxic-asphyxic damage to the brain with reactive gliosis and angiogenesis. Both types of lesions may be induced by the same teratogen: early onset of persisting hypoxia due to a reversed arterial perfusion. The quality of the description contributes valuably to a better understanding of the basic mechanism underlying the acardius phenotype.

Prognostic significance of S100A4 expression in gallbladder cancer.

The calcium-binding protein S100A4 has been characterized as a metastasis-inducing molecule, and regulates cell motility and invasiveness of cancer cells. In order to clarify the significance of the expression of S100A4 as a prognostic factor in gallbladder cancer, S100A4 expression in resected gallbladder cancers were examined using an immunohistochemical staining technique. The relationship between S100A4 expression and clinicopathological factors including prognosis were evaluated. Twenty-five of 60 cases (42%) demonstrated positive staining for S100A4. There was no statistically significant association between S100A4 and histological grade, T, N, M factor, presence of stone, or stage. Kaplan-Meier method showed the 5-year survival rate of the group staining positive for S100A4 (31.5%) to be statistically poorer than that of the group staining negative for S100A4 (78.2%). Also in T2 cases, the 5-year survival rate of the group staining positive for S100A4 (57.1%) was statistically poorer than that of the group staining negative for S100A4 (83.3%). On univariate analysis, positive staining for S100A4 was a significant prognostic factor, and the hazard ratio was 4.05. On multivariate analysis, positive staining for S100A4 is also a significant predictor of prognosis second to T factor. These results indicate that positive staining for S100A4 is useful in assessing the prognosis of patients with gallbladder cancer as well as TNM factors.