Cross-sectional study on respiratory effect of toner-exposed work in manufacturing plants, Japan: pulmonary function, blood cells, and biochemical markers

The aim of the study is to examine the relationship between toner-exposed work and health indices related to respiratory disorders and to confirm the baseline of a cohort study to clarify the effect of toner exposure in manufacturing plants. Subjects were 1614 male workers (809 toner-exposed workers and 805 referents) who were engaged in toner manufacturing plants in Japan (Fuji Xerox Co., Ltd). The age of subjects was from 19 to 59 years, and the average age was 40.2 years(median 40 years, SD 7.67). We conducted a pulmonary function test (PEFR, VC, FVC, FEV(1.0)%, V25/Ht) and a blood cell test (RBC, Hb, Hct, Plt, WBC, cell contents of WBC) and measured biochemical indices in blood (ALT, AST, gamma-GTP, CRP, IgE) and 8-hydroxy-2'-deoxyguanosine (8-OHdG) in urine. Student t-test and logistic regression analysis were applied to compare between the toner-exposed workers and the referents and to analyze the relationship among indices of effects and independent factors. There was no significant difference between the two groups in blood cell count and biochemical indices. Inflammation- and allergy-related markers such as 8OHdG and IgE also showed no significant difference between toner-exposed workers and the referents. The influence of smoking on pulmonary function indices was observed, but there was no relationship between the pulmonary function and toner-exposed work. In this article, we report a preliminary cross-sectional analysis in the subjects of a cohort study. No difference in pulmonary function indices was observed between the toner-exposed workers and the referents, and there was no consistent relationship between the exposure status and examined indices; however, the prevalence of subjective respiratory symptoms was higher in the exposed workers as presented in another report. Further analysis is important in the ongoing cohort study to clarify the effect of toner exposure on respiratory systems.

Adsorption, desorption and dissipation of metolachlor in surface and subsurface soils

BACKGROUND

Variations in soil properties with depth influence retention and degradation of pesticides. Understanding how soil properties within a profile affect pesticide retention and degradation will result in more accurate prediction by simulation models of pesticide fate and potential groundwater contamination. Metolachlor is more persistent than other acetanilide herbicides in the soil environment and has the potential to leach into groundwater. Reasonably, information is needed about the dissipation and eventual fate of metolachlor in subsoils. The objectives were to evaluate the adsorption and desorption characteristics and to determine the dissipation rates of metolachlor in both surface and subsurface soil samples.

RESULTS

Adsorption of metolachlor was greater in the high-organic-matter surface soil than in subsoils. Lower adsorption distribution coefficient (K(ads)) values with increasing depth indicated less adsorption at lower depths and greater leaching potential of metolachlor after passage through the surface horizon. Desorption of metolachlor showed hysteresis, indicated by the higher adsorption slope (1/n(ads)) compared with the desorption slope (1/n(des)). Soils that adsorbed more metolachlor also desorbed less metolachlor. Metolachlor dissipation rates generally decreased with increasing soil depth. The first-order dissipation rate was highest at the 0-50 cm depth (0.140 week(-1)) and lowest at the 350-425 cm depth (0.005 week(-1)). Degradation of the herbicide was significantly correlated with microbial activity in soils.

CONCLUSION

Metolachlor that has escaped degradation or binding to organic matter at the soil surface might leach into the subsurface soil where it will dissipate slowly and be subject to transport to groundwater.

[Thoracic drainage]

The thoracic drainage system is a sophisticated and useful technology, especially in thoracic surgery. therefore, lung resections are able to be performed safely in spite of air leaks which are a common problem after pulmonary resection. The thoracic drainage system is called the 3 bottles system, which are consisted of a drainage-bottle, an underwater-seal-bottle, and a continuous low-pressure-suction devise. Based on this basic structure, a lot of convenient thoracic drainage products such as a small thoracic drainage kit for pneumothorax have been developed. Some chest tubes which changed tubal form for efficient drainage are developed as well. However, each product has both advantages and disadvantages, then, we should understand characteristics of those new products and know the physiology of respiratory, when we use them.

