Objective: The purpose of this study was to compare delayed enhancement (DE) cardiac magnetic resonance (MR) imaging with the indine-123-metaiodobenzylguanidine(123I-MIBG) scintigram for measurement of left ventricular (LV) contraction function in patients with dilated cardiomyopathy (DCM). Materials and methods: DCM patients (n=29: mean age,51.9years; seven women) were evaluated by both DE cardiac MR imaging and 123I-MIBG scintigram. In all patients biopsy specimen showed disarray of the myocardium that was consistent with DCM. DE cardiac MR images were acquired using a two-dimensional segmented inversion-recovery prepared gradient-echo sequence (TI=250msec) 15minutes after intravenous administration of 0.1 mmol/kg gadolinium.The average CNR per slice (aCNR) for the LV myocardium was calculated.123I-MIBG scintigram was acquired at 15minutes and 3 hours (delayed imaging) after intravenous administration of 123I-MIBG (111MBq). The heart-to-mediastinum radioactivity ratio (H/M ratio) and washout rate (WR) was calculated. We evaluated the relationships between aCNR, WR, delayed H/M ratio, and the contraction function of the LV. Results: In MR imaging, mean aCNR was significantly higher in the low LV ejection fraction (LVEF<25%) group (n=11, 6.6±3.6) than in the high LVEF (≥25%) group (n=18, 2.4±2.9). However, with the 123I-MIBG scintigram, delayed H/M and WR were not significantly different between high (delayed H/M ratio ; 1.7±0.3, WR; 37.6±14.5) and low (delayed H/M ratio; 1.7±0.2, WR; 38.2±14.2) LVEF groups. Conclusions: DE MR imaging reflects the contraction function of the LV in patients with DCM, which may be related with myocardial fibrosis. DE MR imaging may be more useful to evaluate the contraction function of LV than 123I-MIBG scintigram.

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Although the inducible form of cyclooxygenase (COX), COX-2, is highly expressed in various cancers and it is also involved in cancer progression, its role in thyroid cancer is not fully understood. We assessed in the situ cyclooxygenase expression in normal thyroids (n=6), Graves' thyroids (n=6), thyroid adenomas (n=12), thyroid follicular (n=15) and papillary carcinomas (n=30). In comparison to the constitutive expression of COX-1, COX-2 was highly expressed in thyroid cancers (90.0% of thyroid papillary carcinomas and 73.3% of thyroid follicular carcinomas) and moderately in thyroid adenomas (25.5%), but barely expressed in normal and Graves' thyroid tissues. This quantitative assessment employed immunohistochemical methods. Thereafter we compared the effect of COX-2 inhibition on a human follicular thyroid carcinoma cell line (WRO), and a human papillary carcinoma cell line (NPA), using selective COX-2 inhibitor(NS-398). The treatment with 50 μM NS-398 suppressed the growth of the COX-2 expressing cells, NPA cells (37.7%;p<0.01) and WRO cells (10.1%;p<0.05). Moreover, at concentrations ≥ 100 μM, NS-398 induced cell death a mitochondrial dysfunction. In addition, 50 μM of NS-398 inhibited the activation of extracellular signal-regulated kinase in NPA cells after the stimulation with fetal bovine serum. Our results indicate that COX-2 is involved in the progression of thyroid cancer.

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There have been various arguments concerning the patient-prosthesis mismatch (PPM) after aortic valve replacement (AVR) for small valves. The objective of this study was to evaluate the postoperative hemodynamics in patients. Methods: The subjects were 6 patients [6 females aged 64 (17~74) years, with a median body surface area (BSA) of 1.37 (1.29~1.51) m²] who underwent AVR at our facility using the 18-mm ATS-AP and tolerated exercise loading. We estimated pressure gradient(PG) ,ejection fraction(EF), left ventricular mass Index(LVMI)at pre-operation and post-operation. Exercise echocardiography on an ergometer was performed before and 29.0 ± 14.4 months after surgery. We estimated PG and effective orifice area(EOAI) at rest and at exercise. We compared echo data between pre-operation and post-operation, between at rest and at exercise. Results: The effective orifice area index(EOAI) at rest was 0.92(0.75~1.06) cm²/m². There was a significant change in the LVMI between pre-operation and post-operation[158.5(104.0~222.2) g/m² versus 102.4(92.3~146.4) g/m²; P < 0.05]. However, There was no significant change in the EOAI[0.92(0.75~1.06) cm²/m² versus 0.84(0.78~0.91) cm²/m²; P > 0.05] and mean PG[11.0(6.6~16) mmHg versus 14.0(6.3~16) mmHg; P > 0.05], on maximal exercise. Conclusion: In patients whose BSA were 1.37(1.29~1.51) m²,the 18-mm ATS-AP was suggested to be a prosthetic valve that improves myocardial remodeling and provides stable hemodynamics even during exercise.

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[in Japanese]

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Jejunoileal fistula is an extremely rare complication in patients with intestinal lymphoma. Here, we report a Japanese male patient with enteropathy-type intestinal T-cell lymphoma presenting abdominal pain and weight loss. A jejunoileal fistula was discovered during colonoscopy and pathological diagnosis was performed preoperatively by forceps biopsy. After elective surgery for partial resections of jejunum, ileum, and sigmoid colon, eight cycles of cyclophosphamide, doxorubicin, vincristine and prednisolone chemotherapy led complete remission of the disease.

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