INVITED REVIEW ARTICLES
Editors' Choice
Meddling with meddlers: curbing regulatory T cells and
augmenting antitumor immunity
Vitaly Kochin and Hiroyoshi Nishikawa
pg(s) 1 - 18
<Abstract> - < PDF >
CD4+ regulatory T cells (Tregs) expressing the transcription factor forkhead box P3 (FoxP3) play an
important role in self-tolerance and immune homeostasis. Tregs have evolved to protect the host from
aberrant immune responses against self-components and collateral damages occurring in the process of
defense against invading pathogens by softening immune responses. However, they turned to be a scourge
in malignant tumors by not only allowing and promoting tumor growth but also suppressing effective
antitumor actions, both inherent (host’s immune surveillance) and extrinsic (anticancer therapy). An increase
in the number of Tregs infiltrating into tumor sites and a concomitant decrease in the number of CD8+
cytotoxic T lymphocytes are associated with a poor prognosis for various types of cancers, marking Tregs
as notorious meddlers with an effective antitumor response. Various cancer immunotherapy approaches are
often dampened by meddling Tregs, making them one of the major targets in the treatment of cancer. The
recent success of immune checkpoint inhibitors (ICIs) that target immune checkpoint molecules expressed
by Tregs or effector T cells implies, that “meddling with meddlers” represents an effective strategy in cancer
immunotherapy. However, clinical responses to ICIs are effective and durable only in some patients with
cancer, whereas more than half of them do not show significant clinical improvement. This implies that a
therapeutic approach based on the use of a single ICI, or targeting Tregs alone, is insufficient, highlighting
the need for combinatorial approaches. With regard to antitumor immune stimulation, several approaches,
such as vaccination with peptides (or the corresponding DNA) to stimulate antigen-presenting CD8+ T
cells with tumor-specific neoantigens, cancer/testis antigens, or cancer stem cell antigens, that eventually
boost effective cytotoxic antitumor responses are being tested. This review describes the immunosuppressive
physiology of Tregs and their meddling with the host’s antitumor immunity; current and prospective
approaches to curb Tregs; and approaches to augment antitumor immunity.
Editors' Choice
Pulmonary Hypertension:
Diagnosis, Management, and Treatment
Takahisa Kondo, Naoki Okumura, Shiro Adachi, and Toyoaki Murohara
pg(s) 19 - 30
<Abstract> - < PDF >
Pulmonary hypertension (PH) is a hemodynamic state that is characterized by a resting mean pulmonary
artery pressure ≧ 25 mmHg. The common forms of PH are pulmonary arterial hypertension (PAH),
chronic thromboembolic pulmonary hypertension (CTEPH), PH caused by left-heart disease, and PH
due to lung disease. Previously regarded as untreatable, the treatment of PAH has dramatically advanced
since the introduction of the drug epoprostenol in 1999, with three-year survival rates improving from
30%–40% to over 85%. Drugs available for the specific treatment of PAH include endothelin-receptor
antagonists, phosphodiesterase type 5 inhibitors, soluble guanylate cyclase stimulators, prostacyclin analogs,
and prostacyclin-receptor agonists. In the past decade, management and treatment of CTEPH have also
improved. While pulmonary endarterectomy used to be the only option for the treatment of CTEPH, newer
treatments include a soluble guanylate cyclase stimulator, which has proven to be an efficacious targeted
therapy. Other cases benefit from balloon pulmonary angioplasty.
