RESUMEN
Accurate predication of axillary node status by non-invasive diagnostic method would be of great value in cases of breast cancer. There have been few reports advocating digital subtraction angiography (DSA) as specifically advantageous for the detection of lymph node metastasis. IV (intravenous)-DSA was carried out on 42 patients with breast carcinoma using a DSA system with a matrix of 1024 x 1024 pixels. When a mass became stained in the axilla, it was considered to be metastatic. An immunohistochemical technique with JC70 antibody to platelet/endothelial cell adhesion molecules was used to evaluate the microvascular density (MVD) of the axillary lymph nodes. IV-DSA achieved a 76.2% sensitivity, 85.7% specificity, and 81.0% accuracy. The average MVD with JC70 antibody was 97.7 +/- 44.4 in metastatic and 62.9 +/- 23.6 in nonmetastatic nodes. MVD was significantly higher in the cancerous than in the noncancerous regions within lymph nodes. The MVD was 105 +/- 38.4 in DSA-N(+) cases and was 57.8 +/- 21.9 in DSA-N(-) cases, and the difference was statistically significant. In conclusion, IV-DSA is a useful diagnostic modality for detection of axillary lymph node metastasis. This new modality predicts lymph node status by assessing the neovascularization of the lymph node.
Asunto(s)
Angiografía de Substracción Digital/métodos , Neoplasias de la Mama/diagnóstico por imagen , Ganglios Linfáticos/diagnóstico por imagen , Neovascularización Patológica/diagnóstico por imagen , Adulto , Anciano , Axila , Neoplasias de la Mama/irrigación sanguínea , Neoplasias de la Mama/diagnóstico , Neoplasias de la Mama/secundario , Femenino , Humanos , Técnicas para Inmunoenzimas , Metástasis Linfática/diagnóstico por imagen , Persona de Mediana Edad , Análisis de Supervivencia , Resultado del TratamientoRESUMEN
We herein report on a 64-year-old Japanese female patient who presented with a splenic artery aneurysm (SAA) associated with systemic lupus erythematosus (SLE). The saccular aneurysm, which measured 3 cm in diameter, was located in the proximal third of the splenic artery from the pancreas with a portosystemic shunt. A double ligation of the splenic artery (the distal and proximal sides of the aneurysm) was performed without a splenectomy. The postoperative course showed acute pancreatitis without either splenic infarction or portal thrombus. To our knowledge, the closed association of SLE with an aneurysmal dilatation of the splenic artery has not been previously reported. Both the pathogenesis and the management of SAA associated with SLE are discussed following the presentation of this case. This is the first reported case of SAA associated with SLE.
Asunto(s)
Aneurisma/complicaciones , Aneurisma/cirugía , Lupus Eritematoso Sistémico/complicaciones , Arteria Esplénica/cirugía , Aneurisma/diagnóstico , Angiografía de Substracción Digital , Femenino , Humanos , Hipertensión Portal/complicaciones , Ligadura , Persona de Mediana Edad , Tomografía Computarizada por Rayos XRESUMEN
The patient, a 55-year-old female, was diagnosed as having right breast cancer (T1aN2M1, Stage IV) with metastasis of multiple organs (lung, pleura, bone, mediastinal and unilateral axillary lymph nodes) when she underwent tumorectomy. Postoperative adjuvant therapy was performed using oral administration of MPA (800 mg/day). After 3 months of this treatment, metastatic lesions in the lung and pleura had disappeared. After 37 months, complete remission (CR) was evaluated in the multiple lesions of bone metastasis. She achieved a complete remission (CR) by this treatment lymph nodes metastasis in both mediastinum after 24 months and unilateral axillae after 15 months. Complete response time was 38 months in both lung and pleura, 15 months in bone metastasis, 15 months in mediastinal lymph nodes, 24 months in unilateral ones. Normalization of tumor markers was acquired after 7 months of this hormonal therapy. This CR condition continues at present without severe complications.
