Biomedical subjects

Hitoshi Tsuda

Publications and source records attributed to Hitoshi Tsuda.

At least 37 records · Page 2Linked to original sources

PubMed2005

Reliability and validity of TEMPS-A in a Japanese non-clinical population: application to unipolar and bipolar depressives.

BACKGROUND: In Japan, TEMPS-A has gathered much attention, because Kraepelin's concepts on "fundamental states" of mood disorder and temperaments have been widely respected. METHOD: TEMPS-A was translated into Japanese (and after the approval of the English back translation by H.S.A.), it was administered to 1391 non-clinical subjects, and 29 unipolar and 30 bipolar patients in remission. Of the non-clinical sample, 426 were readministered the instrument again in 1 month. A control group matched for gender and age was drawn from the non-clinical sample. RESULTS: Regarding test-retest reliability, Spearman's coefficients for depressive, cyclothymic, hyperthymic, irritable and anxious temperaments were 0.79, 0.84, 0.87, 0.81 and 0.87, respectively; regarding internal consistency, Cronbach's alpha coefficients were 0.69, 0.84, 0.79, 0.83 and 0.87, respectively. The unipolar and bipolar groups showed significantly higher depressive, cyclothymic and anxious temperament scores than the control group. Curiously, the bipolar group showed significantly lower hyperthymic score than the control group; irritable temperament scores showed no significant differences. Depressive, cyclothymic, irritable and anxious temperament scores showed significant correlations with each other. Between the unipolar and bipolar groups, there was little difference regarding the temperament scores. Also the inter-temperament correlations showed the same pattern in the unipolar and bipolar groups. LIMITATION: The clinically well cohort was 70% male. CONCLUSION: TEMPS-A showed a high reliability and validity (internal consistency) in a Japanese non-clinical sample. By and large, the hypothesized five temperament structure was upheld. Depressive, cyclothymic and anxious temperaments showed concurrent validity with mood disorder. Irritable temperament may represent a subtype of depressive, cyclothymic or anxious temperaments. There may be a temperamental commonality between unipolar and bipolar disorders. TEMPS-A will open new possibilities for international research on mood disorder and personality traits.

Adult↗

PubMed2005

The proposed factor structure of temperament and personality in Japan: combining traits from TEMPS-A and MPT.

BACKGROUND: In Japan, Kraepelin's descriptions on four "fundamental states" of manic depressive illness, the concepts of schizoid temperament by Kretschmer and obsessional and melancholic type temperament by Shimoda and Tellenbach have been widely accepted. This research investigates the construct validity of these temperaments through factor analysis. METHOD: TEMPS-A measured depressive, cyclothymic, hyperthymic and irritable temperaments and MPT rigidity, esoteric and isolation subscales measured, respectively, melancholic type and schizoid temperaments. Factor analysis was implemented with TEMPS-A alone and TEMPS-A and MPT combined data. RESULTS: With TEMPS-A alone analysis, Factor 1 included 1 depressive, 11 cyclothymic and 12 irritable temperament items with a factor loading higher than 0.4; Factor 2 included 1 depressive and 10 hyperthymic temperament items; and Factor 3 included 2 depressive temperament items only. With TEMPS-A and MPT combined data, Factor 1 included 3 depressive, 11 cyclothymic and 5 irritable temperament items with a factor loading higher than 0.4 (interpreted as the central cyclothymic tendency for all affective temperaments along Kretschmerian lines and accounting for 11.7% of the variance); Factor 2 included 6 hyperthymic temperament items (6.22% of variance); Factor 3 included 1 cyclothymic, 7 irritable and 1 schizoid temperament items (interpreted as the irritable temperament and accounting for 3.24% of the variance); Factor 4 included 1 depressive temperament and 5 melancholic type items (interpreted as the latter, accounting for 2.66% of the variance); Factor 5 included 5 depressive temperament items, along interpersonal sensitivity and passivity lines, and accounting for 2.31% of the variance; and Factor 6 included 4 schizoid temperament items accounting for 2.07% of the variance. LIMITATION: We did not use the Kasahara scale, which some believe to better capture the Japanese melancholic type. Sample was 70% male. CONCLUSION: These analyses confirm the factor validity of depressive, hyperthymic, cyclothymic and irritable temperaments (TEMPS-A), as well as the melancholic type and the schizoid temperament (MPT). Traits of the depressive and melancholic types emerge as rather distinct. Indeed, our results permit the delineation of an interpersonally sensitive type that "gives in to others" as the core features of the depressive temperament; this is to be contrasted with the higher functioning, perfectionistic, work-oriented melancholic type. Mood dysregulation is represented by the largest number of traits in this population. Contrary to a widely held belief that the melancholic type with its devotion to work and to others is the signature temperament in Japan, cyclothymic traits account for the largest variance in this nonclinical population. Hyperthymic temperament, melancholic type and schizoid temperaments appear largely independent of mood dysregulation. In this Japanese population, TEMPS-A may identify temperament constructs more comprehensively when implemented with melancholic type and schizoid temperament question items added to it. The proposed new Japanese Temperament and Personality (JTP) Scale has self-rated items divided into six subscales.

