Intrathoracic chemothermotherapy following panpleuropneumonectomy for pleural dissemination of invasive thymoma

We report a case of pleural dissemination of invasive thymoma, which was successfully treated with intrathoracic chemothermotherapy following panpleuropneumonectomy. Intrathoracic chemothermotherapy in combination with surgery may be a hopeful adjuvant treatment to control pleural disseminated lesions of invasive thymoma.

Pleural invasion by peripheral bronchogenic carcinoma: assessment with three-dimensional helical CT

PURPOSE

To evaluate the potential role of three-dimensional (3D) computed tomography (CT) in assessment of pleural invasion by peripheral bronchogenic carcinoma.

MATERIALS AND METHODS

Twenty-four-second helical CT scans were obtained during a single breath hold in 42 consecutive patients with peripheral bronchogenic carcinoma. Conventional two-dimensional (2D) images and 3D reconstruction images were reviewed independently by three blinded observers, who reached a decision by consensus. All patients underwent surgical resection of the tumor, and CT findings were correlated with the findings in pathologic specimens.

RESULTS

Twelve patients had visceral pleural invasion, five had parietal pleural invasion, and 25 had no evidence of pleural invasion. Visceral pleural invasion was identified on 2D CT images in two patients and on 3D reconstructions in 11. Parietal pleural invasion was identified on 2D CT images in two patients and on 3D reconstructions in three.

CONCLUSION

3D reconstruction imaging is superior to conventional 2D CT in assessment of pleural invasion by peripheral bronchogenic carcinoma.

Case report: new sonographic finding in renal infarction

We observed a unique sonographic finding in a patient with right global renal infarction associated with an abdominal aortic dissection. Sonography in the acute phase revealed a highly echogenic and thickened perirenal fascia without demonstrable abnormality of the renal parenchyma. This finding may be helpful in the early diagnosis of renal infarction by routine sonography.

Surgical treatment of adrenal metastasis following pulmonary resection for lung cancer: comparison of adrenalectomy with palliative therapy

Although adrenal metastases from lung cancer are frequently detected during the late clinical stage or at autopsy, they are rarely surgically treated following pulmonary resection for lung cancer. We detected adrenal lesions as initial clinical recurrence in 9 (1%) of 904 patients who underwent pulmonary resection for lung cancer at our institute between 1980 and 1992. Adrenalectomy was performed in five who had developed unilateral adrenal metastasis. One underwent simultaneous operation for primary and metastatic lesions, and 4 underwent adrenal surgery following pulmonary resection. The adrenal tumor was removed via laparotomy in three patients, and via posterolateral non laparotomic approach in two. Co-metastatic lesions which were detected incidentally at operation included intestinal metastasis in two patients and regional lymph node metastasis in two; these were simultaneously resected. Following adrenalectomy, all these patients were treated with adjuvant chemotherapy or radiotherapy. Two patients have remained free of relapse for 40 and 26 months, respectively, after adrenal surgery, while three died of other distant metastases more than 9 months after adrenalectomy. In contrast, the four patients who received chemotherapy or radiation therapy died less than 6 months after palliative therapy. Thus, we consider that surgical treatment for adrenal metastases following pulmonary resection for lung cancer is effective in selected cases. The indications for adrenalectomy are presented in comparison with those for palliative therapy, and several difficulties in the surgical management of adrenal metastases are discussed.

Gallium-67 citrate scintigraphy in idiopathic pericarditis--report of a case

We report a case of idiopathic pericarditis in a 71-year-old woman without a friction rub or electrocardiographic changes suggestive of pericardial inflammation. She noticed dyspnea and palpitation on exertion about 40 days before admission. After admission, pericardial effusion and inflammatory reactions, such as elevated C-reactive protein, were found. Moreover, gallium-67 citrate scintigraphy revealed abnormal isotope accumulation over the cardiac silhouette. Therefore, she was diagnosed as having "active" pericarditis. The finding with the gallium scan became negative with steroid therapy. In this case, a gallium scan was very useful in assessing and monitoring the course of pericardial inflammation.

