These findings indicate that DFP treatment is effective for controlling POD in elderly patients after general surgery and does not appear to be associated with severe complications or side effects. To our knowledge, this is the first report proposing artificial control of the sleep-awake rhythm by medication as a means of preventing POD in elderly patients.
Synthesis of complement components is part of the acute-phase response. Interleukin-6 (IL-6) is a critical mediator of the acute-phase response during infections and injuries. Plasma levels of C3a and IL-6 have been proposed as prognostic indicators in sepsis and trauma. The effects of C3a and C3a(des)Arg on IL-6 gene expression and protein production in human peripheral blood mononuclear cells (PBMC) were investigated. Neither C3a nor C3a(des)Arg alone induced detectable IL-6 protein or mRNA levels. However, C3a and C3a(des)Arg affected endotoxin-induced IL-6 synthesis in a dose-dependent manner. In nonadherent PBMC, C3a or C3a(des)Arg suppressed, while in adherent PBMC, C3a or C3a(des)Arg enhanced IL-6 protein and mRNA levels. These results suggest that C3a and C3a(des)Arg may provide a control mechanism of acute-phase responses by enhancing IL-6 synthesis in adherent monocytes at local inflammatory sites and by inhibiting IL-6 synthesis in circulating monocytes.
A 17-year-old Japanese female underwent major hepatic resection for a huge fibrolamellar hepatocellular carcinoma that was compressing the inferior vena cava. The tumor was not exposed at the surgical margin but was very close to it. A recurrent lesion at the surgical margin of the liver and a lymph node metastasis were discovered 9 months postoperatively together with a marked elevation of vitamin B12 binding capacity. These lesions were resected, and vitamin B12 binding capacity decreased thereafter. Peritoneal dissemination was detected by CT 16 months postoperatively, together with recurrent elevation of vitamin B12 binding capacity. Several types of chemotherapy, including intraperitoneal injection of epirubicin, were applied and improved the patient's quality of life somewhat, but the patient died of recurrent disease 34 months after the initial hepatic resection. This is the first report in Japan of fibrolamellar hepatocellular carcinoma with increased vitamin B12 binding capacity as a useful marker. Fibrolamellar hepatocellular carcinomas, if resected, have a better prognosis than ordinary hepatocellular carcinoma in Japan, as well as in Western countries. An aggressive strategy should be chosen, which consists mainly of precise surgical resection and postoperative multimodality therapy, including chemotherapy.
SirNeuromuscular and vascular hamartoma is a rare benign neoplasm occurring in the small intestine. Fernando and McGovern [3] first described it in 1982, and only ten cases have been reported since. The tumor consists of fascicles of smooth muscle, nerve fibers with ganglion cells, and hemangiomatous vessels. All cases have occurred in the small bowel [1,2,3,4,5,6,7,8]. This lesion has been considered a hamartoma, but Shepherd and Jass [6] have questioned whether it represents a distinct entity, since similar lesions can be observed in inflammatory bowel diseases. In this report, we have described the first case of this tumor that arose in the cecum and discussed the lesion with reference to the previous reports.A 76-year-old woman was admitted to the hospital for investigation of a mass lesion at the cecum which was incidentally found by means of computed tomography scan. This examination was performed as a follow-up to treatment of uterocervical cancer with hysterotrachelectomy and radiation therapy. Her past history also included pulmonary tuberculosis, gastric ulcer and hemorrhoids. She had no symptoms and her physical examination was normal. Barium enema roentgenogram revealed a 5-to 6-cm-diameter mass in the bottom of the cecum. By means of colon fiberscopy, this lesion appeared to be a submocasal tumor with surface erosion. Laparoscopyassisted ileocecal resection and lymphoidectomy were carried out. Postoperative course was uneventful and the patient was discharged 21 days after the operation.The terminal ileum, cecum, appendix vermiformis, and ascending colon were submitted for pathological examination. Macroscopically, this specimen showed a polypoid mass measuring 3.0×2.0×1.0 cm in the greatest dimensions, which showed surface erosion and a dense pale-tan thickening of the submucosa at the bottom of the cecum (Fig. 1a, b). Fig. 1. Macroscopic observation of the tumor. a A mass lesion with erosive surface located at the bottom of cecum. The tumor is overlying the ostium appendicis vermiformis indicated by a probe. b The cut surface of the tumor. The tumor shows dense pale-tan thickening of the submucosa (arrowheads)
CD117 (c-kit proto-oncogene protein product) is expressed in most gastrointestinal stromal tumors (GISTs) and plays a crucial role in the pathogenesis and treatment of this disease. However, the clinicopathological and immunohistochemical features of CD117-positive mesenchymal tumors without connection to the gastrointestinal tract, known as extragastrointestinal stromal tumors (EGISTs), are not well documented because these tumors are rare. We describe the clinicopathological and immunohistochemical features of two cases of EGIST and compare them with those of GIST. Of the 1855 abdominal or esophageal tumors resected during the past 10 years at our hospital, 23 were GISTs and 2 were EGISTs. The clinicopathological or immunohistochemical characteristics do not seem to differ remarkably between EGISTs and GISTs. Although rare, CD117 positivity should be tested in abdominal mesenchymal tumors that have no connection to the gastrointestinal tract. The clinicopathological features of CD117-positive abdominal mesenchymal tumors may not depend on whether the tumor is connected to the gastrointestinal tract.
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