Adult↗

PubMed2005

Prognostic implication of laminin-5 gamma 2 chain expression in the invasive front of colorectal cancers, disclosed by area-specific four-point tissue microarrays.

The laminin-5 gamma 2 chain (LN-5gamma2) is known to be a marker of invasion in several cancer types. Our purpose was to examine the prognostic significance of LN-5gamma2 expression in different areas of individual colorectal cancers (CRCs) by using tissue microarrays (TMAs), and to clarify the optimal areas for prognostic assessment. Using formalin-fixed paraffin-embedded tissue blocks of pT3 primary CRCs resected from 120 patients, we constructed TMA blocks of tissue core specimens taken from the submucosal invasive front, subserosal invasive front, central area, and rolled edge of each tumor. Using these four-point TMA sets, cytoplasmic LN-5gamma2 expression was immunohistochemically surveyed, and the area-specific prognostic significance of LN-5gamma2 expression was evaluated. The data revealed that 35, 30, 15 and 10% of the 120 CRCs showed high-grade LN-5gamma2 expression in the submucosal invasive front, subserosal invasive front, central area and rolled edge, respectively. Disease-specific survival curves for the groups with high- and low-grade LN-5gamma2 in the submucosal invasive front and subserosal invasive front were different significantly or of marginal difference (respective 5-year survival rates: 54 and 78% for submucosal invasive front (P=0.030) and 58 and 75% for subserosal invasive front (P=0.055)). Multivariate analysis revealed that the grades of LN-5gamma2 expression in submucosal invasive front (hazard ratio=2.0, P=0.047) and subserosal invasive front (hazard ratio=2.9, P=0.0033) were independent prognostic factors. In contrast, the grades of LN-5gamma2 expression in the central area and rolled edge did not have a significant impact on patient prognosis. Analysis using area-specific four-point TMAs clearly demonstrated that LN-5gamma2 expression in the invasive front largely influences the degree of clinical aggressiveness of CRC and its tendency to metastasize.

Aged↗

PubMed2005

Involvement of cyclin D3 in liver metastasis of colorectal cancer, revealed by genome-wide copy-number analysis.

The question of whether any genetic differences exist between primary and colorectal cancers (CRCs) and their metastatic foci is controversial. To look for genetic aberrations involved in metastasis of CRCs to the liver, we performed subtractive comparative genomic hybridization (CGH) experiments using paired samples from 20 CRC patients with primary tumors and synchronous or metachronous liver metastases. Relatively frequent gains in DNA copy number were detected at 6p, suggesting the presence of one or more metastasis-related genes in the region. Analysis of 11 CRC cell lines using array-based CGH (CGH-array) revealed one 6p candidate gene, CCND3. Quantitative reverse transcriptase-polymerase chain reaction experiments showed that CCND3 was significantly upregulated in liver-metastatic lesions compared with primary lesions (P<0.0152). In addition, immunohistochemical analysis of 120 primary CRC tumors demonstrated that cyclin D3 expression in the region of rolled edge was significantly associated with total recurrence, especially hematogenous recurrence (P=0.0307). The results implied involvement of cyclin D3 in liver metastasis of CRC, and the data may contribute to the development of a novel therapy or diagnostic agent for this currently intractable disease. Our experiments also confirmed the power of subtractive CGH and CGH-array analysis for identifying cancer-related genes.