Differentiation of a Ewing's sarcoma cell line towards neural and mesenchymal cell lineages

Two different pathways of differentiation were investigated in Ewing's sarcoma (ES) cell line, designated CADO-ES1, which has been established in our laboratory. This cell line was induced to differentiate and display a neural phenotype when treated with dibutyryl cyclic adenosine monophosphate or when cultured in serum-free medium (HB101). In these in vitro differentiation studies, two different phenotypes were demonstrated by light and electron microscopy. One phenotype, present in a major portion of the cell population, had long neurites in which microtubules were ultrastructurally demonstrated. The other one, present in a minor portion of the cell population, consisted of flat cells with many short processes. After differentiation in serum-free medium, tumorigenicity in nude mice or colony-forming efficiency in soft agar was strongly depressed. In the cells, N-myc, c-fos and c-src genes were not amplified, and although c-myc was amplified by up to 2-fold, depending on the culture conditions, this appeared to be unrelated to the changes of phenotype. When tumor cells were transplanted into nude mice, cartilage was formed. The cartilage was immunoreactive with the antibody for HLA-ABC, indicating that it was derived from the tumor cells, not from mouse tissue.

Local pathological reactions induced in pigs and cats by adjuvant ISA-70 containing inactivated Newcastle disease virus antigen

Gross and microscopic changes at the injection site in pigs and cats were investigated for 8 weeks after an intramuscular injection of oil adjuvant ISA-70 emulsion, containing inactivated Newcastle disease virus antigen. In pigs, an egg-sized and discolored lesion with pinpoint to miliary-sized nodules was observed at 2 to 8 weeks post injection (PI). In cats, there was partial thickening of the subcutaneous tissue at 2 to 8 weeks PI. Histopathologic changes in pigs were fundamentally similar to those in cats, however, the local tissue reactions in pigs were severer and more protracted than those in cats. The lesions in pigs were characterized by formation of large-sized cysts and well-developed encapsulation of the cysts with epithelioid cells.

Neointimal coverage of stents in human coronary arteries observed by angioscopy

OBJECTIVES

The aim of this study was to reveal the time course of the neointimal coverage of stents placed in the human coronary arteries.

BACKGROUND

In deciding the protocol of anticoagulant and antiplatelet therapy for patients who undergo stent implantation, the condition of the neointimal coverage of stents should be taken into consideration. However, the time course of the neointimal coverage of stents has not been elucidated in human coronary arteries.

METHODS

Serial angioscopic observations were performed immediately after stenting, at 8 to 45 days (short-term follow-up) and at 65 to 142 days (long-term follow-up) in patients who underwent implantation of the Wiktor coronary stent in the restenotic lesion or in the lesion of acute or threatened closure after balloon angioplasty.

RESULTS

Angioscopic observations were successfully performed in 14 cases immediately after stenting, in 11 cases at short-term follow-up and in 13 cases at long-term follow-up. Immediately after stenting and even at 8 to 18 days after stenting, the stent was not covered by the neointimal layer in any case. However, at 65 to 142 days after stenting, the stent was covered by the neointimal layer in all cases. Angioscopically, three types of neointimal layer were recognized: a white layer with a cottonlike surface in three cases, a white layer with a smooth surface in eight cases and a transparent layer with a smooth surface in two cases.

CONCLUSIONS

Although some experimental results in animals have shown completion of neointimal coverage of stents in a few weeks, in this serial angioscopic follow-up study, the completion of neointimal coverage of stents in human coronary arteries required approximately 3 months.

Pharmacokinetics and pharmacodynamics of intravenous OPC-18790 in humans: a novel nonglycosidic inotropic agent

OPC-18790, a nonglycosidic intropic agent, is now under clinical development for treatment of congestive heart failure. Two separate studies (one placebo-controlled) were conducted to evaluate its pharmacokinetics and pharmacodynamics after intravenous administration to a total of 36 healthy male subjects. The drug was administered both rapidly as a .05-, .1-, .2-, or .4-mg/kg intravenous dose, and as a 1-hour infusion of .5, 1.0, 2.5, 5.0, 10.0, or 15.0 micrograms/kg/minute. Echocardiograms (ECHO) were evaluated before and immediately and 4 hours after the rapid administrations. Blood pressure (BP), heart rate (HR), and QTc in the electrocardiogram also were monitored in the rapid administration study. OPC-18790 was generally well tolerated by all subjects. Maximum peak plasma concentration and area under the curve increased linearly with dose in both studies. The t1/2, total body clearance of drug from plasma (CL), and the dose fraction excreted unchanged in the urine (fe) were comparable and dose-independent at the doses tested in both studies. The overall mean values of t1/2 alpha, t1/2 beta, CL, and fe were .08 +/- .01 hours, 3.64 +/- .22 hours, .46 +/- .01 L/kg, and 43.5 +/- 1.0%, respectively. Echocardiograms showed that, immediately after rapid administration of up to .4 mg/kg, OPC-18790 increased left cardiac function dose-proportionally (P < .05 to .01): the ejection fraction by 21.1% and fractional shortening by 26.5% compared with the predose values, blood pressure, heart rate, and QTc did not differ between subjects given OPC-18790 and these receiving placebo.(ABSTRACT TRUNCATED AT 250 WORDS)

