Malignancy in pancreatic neuroendocrine tumors (PNETs) is graded by assessing the resected specimens according to the World Health Organization (WHO) 2010 criteria. The feasibility of such grading ...using endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) specimens remains unclear. The aim of this study was to ascertain the optimal method of measuring the Ki-67 index in EUS-FNA specimens, using resected specimens as the criterion standard.
A total of 58 consecutive patients diagnosed with PNETs between March 1998 and May 2011 were included. The study measured intratumoral Ki-67 index heterogeneity, concordance rates of PNET grading by EUS-FNA with grade of the resected tumor, optimal method of measuring the Ki-67 index in EUS-FNA specimens, and survival analysis based on EUS-FNA specimen grading.
Intratumoral dispersion of Ki-67 index in resected specimens was 0.033 for Grade 1 and 0.782 for Grade 2 tumors (P<0.001). Concordance rates for WHO classification between EUS-FNA and resected specimens were 74.0% using the mean Ki-67 index in EUS-FNA specimens and 77.8% using the highest Ki-67 index. The concordance rate rose to 90% when EUS-FNA samples with less than 2000 tumor cells were excluded (26% of EUS-FNA cases). The Kaplan-Meier survival curves were significantly stratified by the EUS-FNA grading of PNETs with 5-year survival rates of 100%, 58.3%, and 0%, for Grade 1, Grade 2, and neuroendocrine carcinoma (NEC) tumors, respectively.
Grading of PNETs by the highest Ki-67 index in EUS-FNA specimens with adequate cellularity has a high concordance with grading of resected specimens, and can predict long term patient survival with high accuracy.
Both endoscopic ultrasonography （EUS）-guided choledochoduodenostomy （EUS-CDS） and EUSguidedhepaticogastrostomy （EUS-HGS） are relativelywell established as alternatives to percutaneoustranshepatic ...biliary drainage （PTBD）. Both EUSCDSand EUS-HGS have high technical and clinicalsuccess rates （more than 90%） in high-volume centers.Complications for both procedures remain high at10%-30%. Procedures performed by endoscopistswho have done fewer than 20 cases sometimes resultin severe or fatal complications. When learning EUSguidedbiliary drainage （EUS-BD）, we recommend amentor＇s supervision during at least the first 20 cases.For inoperable malignant lower biliary obstruction,a skillful endoscopist should perform EUS-BD beforeEUS-guided rendezvous technique （EUS-RV） andPTBD. We should be select EUS-BD for patientshaving altered anatomy from malignant tumors beforeballoon-enteroscope-assisted endoscopic retrogradecholangiopancreatography, EUS-RV, and PTBD. Ifboth EUS-CDS and EUS-HGS are available, we shouldselect EUS-CDS, according to published data. EUSBDwill potentially become a first-line biliary drainageprocedure in the near future.
A 65-year-old man was admitted to the National Defense Medical College Hospital for acute anterolateral myocardial infarction and cardiogenic shock. Emergency coronary angiography demonstrated ...occlusion of the proximal left anterior descending artery. Primary percutaneous transluminal coronary angioplasty (PTCA) was successfully performed with the support of intra-aortic balloon pumping (IABP) and medical treatment to stabilize the patient's blood pressure. On the second hospital day, the patient suffered cardiac tamponade. Pericardiocentesis showed bloody fluid and revealed that an oozing-type of left ventricular rupture had occurred after the myocardial infarction. Cardiogenic shock persisted after successful removal of the pericardial effusion. Although the heparinization required during percutaneous cardiopulmonary support (PCPS) can increase pericardial effusion, PCPS was initiated to correct the systemic hypoperfusion; a surgical team was on standby in case massive pericardial effusion resulted, but fortunately that did not occur, and cardiac function recovered. The patient was weaned successfully from PCPS and IABP and has remained in a satisfactory condition for over 1 year. PCPS contributed to the patient's recovery from cardiac shock and may have decreased the effusion from the oozing-type rupture by reducing ventricular wall tension. (Circ J 2002; 66: 769 - 772)
A 48-year-old man with a history of hypertension and diabetes mellitus was hospitalized with sudden onset of severe chest pain. He was in cardiogenic shock with a systolic pressure of 60 mmHg. His ...electrocardiogram (ECG) showed ST-segment elevation in the precordial leads suggestive of acute anteroseptal myocardial infarction. The ST-segment returned to baseline after the systolic blood pressure rose to 100mmHg with the administration of sympathomimetic agents. Aortography and transesophageal echocardiography demonstrated type A aortic dissection and aortic regurgitation. Aortography and short-axis transesophageal echocardiography showed during diastole almost complete collapse of the true lumen of the ascending aorta caused by the intimal flap. The patient underwent surgical repair of the aortic dissection and implantation of Palmaz stents in the carotid arteries. Decreased blood pressure and the presence of aortic regurgitation accelerated the collapse of the true lumen during distole in the ascending aorta, resulting in functional obstruction of the left main coronary artery, which may have been related to ST-segment changes in this case.
The purpose of the present work is to simulate the three-dimensional flow in an air-cushion and suction pad, which acts as repulsive and suction forces to strips, by ejecting a jet to the surface of ...the strip. A new type of pad, which uses an annular jet, is proposed to generate the strong repulsive force. A simple numerical calculation using the discrete vortex stick method is carried out to study the generation mechanism of the repulsive and suction forces. The numerical results of the development of transient flow in the gap between the pad and the surface of strips is discussed. The results show that the existence of circulatory flow outside the jet plays an important role in generating negative pressure, and circulatory flow is constantly formed in the gap in the case where the length of the pad fringe is large whereas the gap clearance is not so large.
Rotational Analysis of γ System of ZrO Bands TANAKA, Tutomu; HORIE, Tadao
Proceedings of the Physico-Mathematical Society of Japan. 3rd Series,
1941, Letnik:
23
Journal Article
Odprti dostop
(1) The rotational analysis of the γ system bands has been done, the third order emission spectra due to 21-foot concave grating being _??_sed. (2) These bands can be attributed to the transition of ...3∑→3Π, of which the final state coincides with that of the α system. (3) The trebling of the level with each value of K in the 3∑ rate cannot be found, and the levels for small values of K of the ranches of v'=0 undergo peculiar perturbations. (4) The 3_??_Π state gives an example approximating to Case a. (5) The following values of the rotational constants have been obtained: - B'e=0.5658cm-1, α'=0.0077, r'e=1.477×10-8cm, B''e=0.6189cm-1, α''=0.0038, r''e=1.412×10-8cm. _??_he constants of the final state are quite near those obtained by Lowater for α system. (6) The Λ-type separations in the 3Π state have been determined. (7) The isotope effect is discussed
Zeeman Effect in Sun-Spots TANAKA, Tutomu; TAKAGI, Yutaka
Proceedings of the Physico-Mathematical Society of Japan. 3rd Series,
1939, Letnik:
21, Številka:
7
Journal Article
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