Colorectal Neoplasms↗

PubMed2005

Photoacoustic diagnosis of burns in rats.

BACKGROUND: Accurate burn depth assessment is important for determining the appropriate treatment plan for severe burn patients. However, conventional methods of diagnoses, such as visual observation and pinprick test, are often inaccurate. We previously proposed a new method for burn diagnosis in which photoacoustic signals originating from the blood in healthy tissue under the injured tissue are measured. In this study, we investigated the validity of this method by an experiment using rat scald burn models. METHODS: Superficial dermal burns (SDBs), deep dermal burns (DDBs), and deep burns (DBs) were made in the dorsal skin of rats by using a Walker-Mason template. Wounds were irradiated with low-energy, 550-nm, nanosecond pulsed light, and photoacoustic signals induced were measured with a piezoelectric film as a function of postburn time. Measurement in normal skin as a control was also performed. Temporal profiles of the photoacoustic signals were converted into depth profiles using sound velocity of tissue, and for each profile, a peak showing highest signal intensity was selected. For this peak, the depth at which the signal rose (signal rise depth) and the depth that gave a peak value (signal peak depth) were recorded. Statistical analysis was performed to clarify the difference in depth information of signals between burn groups. RESULTS: Depth profiles of photoacoustic signals showed unique features depending on the degree of burn; pronounced peaks shifted to deeper tissue as the burn severity increased. This indicates that the zone of stasis formed due to injuries can be monitored. There were significant differences in both the signal rise depth and the peak depth between the control and SDB groups, SDB and DDB groups, and DDB and DB groups (p < 0.001). CONCLUSION: SDBs, DDBs, and DBs can be differentiated by photoacoustic signals, suggesting that the method proposed is useful for diagnosing burn injuries.

Acoustics↗

PubMed2005

Correlation of KIT and EGFR overexpression with invasive ductal breast carcinoma of the solid-tubular subtype, nuclear grade 3, and mesenchymal or myoepithelial differentiation.

Although KIT and EGFR overexpressions are reported to occur in breast cancer, their pathological significance is still unclear. We examined KIT, EGFR, and c-erbB-2 overexpressions immunohistochemically in 150 cases of surgically resected breast cancer and their correlation with the histological type and grade and mesenchymal and/or myoepithelial immunophenotype of primary tumors. To facilitate the analysis, we constructed a tissue microarray comprising 2-mm diameter tissues cored from the representative tissue block of each tumor. KIT, EGFR, and c-erbB-2 overexpressions were detected in 15 (10%), 12 (8%), and 23 (15%), respectively. The KIT was more frequent in the group comprising comedo-type ductal carcinoma in situ and invasive ductal carcinomas (IDCs) of the solid-tubular subtype than in the group of other histological types (P=0.027), and the EGFR was more frequent in IDCs of solid-tubular type than in other histological types (P <0.05). KIT and EGFR overexpressions were correlated with nuclear grade 3 (P=0.0095 and 0.0005) and tended to be concurrent (P=0.005). KIT overexpression was correlated with vimentin and S-100 expression (P=0.003 and P=0.005), and EGFR overexpression was correlated with S100 expression (P=0.0001). These correlations with grade and mesenchymal/myoepithelial markers were not observed for c-erbB-2 overexpression. KIT and EGFR appeared to be indicators of high-grade breast carcinoma groups that often contain the carcinomas with mesenchymal and/or myoepithelial differentiation, which are distinct from the group with c-erbB-2 overexpression.

Biomarkers, Tumor↗

PubMed2005

Screening of DNA copy-number aberrations in gastric cancer cell lines by array-based comparative genomic hybridization.