Prognostic significance of pS2 protein expression in pulmonary adenocarcinoma

In the present study, pS2 protein expression in pulmonary adenocarcinoma was investigated on paraffin-embedded sections obtained from 170 patients. 28 (16%) patients showed varying degrees of pS2 protein expression in the cytoplasm of tumour cells, as detected by immunohistochemical staining with anti-pS2 protein antibody. There was a significant association between pS2 protein expression and larger tumour size, and the acinar or bronchiolo-alveolar subtype. However, no significant correlations between pS2 protein status and the other clinicopathological factors, i.e. T-factor, N-factor, stage and histological differentiation, were shown. In contrast to breast cancer, patients with pS2-positive pulmonary adenocarcinomas had a significantly worse prognosis than those with pS2-negative pulmonary adenocarcinomas; this was true for stage I patients, as well as for all patients. Multivariate analysis showed that pS2 protein expression was a discriminating variable in overall survival. These findings suggest that pS2 protein status is a possible prognostic indicator in pulmonary adenocarcinoma.

Occurrence of the ventral component of the third branchial nerve as the supernumerary branch of the glossopharyngeal nerve

The authors found supernumerary branches of the glossopharyngeal nerve in 7 out of 368 head sides (184 bodies) of Japanese individuals. The branches entered the submandibular triangle and connected with the superficial cervical ansa. Teasing revealed that the components of the glossopharyngeal nerve were distributed not only in the subcutaneous layer of the neck but also in the lower facial muscles such as the orbicularis oris. This suggests that the third branchial arch sometimes participates in the formation of the facial muscles which are usually composed of the ventral component of the second branchial arch. Therefore, this supernumerary branch of the glossopharyngeal nerve is probably the ventral component of the third branchial nerve, which is originally distributed in the ventral component of the third branchial arch and usually disappears during later development. The present findings will clearly show how the branchiogenous region is demarcated against the somatic body wall.

Levels of parathyroid hormone and calcitonin in serum among atomic bomb survivors

To examine the potential causes of increased levels of calcium in serum with increasing dose of atomic bomb radiation, which was obtained from the previous preliminary analysis, levels of parathyroid hormone (PTH) and calcitonin in serum were examined among 1459 subjects in Hiroshima and Nagasaki. A significant effect of radiation on levels of calcium, PTH and calcitonin in serum was found, even after patients with hyperparathyroidism were excluded. The level of calcium in serum increased with radiation dose; this can be explained partly by the increase in the level of PTH with radiation dose. However, the dose effect on calcium remained even after adjustment for PTH, calcitonin and confounding factors such as renal function, serum albumin level and medication. Parathyroid hormone increased initially by 6.8% per gray, but the dose response leveled off after about 1 Gy. The level of calcitonin increased with radiation dose, probably in part due to feedback mechanisms stimulated by the increase in calcium. However, after adjustment for the level of calcium, the increase in the level of calcitonin with dose was still found. Although the etiological mechanisms of the effect of radiation on serum levels of calcium, PTH and calcitonin are unclear, radiation exposure may affect secretion of PTH and calcitonin and regulation of calcium a long time after atomic bomb exposure.

Autoantibodies and immunoglobulins among atomic bomb survivors

The purpose of this study was to determine if exposure to atomic bomb radiation affects immune responsiveness, such as the occurrence of autoantibodies and levels of immunoglobulins. Rheumatoid factor, antinuclear antibody, antithyroglobulin antibody, anti-thyroid-microsomal antibody and immunoglobulin levels (IgG, IgM, IgA and IgE) were measured among 2,061 individuals exposed to atomic bomb radiation in Hiroshima and Nagasaki whose estimated doses ranged from 0 to 5.6 Gy. The prevalence and titers of rheumatoid factor were found to be increased in the individuals exposed to higher radiation doses. The IgA level in females and the IgM level in both sexes increased as radiation dose increased, although the effects of radiation exposure were not large. No effect of radiation was found on the prevalence of antinuclear antibody, antithyroglobulin antibody and anti-thyroid-microsomal antibody or on the levels of IgG and IgE.