ORIGINAL PAPERS
Mass media exposure and childhood diarrhea:
a secondary analysis of the 2011
Bangladesh Demographic and Health Survey
Zakia Alam, Michiyo Higuchi, Mohammad Abul Bashar Sarker, and Nobuyuki Hamajima
pg(s) 31 - 40
<Abstract> - < PDF >
In order to reduce child mortality, recommendations for diarrhea management practices have been widely
promoted by various methods, including mass media. This study examined whether mother’s exposure to
mass media was associated with child’s diarrhea, and with the diarrhea management practiced by their
mothers. Data on 7,068 women, whose youngest child was under five years old, were extracted from the
Bangladesh Demographic and Health Survey, 2011, together with information on the child. The outcome
variables were an episode of diarrhea in the two weeks prior to the survey and diarrhea management
practices; exposure to mass media was used as the major explanatory variable. They were descriptively
summarized, and logistic regression analyses were performed. Television was found to be the most common
form of media. Among 346 children who had experienced an episode of diarrhea in the previous 2 weeks,
less than 42.5% were given zinc and only 26.3% of the mothers provided sufficient fluids. No significant
associations between mother’s mass media exposure and child’s diarrhea were observed. Women who read
newspapers/magazines were more likely to provide sufficient fluids and food, and those exposed to the
radio were more likely to provide zinc supplementation. Since mother’s exposure to newspaper/magazines
and radio showed associations with some recommended practices for the treatment of childhood diarrhea,
mass media clearly has the potential to improve diarrhea management practices. More effective use of
mass media is anticipated; in particular, promotion of zinc supplementation and increasing fluid intake
during diarrhea, neither of which were currently well practiced.
Quantitative Follow-Up Assessment of Patients with
Interstitial Lung Disease by 3D-Curved High-Resolution CT
Imaging Parallel to the Chest Wall
Hiroyasu Umakoshi, Shingo Iwano, Tsutomu Inoue, Yuanzhong Li,
Keigo Nakamura, and Shinji Naganawa
pg(s) 41 - 53
<Abstract> - < PDF >
We evaluated the progression of interstitial lung disease (ILD) by three-dimensional curved highresolution
computed tomography (3D-cHRCT) at a constant depth from the chest wall and compare the
results to pulmonary function test (PFT) results on a follow-up assessment. We reviewed the patients with
ILD who underwent HRCT and concurrent PFTs at least twice from April 2008 to December 2014. Fortyfive
patients with ILD were enrolled. 3D-cHRCT images of the lung at various depths from the chest wall
were reconstructed, and total area (TA), high-attenuation area (HAA) >-500 HU, and %HAA ([HAA/TA]
× 100) were calculated. The TA, HAA, and %HAA ratios (follow-up to baseline) were assessed for use
in the diagnosis of physiologically progressive ILD (defined as; forced vital capacity [FVC] ratio <0.9 or
%diffusing capacity of the lung for carbon monoxide [%DLCO] ratio <0.85 [follow-up to baseline]). Of
all ratios obtained from 3D-cHRCT images at 5–30mm depths, the %HAA ratio at 20-mm had the largest
area under the receiver operating characteristic curve (0.815, 95 % confidence interval 0.677–0.953). By
univariate logistic regression analysis, TA, HAA, and %HAA ratios at 20-mm showed significant correlations
with physiologically progressive ILD. 3D-cHRCT imaging performed in parallel with the chest wall
offers novel quantitative parameters that are useful for following ILD.
Partial Identification of Amyloid-β Degrading Activity
in Human Serum
Ryuta Mikawa, Alato Okuno, Tatsuya Yoshimi, Atsushi Watanabe,
Mitsuo Maruyama, and Osamu Takikawa
pg(s) 55 - 64
<Abstract> - < PDF >
The major hallmarks of Alzheimer’s disease (AD) are the extracellular accumulation of pathological
amyloid beta (Aβ) in the brain parenchyma and Aβ deposition in cerebral blood walls (cerebral amyloid
angiopathy; CAA). Although CAA occurs in more than 80% of AD patients, the mechanisms of Aβ
deposition and clearance around the vessel walls are unknown. We found Aβ-degrading activity in human
serum during analysis of the regulatory mechanism of Aβ production in human endothelial cells. To
elucidate the metabolic dynamics of Aβ surrounding the brain microvessels, we identified Aβ-degrading
activity in human serum (blood Aβ-degrading activity: BADA) by column chromatography and LC/MS.