We performed genome-wide screening for deoxyribonucleic acid copy-number aberrations in 31 gastric cancer (GC) cell lines by using custom-made comparative genomic hybridization (CGH)-array. Copy-number gains were frequently detected at 1q, 3q, 5p, 7p, 7q, 8q, 11q, 17q, 20p, 20q, Xp and Xq, and losses at 3p, 4p, 4q, 8p, 9p, 18p and 18q. With respect to histological subtypes, copy-number gains at 1p, 16p, 20p, 20q and 22q, and losses at 8p, 10p, 10q and 18q were significantly frequent in cell lines derived from tumors of the well-differentiated type, whereas copy-number gains at 1q, 7p, 7q, Xp and Xq were frequent in the undifferentiated type. Homozygous deletions were seen at five loci, whereas high-level amplifications were detected in 15 of the 31 GC cell lines; these had occurred at 24 loci, including the segment containing CDK6 (7q21.2). Amplification of that gene had never been reported in GC before. Immunohistochemical studies showed increased levels of CDK6 protein in 54 of the 292 primary GC samples we examined (18.5%). Cytoplasmic localization of CDK6, as well as CDK6 over-expression, was more frequent in well-differentiated GC than in undifferentiated tumors. Nuclear expression of CDK6 was more frequent in early stage GC than in advanced tumors, suggesting that nuclear localization of CDK6 is likely to be a prognostic factor for GC. Taken together, our data indicate that CDK6 might be involved in the pathogenesis of GC and, more generally, that CGH-arrays have a powerful potential for identifying novel cancer-related genetic changes in a variety of tumors.

Adenocarcinoma↗

PubMed2005

Frequent KIT and epidermal growth factor receptor overexpressions in undifferentiated-type breast carcinomas with 'stem-cell-like' features.

It was hypothesized that four histopathological types or subtypes of breast carcinoma were undifferentiated types characterized by bidirectional differentiation toward both luminal epithelial and myoepithelial cells and had characteristic molecular changes: invasive ductal carcinoma (IDC) with a large central acellular zone, atypical medullary carcinoma (a subgroup in Grade 3 solid-tubular carcinoma), matrix-producing carcinoma, and spindle-cell carcinoma (or carcinoma with spindle-cell metaplasia). In 32 cases of the undifferentiated type and 37 cases of the relatively differentiated types, we immunohistochemically examined the expressions of myoepithelial markers and KIT, epidermal growth factor receptor (EGFR), and c-erbB-2 oncoproteins. Vimentin, S-100, and alpha-smooth muscle actin were positive in 28 (88%), 22 (69%), and 15 (47%) of the undifferentiated types, but were positive in seven (19%), one (3%), and one (3%) of relatively differentiated types (P < 0.0001). KIT and EGFR overexpressions were detected more frequently in the undifferentiated types (34 and 88%, respectively) than in relatively differentiated types (3 and 3%, respectively) (P < 0.0001, for both). In 11 (85%) of 13 cases with KIT overexpression, EGFR overexpression concurred. c-erbB-2 overexpression was almost equally detected in both the undifferentiated and relatively differentiated types, and did not correlate with KIT or EGFR overexpression. Phosphotyrosine was detected in 16 (67%) of 24 cases with KIT, EGFR, and/or c-erbB-2 overexpression but only in six (18%) of 34 cases without KIT, EGFR, or c-erbB-2 overexpression (P = 0.0002). The undifferentiated-type breast carcinomas appeared to show mammary epithelial stem cell-like features, and they could be identified by KIT and/or EGFR overexpressions.

Biomarkers, Tumor↗

PubMed2005

Overexpressed Skp2 within 5p amplification detected by array-based comparative genomic hybridization is associated with poor prognosis of glioblastomas.