Effect of shi-ka-ron and Chinese herbs on cytokine production of macrophage in immunocompromised mice

Shi-Ka-Ron is a prescription composed of 8 crude extracts of Chinese herbs. It reduces suppression of cytokine production by peritoneal macrophages in mice Immunocompromised by the anti-tumor agent, cyclophosphamide (CY), in vivo. Although it dose not increase IL-1 production in vitro, it enhances TNF production. We found that Ginseng radix, Lithospermi radix, Astragli radix and Glycyrrhizae radix somewhat reduced suppression of cytokine production in CY treated macrophages. Especially, Glycyrrhizae radix shows an active immune response both in vivo and in vitro. Our results suggested that the mechanism underlying immunomodulation of Shi-Ka-Ron is closely related to cytokine production: each herb stimulating macrophages.

Immunological properties of TtT/M-87 cell line established from murine pituitary tumor-associated macrophages

TtT/M-87 cell is a macrophage cell line established from thyrotropic pituitary tumor tissues in mouse. In this paper, we report the immunological properties of M-87 cells as a model of tumor-associated macrophage. Contrasting with resident peritoneal macrophages, M-87 cells constitutively secreted small but significant amounts of TNF-alpha and IL-1 alpha, which were detectable in both biological assays (cytotoxic activity for L929 and co-mitogenic activity for Con A-induced T cell proliferation, respectively) and ELISA, and produced larger amounts of these cytokines upon stimulation with LPS. They expressed MHC class II molecules on their cell surface without stimulation by IFN-gamma. The accessory or antigen-presenting cell activity in antibody-producing response of spleen lymphocytes to sheep red blood cells was shown to be much higher in M-87 cells than normal peritoneal macrophages. In addition, when normal spleen lymphocytes were cultured with allogeneic tumor cells, such as EL-4 and S-180, in the presence of M-87 cells, lymphocytes reactive to stimulator cells were activated to manifest inhibitory effect on the tumor cell growth and also to manifest specific cytotoxic effect on the allogeneic tumor cells. These results show that M-87 cells derived from tumor-associated tissue are activated macrophages and that they are inhibitory to tumor cell growth and augmentative in the induction of T-cell-mediated immune responses.

The characteristics of another small DNA virus isolated from a pig with diarrhea

A small DNA virus was newly isolated from the small intestines of a pig with diarrhea in 1987, in Japan. Concerning the physicochemical properties, hemagglutination and susceptibility of cell culture to the virus, the virus was identical to a formerly isolated small DNA virus, the H-45 strain and also physicochemically similar to the parvovirus group. In a serological test however, the virus was distinctly, antigenically different from the H-45 strain as well as each of porcine, bovine and canine parvoviruses.

Thiomarinol, a new hybrid antimicrobial antibiotic produced by a marine bacterium. Fermentation, isolation, structure, and antimicrobial activity

Thiomarinol, an antimicrobial antibiotic, was isolated from the culture broth of a marine bacterium, Alteromonas rava sp. nov. SANK 73390. Its structure was deduced as a hybrid composed of a pseudomonic acid analogue and holothin by NMR spectral analysis and chemical degradation. Antimicrobial activity against Gram-positive and Gram-negative bacteria of thiomarinol was stronger than both of pseudomonic acids and pyrrothine antibiotics.

Motor function of infants with athetoid cerebral palsy

The motor function of 35 children with athetoid cerebral palsy was examined retrospectively using videotape recordings made at five to eight months of age. Many infants showed asymmetric tonic neck, Moro and Galant reflexes. Movements shown to be difficult included: keeping a symmetric supine posture, isolated movements of the hips and knees, forward extension of the upper extremity, extension of neck and trunk in the prone position and in ventral suspension, flexion of the neck in the traction response, and weight support by the upper extremities. Asymmetric or excessive opening of the mouth was present in all infants. The grade of difficulty for each posture and movement might reflect subsequent motor disability at three years of age.

Aggressive pulmonary metastasectomy for soft tissue sarcomas

BACKGROUND

To evaluate the efficacy of aggressive pulmonary metastasectomy for treating soft tissue sarcomas, the clinical data on the surgical management of 23 patients with extensive pulmonary metastases from soft tissue sarcomas were reviewed.

METHODS

Between January 1973 and April 1991, 9 male patients and 14 female patients were treated. Their ages ranged from 13-68 years (median, 42 years). Twenty-one patients (91%) had bilateral and multiple metastases, and two patients had solitary metastasis. The number of resected metastatic nodules ranged from 1-110 (mean, 30.5). As an initial surgical approach, median sternotomy was used on 18 patients and lateral thoracotomy on 5 patients. Eleven patients underwent two or more explorations for recurrent metastases using lateral thoracotomy. The neodymium:yttrium-aluminum-garnet (Nd:YAG) laser was adopted in 10 patients since 1986.