BADA exhibited characteristics of an acidic protein, pI 4.3, which had two different protein surface charges
(low and high affinity cations). Both BADA fractions had a relative molecular mass of greater than 400
kDa. Furthermore, BADA in the low affinity cation fraction was inhibited by the serine protease inhibitor
4-(2-Aminoethyl) benzenesulfonyl fluoride hydrochloride (AEBSF). We clarified alpha-2-macroglobulin
(a2M) and several serine proteases from this BADA by LC-MS. Moreover, we demonstrated that BADA
is increased by approximately 5000-fold in human serum by column chromatography. Therefore, BADA
may play an important role in the circulation and metabolism of Aβ in human brain microvessels.
Knowledge, attitude, and usage pattern of tobacco among
high school students in Nay Pyi Taw, Myanmar
Myat Noe Htin Aung Myint, Eiko Yamamoto, Min Htet Ko, Moe Khaing,
Joshua A. Reyer, and Nobuyuki Hamajima
pg(s) 65 - 79
<Abstract> - < PDF >
In Myanmar, although the law prohibits the sale of tobacco products to and by those aged less than
18 years, the use of smoking and smokeless tobacco among high school students is a social problem.
There has been no previous study on tobacco use or knowledge of tobacco law among students in Nay
Pyi Taw. A survey was conducted to assess the knowledge, attitude, and usage pattern of tobacco among
high school students in Nay Pyi Taw, Myanmar. The data were collected in three high schools, from 300
students of Grade 10 and 11, in September 2015, using anonymous self-administered questionnaires which
included characteristics of students, knowledge, attitude, and usage pattern of tobacco. Of the 300 students,
104 (34.7%) were smokers and 85 (28.3%) were users of smokeless tobacco. The average age of first
use of tobacco was 14 years. Although most students knew about the ill effects of tobacco, only 25%
knew about the Tobacco Product Law. The most common source of tobacco was friends and male family
members were main smokers in families. Most students had seen male teachers and headmasters smoking
in schools. The usage of tobacco and smokeless tobacco was associated with sex and the students’ attitude
towards tobacco. This study indicated that the high school students knew about the ill effects of tobacco,
but not about the Tobacco Product Law. Schools need to educate students and teachers about tobacco and
the Tobacco Product Law and the enforcement of the law is also needed.
Healthcare waste management at primary health centres in
Mon State, Myanmar: the comparisons between hospital and
non-hospital type primary health centres
Ei Mon Win, Yu Mon Saw, Kyi Lwin Oo, Thet Mon Than, Su Myat Cho,
Tetsuyoshi Kariya, Eiko Yamamoto, and Nobuyuki Hamajima
pg(s) 81 - 91
<Abstract> - < PDF >
Improper healthcare waste management (HCWM) poses a serious public health problem worldwide.
Primary health centres (PHCs) provide public health and medical care services as the basic structural and
functional units of healthcare services in Myanmar. However, no study has been conducted in Myanmar
about HCWM at PHCs. This study aims to assess the practice of HCWM at PHCs in Mon State, Myanmar.
A cross-sectional study was conducted in all ten townships in Mon State, Myanmar. In total, 93 PHCs (71
non-hospitals and 22 hospitals) were selected using simple random sampling. The observational checklist
which was developed based on the World Health Organization’s standard guideline procedure of HCWM
was used to determine the practice of HCWM at PHCs. Binary logistic regression was used for final data
analysis. The burning in pits method was used as the final disposal method of healthcare waste in 78.5%
of PHCs. Non-hospital type PHC were more likely not to have colour coding system for HCWM (odds
ratio [OR] 7.54; 95% confidence interval [CI] 2.15–26.52), did not have equipment for accidental spillage
of healthcare waste (OR 3.92; 95% CI 1.3–11.77) and did not have separate staff for HCWM (OR 8.27;
95% CI 2.77–24.64), relative to hospitals. Non-hospital type PHCs practices poorly on the colour coding
for waste segregation, assigning separate staff for HCWM, and possessing equipment for accidental spillage
of healthcare waste than hospital type PHCs. The Ministry of Health and Sports should issue technical
guidelines of safe HCWM as a compulsory policy for both hospitals and non-hospital type PHCs.