To better understand the pathogenesis of glioblastoma multiforme (GBM) and to increase the accuracy of predicting outcomes for patients with this disease, we performed genome-wide screening for DNA copy-number aberrations in 22 glioma-derived cell lines using a custom-made comparative genomic hybridization-array. Copy-number gains were frequently detected at 3q, 7p, 7q, 20q, Xp and Xq, and losses at 4q, 9p, 10p, 10q, 11q, 13q, 14q, 18q, and 22q. Among several non-random chromosomal aberrations, the gain/amplification of DNA at 5p, which has never been reported before in GBM, was detected with a relatively high ratio (log2 ratio = 0.41-1.19) in four cell lines. Amplification and subsequent overexpression of SKP2, a possible target of amplification within 5p, were detected in four of the 22 cell lines. We also investigated the expression of the gene product in primary GBM by immunohistochemistry, which revealed increased levels of Skp2 in 11 of the 35 tumors examined (31.4%). Heightened expression of Skp2 was associated with shorter overall survival (P = 0.001, logrank test), especially in patients younger than 65 years. These results suggest that overexpression of Skp2 through gene amplification may contribute to the pathogenesis of GBM, and that overabundance of the protein might be a useful prognostic tool in patients with this disease.

Biomarkers, Tumor↗

PubMed2005

Vascular endothelial growth factor mRNA levels quantified by reverse transcription-polymerase chain reaction in microdissected breast carcinoma tissues are correlated with histological type and grade of both invasive and intraductal components.

In breast cancer, vascular endothelial growth factor (VEGF) is a prognostic factor, but the relationship of VEGF mRNA levels with various parameters or tumor progression is unclear. VEGF mRNA levels were measured in 48 cases of invasive ductal carcinoma by using laser capture microdissection and quantitative reverse transcription-polymerase chain reaction (RT-PCR). The mean VEGF mRNA levels were compared among different histological types and grades in 41 and 29 samples of invasive and intraductal components, respectively. VEGF mRNA levels were always higher in cancerous cells than in non-cancerous cells, but mean VEGF mRNA levels were not significantly different between invasive component (3.24 +/- 3.18-fold the value of non-cancerous tissue) and intraductal component (4.14 +/- 4.43-fold). They were higher in papillotubular type than in other types, and higher in grade 2 carcinomas than in grade 3 carcinomas of invasive component, and higher in comedo type than in other types of intraductal component. Mean VEGF mRNA levels were higher in the VEGF-immunopositive group than in the VEGF-immunonegative group. There was no correlation between VEGF mRNA levels and tumor size, nodal status, or hormone receptor status. VEGF expression may play an important role in the development of both invasive and intraductal carcinoma components, especially those carcinoma components of less aggressive histological features.

Adult↗

PubMed2005

Reproducible and clinically meaningful differential diagnosis is possible between lobular endocervical glandular hyperplasia and 'adenoma malignum' based on common histopathological criteria.

The aim of the present study was to determine if the differential diagnosis between lobular endocervical glandular hyperplasia (LEGH) and minimal deviation adenocarcinoma (MDA), or 'adenoma malignum', is reproducible when clear criteria for these two lesions are given. A total of 44 proliferative endocervical glandular lesions were collected, for which differential diagnosis from MDA was considered to be necessary. Seven observers independently classified these 44 lesions into LEGH, LEGH with adenocarcinoma in situ (AIS), MDA, or common cervical adenocarcinoma, according to the following criteria: LEGH was non-invasive proliferation of endocervical glandular cells without any obvious adenocarcinoma component. MDA was very well-differentiated endocervical-type mucinous adenocarcinoma composed mostly of LEGH-looking glands but containing the component of obviously invasive adenocarcinoma. LEGH with AIS was defined as continuous coexistence of LEGH and AIS. Among these four diagnostic categories, the interobserver agreement level was substantial (kappa = 0.618). The level increased to almost perfect (kappa = 0.928) between the group of non-invasive lesions consisting of LEGH and LEGH with AIS and the other group of invasive lesions comprising MDA and common adenocarcinoma. When the modal diagnosis was adopted as the final diagnosis for individual lesions, the 5 year survival rate of patients after surgery was 100% for the non-invasive lesions but only 54% for the invasive lesions (P < 0.01). It is clearly shown that reproducible differential diagnosis is possible between LEGH, LEGH with AIS, and MDA and that such a differentiation is clinically meaningful.

Adenocarcinoma↗

PubMed2005

Simultaneous imaging of membrane antigen and the corresponding chromosomal locus in pathology archives.

