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Volume 57, Issue 3
Displaying 1-6 of 6 articles from this issue
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REVIEWS
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W.-D. Heiss, J. Sobesky2008 Volume 57 Issue 3 Pages 125-131
Published: September 25, 2008
Released on J-STAGE: March 10, 2009
JOURNAL FREE ACCESSThe penumbra - tissue perfused below the flow threshold for functional disturbance but above that for maintenance of morphological integrity - is the target for therapy in acute ischemic stroke. Irreversible tissue damage and penumbra can be reliably identified by multitracer positron emission tomography (PET) which has severe limitations due to complexity, invasiveness and radiation exposure. Therefore other modalities served as surrogate markers, with diffusion / perfusion-weighted magnetic resonance imaging (DW / PW - MRI) and perfusion computed tomography (PCT) being applied widely in clinical routine.
In order to evaluate the limitations of DW / PW - MRI a comparative study was performed in acute stroke patients in whom cerebral perfusion was assessed by perfusion-weighted magnetic resonance imaging (PW-MRI) and H215O-PET, tissue damage was estimated by diffusion-weighted magnetic resonance imaging (DW-MRI) and 11C-flumazenil (FMZ) PET and DW / PW - MRI mismatch was related to the tissue with increased oxygen extraction fraction (OEF) as an indicator of penumbra. The lesions in DW - MRI and in FMZ-PET were reliable predictors of final infarct on late MRI, but DW - MRI showed a high false positive rate. PW - MRI was limited in estimating flow and yielded values comparable to H215O-PET only in the range between 20 and 30 ml/100g/min. The DW / PW - MRI mismatch overestimated the penumbra as determined by increased OEF. These limitations of DW / PW - MRI have to be considered if used for selection of patients for treatment and might have an impact on the outcome of clinical trials based on this surrogate marker.View full abstractDownload PDF (348K) -
Richard K. Wood, Yu-Xiao Yang2008 Volume 57 Issue 3 Pages 132-138
Published: September 25, 2008
Released on J-STAGE: March 10, 2009
JOURNAL FREE ACCESSWith the rising incidence and overall poor prognosis of esophageal adenocarcinoma (EA) there is great interest in furthering our understanding of Barrett's esophagus, the precursor lesion for most cases of EA. The best available evidence from true population-based analysis suggests that the prevalence of Barrett's is 1.6%. In addition, nearly half of the patients with Barrett's are asymptomatic. Several risk factors for development of Barrett's have been identified including gastro-esophageal reflux disease (GERD), central obesity, H. pylori eradication, and male gender. The precise incidence of progression from Barrett's to esophageal adenocarcinoma is not known, but it probably is less than 0.5% per year, and our ability to predict who is at highest risk for progression remains poor. The degree of dysplasia is currently used as a marker for risk of progression to cancer though there is increasing evidence that biomarkers and level of genetic instability may provide better predictive measures. Intensive acid-suppression and COX-2 inhibition are potential strategies to reduce the risk of progression, though definitive studies are needed. Endoscopic surveillance remains the mainstay of management for non-dysplastic and low grade dysplasia Barrett's. The advent of various endoscopic ablative therapies has provided a promising alternative to surgery for Barrett's patients with high grade dysplasia (HGD).View full abstractDownload PDF (339K)
ORIGINAL ARTICLES
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Takashi Yagi, Keiichi Fukuda, Jun Fujita, Jin Endo, Yasuyo Hisaka, Yos ...2008 Volume 57 Issue 3 Pages 139-149
Published: September 25, 2008
Released on J-STAGE: March 10, 2009
JOURNAL FREE ACCESSWe recently reported that granulocyte-colony stimulating factor (G-CSF) prevented cardiac remodeling by mobilization and differentiation of bone marrow-derived cells in murine experimental myocardial infarction (MI). Little is known, however, whether these findings can be reproduced in large animals. The aim of this study is to investigate the effect of G-CSF after MI in canine model. MI was generated in twenty-six beagle dogs by ligation of left anterior descending artery. They were divided into two groups: G-CSF group which received subcutaneous injection of G-CSF (10 μg/kg/day) for 10 days, and the control group with saline injection. After six weeks, they were subjected to echocardiography and catheterization to measure hemodynamic parameters, and histological analysis was performed. No dogs died during the period. No hemodynamic changes were observed between these two groups probably due to the smaller size of the MI than we expected. We found significant increase in wall thickness and higher cell density in G-CSF group. Immunohistochemical staining against α-smooth muscle actin and CD31 revealed increased vessel density mainly in the epicardium in G-CSF group. The number of survived cardiomyocytes in G-CSF group was slightly greater than that in the control group, although it was not statistically significant. These findings suggested G-CSF prevented cardiac remodeling in canine model not by increasing the cardiomyocytes but by increasing the vessel density and cell numbers in the infarcted area.View full abstractDownload PDF (1093K) -
Nobuyoshi Miyajima2008 Volume 57 Issue 3 Pages 150-154
Published: September 25, 2008
Released on J-STAGE: March 10, 2009
JOURNAL FREE ACCESSAlthough laparoscopic surgery for colorectal cancer improves post operative recovery, its use for curative treatment especially for rectal cancer is still controversial. The present study is an attempt to analyze the results of the safety and feasibility of laparoscopic surgery including short-term results for rectal cancer.
