The optimal protocol for combining high dose rate brachytherapy and external beam irradiation as treatment for localized prostate cancer is unknown. Toxicity rates and clinical and biochemical ...outcomes should be evaluated to validate the current treatment protocol.
Fifty-eight patients were treated for prostate cancer with high dose rate brachytherapy followed by 30 Gy of external beam radiation therapy. Toxicity during treatment and for 12-18 months thereafter, and treatment-related morbidity, were evaluated. Physician-assessed treatment-related toxicity was graded at the time of occurrence using the Radiation Therapy Oncology Group morbidity criteria. Four separate self-administered questionnaires were used to collect longitudinally demographic data and general and prostate disease-related measures of quality of life.
Various degrees of rectal bleeding due to radiation proctitis were experienced by 13 patients (22%) at a median time of 11 months. Two of these patients needed hospitalization to undergo laser coagulation of the rectal mucosa. Study patients had statistically significant decreases in five SF-36 domains during the first month of treatment. All measures recovered by 12 months. Sexual function was not affected by irradiation. Lower urinary tract symptoms assessed by IPSS/QOL scores worsened significantly during the first month of treatment but later recovered to baseline levels. Physician-assessed RTOG scores failed to detect these changes.
Morbidity associated with combined radiation therapy was greatest during the first month of treatment and affected quality of life significantly. Most measures recovered to baseline levels by 12 months following radiation therapy. Although the current protocol appears acceptable, measures should be taken to decrease treatment-related morbidity further.
The aim of this study was to evaluate whether the immunocytochemical expression of cell proliferation markers, such as minichromosome maintenance protein 7 (MCM 7), geminin, topoisomerase II alpha ...(topo IIα) and Ki-67, which are different types of cell proliferation markers, could be useful for their differential diagnosis in reactive mesothelial cells and malignant mesothelioma cells obtained from body cavity fluids.
Samples diagnosed and later histologically confirmed as reactive mesothelial cells (39 cases) or malignant mesothelioma (32 cases) in body cavity fluids were examined. Immunocytochemical staining of MCM 7, geminin, topo IIα and Ki-67 was performed with the immunoperoxidase polymer method.
Labeling indices (LIs) of MCM 7 (cutoff value 20.0%; sensitivity 100%; specificity 100%), geminin (cutoff value 4.5%; sensitivity 88.0%; specificity 70.0%), topo IIα (cutoff value 11.0%; sensitivity 88.0%; specificity 92.0%) and Ki-67 (cutoff value 15.3%; sensitivity 78.0%; specificity 79.0%) of malignant mesothelioma cells were significantly higher than those of reactive mesothelial cells.
LIs of MCM 7, geminin and topo IIα can be reliable tools for the differential diagnosis of reactive mesothelial cells and malignant mesothelioma cells.
Accurate pretreatment identification of the risks that prostate cancer has extended beyond the gland and that it will recur would significantly influence practice patterns. Preoperative nomograms to ...predict such risks have not been developed for the oriental male population.
Construction of nomograms to predict preoperatively pathological outcome and early biochemical failure following radical prostatectomy in Japanese males was based on logistic regression analysis, with predicted probabilities and 95% confidence intervals for the final model being obtained by repeating the analysis on 1000 bootstrap samples from the original cohort.
Prostate-specific antigen level, clinical stage and biopsy Gleason score contributed significantly to the prediction of pathological stage and of biochemical failure in the univariate analysis (p < 0.001). Combined use of these three variables predicted these treatment outcomes better than any single variable (p < 0.001). Nomograms combining these three variables to predict final pathological findings and early biochemical failure were then developed. The medians and 95% confidence intervals of the predicted probabilities are presented in the nomograms.
This information enables clinicians to use their nomograms when counseling Japanese patients, leading to more informed treatment decisions and helping to identify those with a high risk of early biochemical failure. The nomograms may also be used to assure comparability of different treatment modalities in investigational trials.
A 22-year-old woman with a history of diarrhea and bloody stools presented at our hospital because of diarrhea, bloody stools, and loss of appetite. Colonoscopy revealed pan-ulcerative colitis. We ...started treatment with continuous intravenous infusion of prednisolone 40 mg (1 mg/kg), granulocyte apheresis, and oral mesalazine granules (4000 mg). After starting treatment, symptoms promptly improved. The dose of oral prednisolone was decreased to 15 mg/day. Watery stools occurred 5 times per day. The patient wanted to receive Chinese medicine. We requested Hiroshima Sky Clinic to treat the patient with us. Treatment with prednisolone and mesalazine was discontinued, and Hiroshima Chinese medicine was begun. Clinical remission was achieved. The calprotectin level decreased to 37 μg/g. Colonoscopy showed complete mucosal healing. Chinese medicine including natural indigo has side effects. The relevance of use of natural indigo is controversial because of the potential adverse effect. However, Chinese medicine may be useful, and some patients desire such treatment. In the assessment of symptoms on basis of the results of endoscopic and pathological examinations and calprotectin testing, Chinese medicine was effective in our patient.
A 14-year-old boy presented with diarrhea and anemia. The patient had 5 episodes of diarrhea 3 months previously. However, more than 10 episodes of diarrhea accompanied by mucous and bloody stools ...and abdominal pain occurred 2 weeks previously, and the patient presented at the Department of Pediatrics. The face was pale, and a blood test showed severe anemia. The patient was suspected to have inflammatory bowel disease and was referred to the Department of Gastroenterology. Colonoscopy revealed a pancolitis type of ulcerative colitis (UC) , and treatment was begun. Because the patient was in the growth phase, steroids, associated with potential adverse effects on growth, were not used. Intensive granulocyte apheresis (GCAP) procedures were performed twice weekly, and oral mesalazine granules (4000 mg) were administered. After about 2 weeks, diarrhea resolved, the patient defecated solid stools 2 times, and the hemoglobin level normalized. The use of steroids, associated with various adverse effects, should be carefully considered in children. Our findings suggest that treatment with intensive GCAP twice weekly and mesalazine granules (4000 mg) can suppress even severe UC in steroid-naive children.
Although N‐cadherin is necessary for organ formation originating in the endoderm, the expression of N‐cadherin in gastric carcinoma and its role has not yet been reported. The present study was ...conducted to determine the pattern of immunohistochemical expression of E‐cadherin and N‐cadherin, using formalin‐fixed, paraffin‐embedded tissues from 97 primary gastric carcinomas, including 17 which were producing α‐fetoprotein (AFP). Samples were subdivided into 50 tubular adenocarcinomas and 47 poorly differentiated adenocarcinomas. Results showed that E‐cadherin was expressed in varying degrees in areas of cell adhesion between tumor cells, in 94 out of 97 cases studied. Three cases which showed no expression of E‐cadherin were diagnosed as AFP‐producing tumors by immunohistochemistry. Expression of N‐cadherin was observed in varying degrees in the intercellular spaces between tumor cells in 11 tubular adenocarcinomas and in six poorly differentiated adenocarcinomas, including E‐cadherin‐negative cases, all of which were AFP positive. The present findings suggest a possible role for N‐cadherin in gastric carcinoma.
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