A new procedure for the simultaneous staining of membranous antigens, such as tyrosine kinase-type cell surface receptor HER2 (c-erbB2), and the corresponding chromosome (chromosome 17 for c-erbB2) in the same cell for use in examining pathology archives is presented. A multistep procedure involving microwave-assisted fluorescence in situ hybridization and immunofluorescence yielded cell images having c-erbB2 on the membrane and genomic signals from the chromosome 17 centromere and the c-erbB2 locus. Furthermore, a combination of microwave-assisted chromogenic in situ hybridization and immunohistochemistry found colorized signals from both chromosome 17 centromere in the nuclei and c-erbB2 on the membranes of individual cells. Quantitative image analysis further confirmed the presence of a significantly stronger c-erbB2 immunoreactivity on cells containing three or more signals from chromosome 17 than from those with less than three signals. It was possible to extend the constellation of cell surface markers and corresponding chromosomes or locus-specific makers to several other genes including CDH1. In this case, the disappearances of CDH1 expression, a CDH1 locus signal, and a centromere enumeration probe (CEP) 16 signal were simultaneously demonstrated in the less-adhesive tumor cells. Thus, it is believed that this procedure might pave the way for exploiting pathology archives for the genotype-phenotype analysis of individual cells.

Antigens, Surface↗

PubMed2005

Expression of KIT, EGFR, HER-2 and tyrosine phosphorylation in undifferentiated thyroid carcinoma: implication for a new therapeutic approach.

The KIT, epidermal growth factor receptor (EGFR) and HER-2 oncoproteins have tyrosine kinase activity and are molecular targets in human cancer therapy. To clarify the significance of KIT, EGFR, and HER-2 in undifferentiated thyroid carcinoma (UTC), the expression of these receptors and tyrosine phosphorylation was examined immunohistochemically in resected cases of UTC and papillary thyroid carcinoma (PTC). KIT, EGFR, and HER-2 were also examined at the protein and mRNA levels in five UTC cell lines. KIT expression (1+), EGFR overexpression (2+/3+), HER-2 expression (1+), and tyrosine phosphorylation were detected immunohistochemically in 40%, 70%, 10%, and 50% of the 10 UTC. In 20 PTC, KIT, EGFR, and HER-2 were not detected, but tyrosine phosphorylation was detected in 25% of cases. In the five UTC cell lines, KIT expression (1+), EGFR overexpression (3+), HER-2 expression (1+), and tyrosine phosphorylation were detected immunocytochemically in 60%, 100%, 20%, and 40%, respectively. Western blot analysis did not detect KIT expression, but did detect EGFR and HER-2 expression in all five cell lines. Real-time polymerase chain reaction detected KIT mRNA in two of the cell lines (40%), EGFR in five (100%), and HER-2 in three (60%). The present findings suggest that EGFR overexpression was involved in the proliferation and development of UTC and was frequently accompanied by tyrosine phosphorylation. Expression of KIT and HER-2 appeared to be weak but significant, suggesting a possible role in the development of UTC. Molecular therapies targeting KIT, EGFR, HER-2, and/or tyrosine phosphorylation might be indicated for UTC.

Antigens, Neoplasm↗

PubMed2005

Interim analysis of a phase II trial of cyclophosphamide, epirubicin and 5-fluorouracil (CEF) followed by docetaxel as preoperative chemotherapy for early stage breast carcinoma.