Enhanced efficacy of histone deacetylase inhibitor
panobinostat combined with dual PI3K/mTOR inhibitor
BEZ235 against glioblastoma
Wei Meng, Baocheng Wang, Weiwei Mao, Jiajia Wang, Yang Zhao, Qifeng Li,
Chenran Zhang, and Jie Ma
pg(s) 93 - 102
<Abstract> - < PDF >
Glioblastoma multiforme (GBM) is the most common malignant brain tumor in adults. Despite multiple
treatment strategies, the prognosis is still poor. This study aimed to evaluate the efficacy of combination
treatment of GBM with the histone deacetylase (HDAC) inhibitor panobinostat and dual phosphoinositide
3-kinase (PI3K) and mammalian target of rapamycin (mTOR) inhibitor BEZ235. GBM cells were exposed
to panobinostat and BEZ235 treatment alone or in combination, after which cell viability, proliferation
and apoptosis were detected. Furthermore, the inhibitory mechanisms were investigated by Caspase-Glo
assay, Western blot and qPCR analysis. We found that combination treatment with panobinostat and
BEZ235 synergistically inhibited cell viability, markedly inhibited cell proliferation and induced apoptosis
in GBM cells. Mechanistically, cotreatment with panobinostat and BEZ235 increased caspase 3/7 activity,
suppressed proliferation- and antiapoptosis-related markers and AKT signaling in GBM cells. Cotreatment
with panobinostat and BEZ235 warrants further evaluation in GBM therapy.
Oral health-related quality of life among community
dwelling middle-aged and older adults in an urban area
in Magway region, Myanmar
Khin Chaw Su Su Htun and Karl Peltzer
pg(s) 103 - 112
<Abstract> - < PDF >
This study aims at describing oral health-related quality of life (OHRQoL) and determining its associated
factors in a middle-aged and older adult community dwelling population in Myanmar. In a cross-sectional
community survey, 633 individuals (men 55% and women 45%), aged 35–65 years, selected by multi-stage
random sampling, responded to a structured questionnaire on the Oral Health Impact Profile-short form
(OHIP-14), health status, health behavior and socio-demographic information. Participants had an overall
mean score of 8.1(item mean=0.65) on the OHIP-14, 57.2% had impaired OHRQoL and 16.6% frequent
impaired OHRQoL. The highest prevalence of problems was found to be psychological discomfort (60.2%),
followed by physical pain (51.7%) and physical disability (40.9%). In adjusted logistic regression analysis,
poor oral health status (tooth loss, having one or more cavities, and poor perceived periodontal health), and
poor general health status (depressive symptoms) were positive while oral health behavior (drinking piped
or bottled water, using toothpaste with fluoride, and never visited a dentist) were negatively associated
with both impaired and frequent impaired OHRQoL. In addition, frequent soft drink consumption was
associated with impaired OHRQoL, and having a high household income and being physically inactive
were associated with frequent impaired OHRQoL. A high prevalence of impaired OHRQoL was found
among this middle-aged and older adult population in central Myanmar. Several risk factors (poor oral
health status, poor general health status, poor oral and general health behavior) for impaired OHRQoL
were identified, which could help in guiding oral health interventions among the populace.