Methods: This study accumulated 109 patients with rectal cancer retrospectively who underwent laparoscopic surgery. Patients with rectosigmoid colon cancer were excluded from this study. Patients' data, perioperative data including morbidity and mortality, surgical data were analyzed, and the 3-year disease-free survival data were calculated by Kaplan-Meier method, according to the location of the tumor and the UICC stage.
Results: There were 71 males and 38 females who underwent laparoscopic surgery for rectal cancer. Mean age of them was 63.7±12.5 years. The mean BMI was 22.6±2.8 kg/m2. The operative procedure was low anterior resection (LAR) in 80 cases, abdominoperineal resection (APR) in 14 cases, intersphincteric resection (ISR) in 14 cases, and Hartmann's procedure in 1 case. The operation time was 237.0±71.6 minutes. Blood loss was 165.0±163.8. The postoperative morbidity was 22.9%. The postoperative mortality within 30 days after surgery was not experienced. The 3-year disease-free survival rate was 94.2% after curative surgery. According to the UICC stage, the 3-year disease survival rate was 100% in stage 0/I, 89.1% in stage II, and 84.6% in stage III.
Conclusions: Laparoscopic surgery for rectal cancer was safe and feasible including postoperative morbidity, mortality and postoperative short-term results. Further study is necessary to clarify the quality of laparoscopic surgery including the postoperative long-term results.View full abstractDownload PDF (297K)
LECTURE
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Masahiro Toda2008 Volume 57 Issue 3 Pages 155-161
Published: September 25, 2008
Released on J-STAGE: March 10, 2009
JOURNAL FREE ACCESSThe current basic goals in glioma surgery are radical tumor resection without triggering the development of new neurological deficits. Although complete removal of malignant gliomas is extremely difficult because of the tumors' infiltrative characteristics, gross total resection of the tumor is known to be associated with improved outcome in the patients. To enable safe and radical resection of malignant gliomas, especially those adjacent to eloquent brain areas, rapid progress has been made in the development of operative support techniques; e.g., navigation systems to provide information about the anatomical and functional locations in the brain and a fluorescence imaging technique for differentiating brain tumors from normal brain tissue. These intraoperative imaging techniques in glioma surgery have improved the functional outcomes of glioma patients.View full abstractDownload PDF (805K)
CASE REPORT
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Kimitaka Hase, Toshiyuki Fujiwara, Tetsuya Tsuji, Meigen Liu2008 Volume 57 Issue 3 Pages 162-167
Published: September 25, 2008
Released on J-STAGE: March 10, 2009
JOURNAL FREE ACCESSDuring recovery from a stroke, body weight-bearing on a paretic leg is spontaneously avoided. In physiotherapy for hemiparetic gait, as long as the patients can use their non-paretic leg, adaptive and compensatory strategies are always used to support and move the body. We examined the effects of gait training using prosthetics to induce the use of a paretic leg during walking. The prosthesis was applied to the non-paretic leg of three right hemiparetic patients. Prosthetic gait training was performed until finishing 5 successive motor learning sessions involving walking over 200 m and the changes of asymmetric gait performances were analyzed. The ground reaction forces during the initial stance phase of the paretic leg were increased in all patients after prosthetic gait training. Simultaneously, the propulsive force produced by the paretic leg was increased in 2 patients. By contrast, another patient developed more use of his non-paretic leg for propulsion corresponding to acquiring stability on the paretic leg, resulting in an improvement in single-support-time asymmetry. Task-specific effects provided by prosthetic gait training may be able to reorganize the motor strategy for hemiparetic gait by inducing the use of the paretic leg to support and propell the body.View full abstractDownload PDF (553K)
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