PURPOSE: A single-arm phase II multicenter trial of the combination of cyclophosphamide (C), epirubicin (E), and 5-fluorouracil (F) followed by docetaxel as neoadjuvant chemotherapy is being conducted by the Japan Breast Cancer Research Group. This report describes an interim analysis of the clinical response and safety of 79 patients who finished preoperative chemotherapy and surgery. PATIENTS AND METHODS: Patients with operable breast cancer received C at 500 mg/m2, E at 100 mg/m2, and F at 500 mg/m2 every 21 days for 4 cycles followed by docetaxel at 75 mg/m2 every 21 days for 4 cycles. RESULTS: Of the 79 patients evaluable for analysis the median age was 46 years (28-59), and 61 patients (77.2%) had T2 tumors. A total of 312 of 316 (98.7%) cycles of CEF and 296 of 312 (94.9%) cycles of docetaxel were administered. Average total cumulative dose was 92% and 95% for CEF and docetaxel, respectively. The rate and grade of edema, neuropathy, arthralgia and myalgia were higher with docetaxel than with CEF. The overall clinical response rate was 70.9%. Breast conserving surgery was performed in 31 of 42 patients (73.8%) with a base-line tumor size of more than 3 cm. CONCLUSIONS: Interim data suggest that CEF followed by docetaxel is an active and tolerable neoadjuvant chemotherapy regimen. A final analysis is planned for 2005.

Adult↗

PubMed2005

[Depression and personality].

In the current research concerning the relation between depression and personality a phenomenological, anthropological method and an empirical, statistical method coexist. Each of these methods has its own limitations. The latter is abandoning the classical endogenous-neurotic dichotomy without full considerations. It also tries to treat the personality as an objectively defined entity and it lacks insight into the fact that the "pre"-morbid personality is sometimes revealed "after" onset of the illness. Although the former has succeeded in establishing the concept of "Typus melancholicus," which is still of a clinical significance today, it is not sufficiently well developed to deal with patients having endogenous symptoms who show other types of personality. It also lacks the profound description on the domain of neurotic depression or depression with personality disorder. Typus melancholicus personality includes two components, not only as found in its original phenomenological arguments but also as suggested by the recent empirical research. The first component consists of the tendency to seek for a symbiotic relation with others and the intolerance of ambiguity. The excessive narcissistic cathexis to the "private self," rather than the "official self" (Matussek), can also be included here. The second component consists of the "orderliness" and the "hypernomic" identification with role identities. Typus melancholicus is brought about only when these two components are integrated into one personal structure and the contradiction between them remains not overt. In contrast, it can be considered that in such marginal types as the dependent anaclytic type, avoidant type and soft bipolar type, this contradiction is already overt. Although these marginal types show neurotic or personality disorder-like manifestations, it can be considered that the authentic domain of neurotic depression and the depression of personality disorder spreads outside of these marginal types. In this domain the depression in which the problems of object relations play a dominant role is important. It is worth taking into consideration the contrast between endogenous depression and depression associated with the problems of object relations when we decide therapeutic strategies. This contrast can be pointed out from the following three perspectives; the relation between subject and society, ambivalence, and the status of somatic symptoms. In the former, social elements play a limited role, constituting only the background conditions of patients, while in the latter patients' personal conflicts are closely intermingled with social elements. In the former the patients are almost unable to maintain ambivalent feelings so as to deal with reality and they rather adjust themselves to reality utilizing their syntonic personalities. The latter patients, on the other hand, have intense ambivalent feelings and are impacted when the negative side of the ambivalence predominates. In the former, pathological phenomena are located where somatic and psychological spheres are not yet divided, while in the latter metaphorical interpretations of somatic symptoms from the psychological contents are sometimes possible to a certain degree.

Depression↗

PubMed2004

A proposal for diagnostically meaningful criteria to classify increased epidermal growth factor receptor and c-erbB-2 gene copy numbers in gastric carcinoma, based on correlation of fluorescence in situ hybridization and immunohistochemical measurements.

Amplification of the epidermal growth factor receptor (EGFR) and/or c-erbB-2 oncogenes and overexpression of their proteins are detected in 30% of gastric carcinomas, but there are few reports regarding the correlation between gene amplification and protein overexpression. We examined the correlation between amplification of the EGFR and c-erbB-2 genes, detected using fluorescence in situ hybridization, and overexpression of their proteins, detected using immunohistochemistry, in formalin-fixed tissue sections of 54 surgically resected gastric carcinomas. A mean EGFR copy number per nucleus of four or more and an EGFR/chromosome 7 centromere (CEP7) ratio of 1.7 or more were each detected in 4 specimens (7%). The sensitivity and specificity of both criteria for EGFR protein overexpression were 75% and 92%, respectively. A mean c-erbB-2 copy number per nucleus of 7.0 or more and a c-erbB-2/chromosome 17 centromere (CEP17) ratio of 2.0 or more were detected in six (11%) and eight (15%) specimens, respectively. The sensitivity and specificity of the former criterion to c-erbB-2 overexpression were 83% and 98%, respectively, while those of the latter were 63% and 98%. A mean EGFR gene copy number of 4.0 or more and/or an EGFR/CEP7 ratio of 1.7 and a mean c-erbB-2 gene copy number of 7.0 or more and/or a c-erbB-2/CEP17 ratio of 2.0 or more would be useful in defining increased EGFR and c-erbB-2 gene copy numbers, respectively, in gastric carcinomas.