Acetabular fracture non-union with pelvic discontinuity
treated with two-stage total hip arthroplasty after intra- and
extra-articular plate fixation
Daigo Morita, Taisuke Seki, Yasuhiko Takegami, Takehiro Kasai,
Yoshitoshi Higuchi, and Naoki Ishiguro
pg(s) 113 - 119
<Abstract> - < PDF >
Surgical intervention for the treatment of acetabular fracture non-union is often challenging. Here, we
present a case of acetabular fracture non-union with pelvic discontinuity in a patient who underwent cemented
total hip arthroplasty (THA) after intra- and extra-articular plate fixation. The case was a 70-year-old
male with left T-shaped acetabular fracture non-union neglected for 5 months after the injury. The anterior
and posterior columns were not healed, and the articular surface was displaced toward the medial side
with a protrusion of the collapsed femoral head. As the first surgical intervention, we performed intra- and
extra-articular plate fixation after femoral head decapitation. We fixed non-union regions from the inferior
acetabular margin to the anterior column using a pelvic reconstruction plate bent three-dimensionally at
the acetabular curvature on the intra-articular side. Furthermore, we fixed that of the posterior column on
the outside of the acetabulum using a bent pelvic reconstruction plate. Union of the anterior and posterior
columns was observed at 4 and 6 months after the first surgical intervention. At 7 months, we performed a
cemented THA without additional bone grafting. At 1-year follow-up, the patient did not have left coxalgia
and could walk without any gait supports. Based on our experience, we propose this surgical protocol as
a useful treatment option for cases of acetabular fracture non-union.
Factors associated with antenatal care visits in Afghanistan:
secondary analysis of Afghanistan Demographic
and Health Survey 2015
Mohammad Walid Azimi, Eiko Yamamoto, Yu Mon Saw, Tetsuyoshi Kariya,
Ahmad Shekib Arab, Said Iftekhar Sadaat, Fraidoon Farzad, and Nobuyuki Hamajima
pg(s) 121 - 131
<Abstract> - < PDF >
Afghanistan is one of the countries with the poorest maternal mortality ratio in the world. Inadequate
utilization of antenatal care (ANC) services increases the risk of maternal mortality. This study aimed to
identify the factors associated with ANC visits in Afghanistan. The dataset of the Afghanistan Demographic
and Health Survey (AfDHS) 2015 were used for taking the socio-demographic factors, cultural factors, and
the number of ANC visits. The subjects of this study were 18,790 women who had at least one live birth
in the last five years, and 10,554 women (56.2%) had availed of at least one ANC visit. Most women
were 20-29 years old (53.3%), poor (41.7%), had 2–4 children (43.9%), lived in rural areas (76.1%),
and had no education (85.0%) or no job (86.7%). Most women answered that husbands made a decision
about their healthcare and that getting permission from their husbands was a major challenge. Multivariate
analysis showed that age, ethnicity, area of residence, parity, women’s education, husband’s education,
literacy, having a job, wealth, the decision maker for healthcare, and difficulty in getting permission from
the husband were significantly correlated with availing of the ANC visits. This study showed that not
only the socio-demographic factors but also the cultural factors were associated with ANC visits. The
Afghanistan government should improve the education programs at schools and healthcare facilities, for
both men and women. To augment women’s propensity to take a decision, the programs for women’s
empowerment need to be supported and extended across the country.