Asunto(s)
Antineoplásicos Hormonales/uso terapéutico , Neoplasias de la Mama/tratamiento farmacológico , Acetato de Medroxiprogesterona/uso terapéutico , Neoplasias Óseas/tratamiento farmacológico , Neoplasias Óseas/secundario , Neoplasias de la Mama/patología , Neoplasias de la Mama/cirugía , Quimioterapia Adyuvante , Terapia Combinada , Femenino , Humanos , Neoplasias Pulmonares/tratamiento farmacológico , Neoplasias Pulmonares/secundario , Metástasis Linfática , Persona de Mediana Edad , Neoplasias Pleurales/tratamiento farmacológico , Neoplasias Pleurales/secundario , Inducción de RemisiónRESUMEN
Rats were housed under a 12-hr light (07:00-19:00)/12-hr dark cycle. Hepatic 3-hydroxy-3-methylglutaryl coenzyme A reductase mRNA appeared at 3 weeks of age, and diurnal variation was established at 5 weeks of age. Diurnal variation of the D-Site binding protein (DBP) mRNA was faintly seen 1 week after birth and became evident with age. Serine dehydratase mRNA level was high at 11:00 in the livers of rats at 2-3 days of age, and at 15:00 in those at 1-2 weeks of age. The rhythm became ambiguous at 3-4 weeks of age, but an adult-type rhythm with a peak at 19:00 was established at 5 weeks of age.
Asunto(s)
Proteínas de Unión al ADN , Regulación del Desarrollo de la Expresión Génica/fisiología , Hidroximetilglutaril-CoA Reductasas/genética , L-Serina Deshidratasa/genética , Hígado/metabolismo , ARN Mensajero/metabolismo , Factores de Transcripción/genética , Animales , Northern Blotting , Ritmo Circadiano/fisiología , Femenino , Hígado/enzimología , Hígado/crecimiento & desarrollo , Masculino , Fosfoenolpiruvato Carboxiquinasa (GTP)/genética , Ratas , Ratas Wistar , Caracteres SexualesRESUMEN
It is generally accepted that a clock generating biological rhythms exists in the suprachiasmatic nuclei (SCN) of the hypothalamus in rodents. We have examined if diurnal variations of rat liver serine dehydratase (SDH), D-site binding protein (DBP), and 3-hydroxy-3-methyl-glutaryl coenzyme A reductase (HMGR) mRNA levels, each of which exhibits low values during the daytime (06:00-18:00) and high values during the dark period, are controlled by the SCN. The SCN were destructed electrolytically, and, 2 weeks later, rats were sacrificed at 06:00, 12:00, 18:00, and 24:00. Completeness of SCN lesions was assessed by the alteration of spontaneous locomotor activity and histological examination of the brains. The SDH and DBP mRNA levels in SCN-lesioned rats were very low at 06:00 and almost eliminated at 18:00, whereas the HMGR mRNA level at 06:00 was low at 06:00 and slightly increased at 18:00 compared to the control values. When determined at 12:00 and 24:00, the SDH, DBP, and HMGR mRNA levels in sham-operated rats were higher at 24:00 than at 12:00, whereas those in SCN-lesioned rats were higher at 12:00 than at 24:00. The hepatic beta-actin and glycine N-methyltransferase mRNA levels showed no significant diurnal variation and were not affected by SCN lesions. These results indicate that the SCN also play a pivotal role in determining rhythmic gene expression in liver.
Asunto(s)
Ritmo Circadiano , Proteínas de Unión al ADN , Expresión Génica , Hidroximetilglutaril-CoA Reductasas/biosíntesis , L-Serina Deshidratasa/biosíntesis , Hígado/metabolismo , Actividad Motora , Núcleo Supraquiasmático/fisiología , Factores de Transcripción/biosíntesis , Actinas/biosíntesis , Animales , Glicina N-Metiltransferasa , Leucina Zippers , Masculino , Metiltransferasas/biosíntesis , ARN Mensajero/metabolismo , Ratas , Ratas Wistar , Valores de Referencia , Transcripción GenéticaRESUMEN
Rat liver serine dehydratase mRNA shows rhythmicity with a high level at the onset of dark (19:00) and a low level at the onset of light (07:00). We have examined the effect of stress (laparotomy) on the rhythm. Upon laparotomy at 09:00 or 17:00, a marked induction of serine dehydratase mRNA occurred 2 h after operation. The elevated mRNA level then decreased and the original mRNA rhythm resumed 2 days later. By contrast, the transcription activator protein DBP mRNA level which shows a similar oscillation was not affected by this treatment. The induction was also seen in adrenalectomized rats that had been treated with hydrocortisone but not with saline or noradrenaline, indicating that glucocorticoids are absolutely necessary for the induction. Pretreatment of rats with phenoxybenzamine, and prazosin prevented the effect of laparotomy, but propranolol and yohimbine had no effect, indicating the necessity of the alpha 1-adrenergic stimulation for the induction. These results suggest that laparotomy releases glucocorticoids and neural noradrenaline that stimulates alpha 1-adrenergic receptors, thereby leading to the serine dehydratase gene expression.