Adenocarcinoma↗

PubMed2004

The subserosal elastic lamina: an anatomic landmark for stratifying pT3 colorectal cancer.

PURPOSE: Approximately 50 percent of all patients with resected colorectal carcinoma have tumors with pT3 status; however, no subclassifications of the penetration depth have been proposed. The purpose of this study is to evaluate the significance of histologic invasion beyond subserosal elastic lamina by colorectal carcinoma for postoperative recurrence and long-term survival after resection. METHODS: pT3 colorectal carcinomas located above the peritoneal reflection were retrospectively classified into two depth grades (subserosal elastic lamina classification). Namely, "pT3-shallow" is defined as tumors those are confined above the subserosal elastic lamina, and "pT3-deep" is defined as tumors those penetrate beyond it. Based on subserosal elastic lamina classification, the 325 consecutive patients who underwent resections were divided into two groups, and then the clinicopathologic features, incidence of postoperative recurrence, and survival rates were compared between the two groups. RESULTS: The overall postoperative recurrence rate in the pT3-deep group (35.2 percent) was higher than that in the pT3-shallow group (20.8 percent). In detail, liver and peritoneal recurrence rates in the pT3-deep group (19.7 percent, 7.7 percent, respectively) were higher than those in the pT3-shallow group (9.4 percent, 2.0 percent, respectively). There was a strong difference ( P < 0.0001) in overall survival rate between the pT3-deep group (5-year survival of 57.0 percent) and the pT3-shallow group (5-year survival of 78.6 percent). Multivariate analysis revealed that synchronous hematogenous metastasis ( P < 0.0001), lymph node metastasis ( P < 0.05), venous invasion ( P < 0.01), and subserosal elastic lamina classification ( P < 0.05) were the independent prognostic factors for postoperative survival. CONCLUSIONS: The newly proposed subserosal elastic lamina classification is a useful subclassification to predict the prognosis of patients with resected pT3 colorectal carcinomas.

Aged↗

PubMed2004

Optimal particle size of radiocolloid for sentinel node identification in breast cancer-electron microscopic study and clinical comparison.

BACKGROUND: Sentinel node (SN) biopsy using a radiotracer is easy to learn, reproducible, and performed by the majority of breast cancer surgeons. However, this technique raises the question: what is the optimal particle size of colloid? METHODS: Patients were injected with conventional tin colloid (median particle diameter: 700 nm) and the predominant particle size of radiocolloid retained in the SN was measured using electron microscopy. This showed a narrow distribution of colloidal size (100-150 nm). Patients were then injected with modified tin colloid having a median particle size of 100 nm. A clinical comparison was performed between conventional particle size or reduced particle size tin colloid and the SN biopsy success rate, the number of SNs, and the colloidal uptake in SNs. RESULTS: A total of 118 patients were injected with the conventional tin colloid (group I) and 124 patients with the smaller particle colloid (group II). The identification rate and the number of SN in both groups were almost equal, and the patients with low-uptake SNs were not significantly less in group I(p = 0.55). However, in the subgroup of patients 60 years of age or more, group II had significantly more SNs than group I(1.4 vs 1.9; p = 0.03) and low-uptake SNs were significantly less common than in group I(p = 0.02). CONCLUSIONS: The improvement of colloidal uptake in SNs using the smaller particle size tin colloid was confirmed, and this impact was statistically significant in the older population.

Adult↗