A descriptive study of gambling practices
and problem gambling among internal migrants
in Muse, Northern Shan, Myanmar
La Seng Aung, Seo Ah Hong, and Sariyamon Tiraphat
pg(s) 133 - 141
<Abstract> - < PDF >
Due to rapid economic growth in China, many gambling sites have emerged along the neighboring
countries, including Myanmar, which place migrants at risk of developing gambling problems. This study
aimed at identifying: i) types of gambling, ii) gambling involvement and intensity, and iii) the associations
with problem gambling. A community-based cross-sectional study was conducted in Muse, Myanmar. A
convenience sample of 273 internal migrants (18–49 years) filled a self-administered questionnaire. Chisquare
tests and multiple logistic regression explored associations between gambling practices and problem
gambling. Among the categories of gambling, the popular gambling types were lottery games (Aung Bar
Lay, Thone-Lone and Nhit-Lone) and card games, as well as the use of Electronic Gambling Machines
(EGMs). An average number of past-year gambling types involved and of gambling types engaged in
regularly were 1.61 (SD=0.95) and 1.22 (SD=0.70), respectively. In association with PG, Nhit-Lone,
EGMs, cards, and dice games were strongly associated among the gambling types. Those with PG had a
higher number of involvement by past-year gambling types (1.92 vs. 1.18 for no PG) and spent 5 times
higher amount of money on gambling. In conclusion, this study showed that types of gambling, such
as Nhit-Lone, cards and dice games and higher involvement and intensity were associated with problem
gambling. The findings provide new and important insights into gambling behavior among internal migrant
workers in the border area with China and highlight the need for culturally specific preventive measures
for the Myanmar population, with preference to gambling types.
SHORT COMMUNICATIONS
Coffee consumption and liver cancer risk in Japan:
a meta-analysis of six prospective cohort studies
Takashi Tamura, Asahi Hishida, and Kenji Wakai
pg(s) 143 - 150
<Abstract> - < PDF >
Previous epidemiological studies have shown that coffee consumption may reduce liver cancer risk.
The present study aimed to summarize the evidence for this association in the Japanese population by
performing a meta-analysis of the results of relevant cohort studies conducted in Japan. We searched studies
published prior to September 1, 2018 in PubMed. Extracted data were analyzed using a random effects
model. A total of six cohort studies from five publications were included in the final analysis. The pooled
estimate of relative risk with 95% confidence interval (CI) for the group with highest coffee consumption
was 0.50 (95% CI: 0.38–0.66, p < 0.001) compared with non-coffee drinkers or those who almost never
drink coffee. No evidence of publication bias was observed (p for Begg’s test = 0.85). This meta-analysis
suggested that coffee consumption among Japanese people has a significant role in preventing liver cancer.
Spontaneous remission of giant cell arteritis: possible
association with a preceding acute respiratory infection and
seropositivity to Chlamydia pneumoniae antibodies
Michitaka Maekawa, Tomonobu Iwadate, Kenshi Watanabe, Rie Yamamoto,
Takahiro Imaizumi, and Taishi Yamakawa
pg(s) 151 - 158
<Abstract> - < PDF >
Recent epidemiological or immunopathological studies demonstrate the possible association between
giant cell arteritis and infectious agents including Chlamydia pneumoniae. A 62-year-old Japanese man with
type 1 diabetes mellitus developed biopsy-proven giant cell arteritis after acute upper respiratory infection.
Serological examination indicated concurrent re-infection with C. pneumoniae. Clinical manifestations of the
vasculitis subsided within a month without any immunosuppressive therapy, and no relapse was observed
for the following 12 months. The natural history of this disease is unclear and spontaneous remission is
rarely reported. The self-limiting nature of the infection could contribute to this phenomenon.
CASE REPORTS
Computed tomography evaluation of the periacetabular gap
of a porous tantalum acetabular component
Shuji Asai, Yasumori Sobue, Nobuyuki Asai, Nobunori Takahashi, Tatsuo Watanabe,
Takuya Matsumoto, Naoki Ishiguro, and Toshihisa Kojima
pg(s) 159 - 163
<Abstract> - < PDF >
The periacetabular gap is an inherent consequence of the peripheral rim press-fit of the porous tantalum
acetabular component. The circumference of the prosthesis is clearly depicted with computed tomography
(CT) images that have been optimised to reduce metal artefacts. This case report highlights the utility of
single-energy metal artefact reduction (SEMAR) for CT evaluation of the periacetabular gap by comparing
CT images with and without SEMAR. A 70-year-old woman with a 5-year history of rheumatoid arthritis
underwent total hip arthroplasty with a porous tantalum modular acetabular component. A periacetabular gap
was suspected by plain radiography 2 weeks postoperatively. The metal artefacts rendered evaluation of the
circumference of the acetabular component difficult in CT images acquired without SEMAR. In contrast,
there were fewer metal artefacts, and a periacetabular gap (depth of 6.5 mm in DeLee and Charnley
zone 2) was clearly depicted in CT images with SEMAR 2 weeks postoperatively. The porous surface
of the acetabular component was in contact with the anterior and posterior rims of the acetabulum. Gap
filling with bone and bone ingrowth into the porous surface were observed on CT images with SEMAR
24 weeks postoperatively. In conclusion, SEMAR reduces metal artefacts and improves CT image quality
around the circumference of the acetabular component. The periacetabular gap and its filling with bone
are clearly depicted in CT images with SEMAR, but not without SEMAR.