RESULTS

The actuarial 2-year and 5-year survival rates after the first pulmonary resection were 49.7% and 24.8%, respectively. Histologic type (alveolar soft part sarcoma versus synovial sarcoma, P < 0.025), histologic grade (G1 and G2 versus G3, P < 0.01), and metastatic localization (subpleural versus extrapleural, P < 0.005) were the most significant prognostic factors for aggressive pulmonary metastasectomy of soft tissue sarcomas. Application of laser surgery, absence of local recurrences, and absence of extrapulmonary metastases before pulmonary resection also correlated with better prognosis with borderline significance.

CONCLUSIONS

Aggressive pulmonary metastasectomy for soft tissue sarcomas is a recommended procedure, even in the case of extensive metastases. The combination of median sternotomy and Nd:YAG laser-assisted surgery is a useful technique, especially in bilateral multiple pulmonary metastases.

Stroke trends in Japan

In Japan, stroke now ranks third among all causes of death following cancer and heart disease. Stroke was the leading cause of death for 3 decades after 1951. Stroke mortality tended to increase until about 1970, but it decreased and yielded first place to cancer in 1981. Heart disease deaths outnumbered stroke deaths beginning in 1985. There have not been any nationwide studies of stroke incidence in Japan, but results of studies in model areas such as Akita/Osaka, Nagano, Hiroshima/Nagasaki, and Hisayama show remarkable decreases in the incidence of cerebral infarction and cerebral hemorrhage. However, the decrease in cerebral infarction is less, especially at advanced ages where the frequency of disability is still high, and a major problem. There have not been any nationwide studies of survival rates after stroke either. In the Hiroshima/Nagasaki Study, the cumulative survival rates of cerebral hemorrhage and cerebral infarction improved from 1958 to 1969 to the period from 1970 to 1984. The decreasing incidence and mortality rates of stroke and the improving survival rate may be explained by the trends toward less severe strokes and improved medical service; however, the most influential factors are considered to be adoption of a less traditional life-style and improved blood pressure management throughout Japan.

Noncancer disease incidence in the atomic bomb survivors: 1958-1986

Using the longitudinal data of the Adult Health Study (AHS) cohort collected during 1958-1986, we examined for the first time the relationship between exposure to ionizing radiation and the incidence of 19 nonmalignant disorders in the A-bomb survivors. Affected individuals were ascertained through the three-digit codes of the International Classification of Diseases which are encoded in the AHS database subsequent to diagnoses made on the basis of general laboratory tests, physical examinations, and history-taking conducted during biennial AHS examinations. The disease onset time was estimated using the mid-point between the AHS examination data when the disease was initially reported and the previously attended disease-free examination date. Dosimetry System 86 organ doses judged to be most appropriate were used. Tests of dose effects were performed assuming a linear relative risk model with stratified background incidence. For the entire study period, significant excess risk was detected for uterine myoma (P < 0.001), chronic liver disease and cirrhosis (P = 0.006), and thyroid disease (P < 0.0001), defined broadly as the presence of one or more of certain noncancerous thyroid conditions. The incidence of myocardial infarction was shown to be increased (P = 0.03) in later years (1968-1986) among the younger heavily exposed AHS subjects, confirming the results of the recent Life Span Study (LSS) noncancer mortality report on coronary heart disease. The findings for uterine myoma may serve as additional evidence indicating benign tumor growth as a possible consequence of radiation exposure. Our results indicating the involvement of radiation in the development of liver diseases are consistent with the report of increased mortality from liver cirrhosis with radiation dose in the LSS cohort. An effect of age at exposure was detected for nonmalignant thyroid disease (P = 0.02), with an increased risk for those exposed who were under 20 years of age, but not for older survivors. Thus the AHS data suggest that thyroid glands in the young are more radiosensitive not only to the development of malignancies, but also to the development of nonmalignant disorders as well. The findings hold independently of the dose effects observed for thyroid cancer. This study also shows that for the period 1958-1986 new occurrences of lens opacity are not increased with radiation dose (P = 0.39) in the AHS subjects.

[A case report of malignant pseudomyxoma peritonei treated by a new modality of intraperitoneal chemo-hyperthermia]

A patient with malignant pseudomyxoma peritonei underwent a palliative surgical resection and intraperitoneal lavage with 5% dextrose. One hundred and twenty-five mg of cisplatin resolved in 1,500 ml saline was infused into the peritoneal cavity through the reservoir, and the patient was treated with hyperthermia (Thermotron RH 8). As a result the tumor markers (CEA, CA 19-9, and CA-125) markedly decreased after two courses of chemo-hyperthermia. These results suggest that intraperitoneal chemo-hyperthermia is an effective treatment for non-resectable malignant pseudomyxoma peritonei.