Lobectomy for subsegmental lymph node metastasis
of unknown origin
Gaku Yamaguchi, Osamu Uchida, Shuji Ichinose, and Norihiko Ikeda
pg(s) 165 - 169
<Abstract> - < PDF >
We report a very rare case of resected subsegmental lymph node metastasis of unknown origin. Hilar
(N1) lymph node metastasis of unknown origin has previously been reported, but intrapulmonary lymph
node metastasis has not been reported to date. At this patient’s first visit to our hospital, an abnormal nodule
was found on the upper lung lobe on a chest radiograph. After 4 years’ follow-up, the nodule vanished,
but a tiny nodule had emerged. 2-Fluoro-2-deoxy-D-glucose positron-emission tomography (FDG-PET)
computed tomography was performed, and abnormal accumulation was observed only in the newly emerged
intrapulmonary nodule. Right upper lobectomy was performed and a metastatic subsegmental lymph node,
but no primary lesion, was found. Our observations suggest that evanescence of a suspicious primary
lesion indicates the possibility of metastasis. FDG-PET was useful in this case for detecting lymph node
metastases and demonstrating that the primary and further metastatic lesions were absent.
Estrogen producing ovarian fibrosarcoma: A case report
Mayo Miura, Shiro Suzuki, Kiyosumi Shibata, Hiroaki Kajiyama, and Fumitaka Kikkawa
pg(s) 171 - 176
<Abstract> - < PDF >
Fibrosarcoma is an extremely rare malignant sex-cord stromal tumor. Fibrosarcoma is generally unknown
as an estrogen producing tumor. This report presents, for the first time, a case of estrogen producing ovarian
fibrosarcoma in an 83-year-old female. We performed total hysterectomy, bilateral salpingo-oophorectomy
and omentectomy. Histopathologically, the tumor of the left ovary had high cellularity, cellular atypia and
10–15 mitotic counts per 10 high power fields. The tumor contained small components composed of cells
that were similar to Sertoli cells. In an effort to examine which component was producing estrogen, we
checked aromatase expression; but both components were positive. We could not explain which component
was producing estrogen. Postoperative clinical stage was IA. As she was geriatric patient, we did not
recommend adjuvant chemotherapy. There were no signs of recurrence or increase in serum estradiol level
at two years after the operation.
A Case of Portal Venous Stenting for Metastatic Hilar
Stricture After the Radical Resection of Colon Cancer
Kanji Minamoto, Nobuyuki Shigeto, and Toshio Ikeda
pg(s) 177 - 182
<Abstract> - < PDF >
Like standard stenting in an unresectable malignant stricture of the biliary or digestive tract, minimally
invasive modality for portal stenosis is indispensable for palliation. We describe here a safe and practical
procedure of portal stenting in a case of metastatic hilar strictures developed nine years after the radical
resection of sigmoid colon cancer. After urgent delivery of the biliary tract stenting for the relief of
jaundice, the patient received palliative stenting for the stricture of the portal trunk. Transhepatic approach,
via the anterior branch, of the portal vein intervention may fit into the standard aspects for portal stenting.