Dendritic cells and macrophages in the genitourinary tract

Dendritic cells (DCs) and macrophages are antigen-presenting cells (APCs) that are important in innate immune defense as well as in the generation and regulation of adaptive immunity against a wide array of pathogens. The genitourinary (GU) tract, which serves an important reproductive function, is constantly exposed to numerous agents of sexually transmitted infections (STIs). To combat these STIs, several subsets of DCs and macrophages are strategically localized within the GU tract. In the female genital mucosa, recruitment and function of these APCs are uniquely governed by sex hormones. This review summarizes the latest advances in our understanding of DCs and macrophages in the GU tract with respect to their subsets, lineage, and function. In addition, we discuss the divergent roles of these cells in immune defense against STIs as well as in maternal tolerance to the fetus.

[Sleeve lobectomy for primary lung cancer]

We reviewed Fukuoka University Hospital thoracic surgery data base of 60 sleeve lobectomy (SL) and 40 pneumonectomy (PN) [for T1-3 disease] for primary lung cancer during 1993-2006. Morbidity rates were 20.0% and 37.5% in SL and PN group, respectively (p = 0.054). Three and 1 patient from PN and SL group, respectively, presented with bronchial anastomotic complications. Multivariate analysis showed that adjuvant chemotherapy and preoperative concomitant respiratory disease, but not the surgical procedures SL or PN, were risk factors for surgical morbidity. SL requires special consideration on its surgical technique either bronchial anastomosis or associated angioplastic procedure, however, it is safe and valuable less invasive surgical option especially for elderly patients.

Different substrate specificities of two triazine hydrolases (TrzNs) from Nocardioides species

Nocardioides sp. strain MTD22 degraded atrazine, ametryn and atraton, as did Arthrobacter aurescens strain TC1 and Nocardioides sp. strain C190. These strains contain trzN, a gene coding for TrzN, triazine hydrolase showing a broad substrate range. However, Nocardioides sp. strain AN3 degraded only atrazine despite containing trzN. These differences in s-triazine degradation are presumed to be due to differences in the amino acid sequences of TrzNs. Consequently, 1371 nucleotides of the trzN coding sequences of strains AN3 and MTD22 were determined. Comparisons of the amino acid sequences of TrzNs indicated that three residues of strain AN3 (Thr(214), His(215) and Gln(241)) were distinct from those of the other three strains (Pro(214), Tyr(215) and Glu(241)). To confirm the relationships between these amino acid sequences and the substrate specificities of TrzNs, wild and chimera trzN genes were constructed and expressed in Escherichia coli cells. Cells expressing wild MTD22 trzN (Pro(214)Tyr(215)Glu(241)) and chimera AN3-MTD22 trzN (Thr(214)His(215)Glu(241)) degraded all s-triazines, but the degradation rate was markedly decreased in AN3-MTD22 trzN. Wild AN3 trzN (Thr(214)His(215)Gln(241)) and chimera MTD22-AN3 trzN (Pro(214)Tyr(215)Gln(241)) degraded only atrazine. These results suggest that the substitution of Glu(241) for Gln(241) significantly decreases enzyme affinity for ametryn and atraton.

Ezrin is a key element in the human vagina

OBJECTIVE

The vagina is a complex tubular structure that has reproductive, support and barrier functions. These depend on the cytoarchitecture of the vaginal cells, which is controlled by key proteins. Cytoskeletal proteins determine cell polarity and membrane specializations by integrating the actin cytoskeleton with cell membranes. This integration is the domain of cytoskeletal proteins including the MERM protein family (moesin-ezrin-radixin-Merlin). Nothing is known about the cyto-localization of the MERM's in the vaginal epithelium or how it influences the cytoarchitecture of the vaginal epithelium and stroma.

DESIGN

Full-thickness human vaginal fornix samples were obtained from 20 normal human specimens obtained at surgery for pelvic relaxation. Light- and electron microscopical immunohistochemistry (IHC) were used to identify and study activation and cellular localization of immuno-reactive-ezrin (ir-ezrin), a prototypical MERM.

RESULTS

Ir-ezrin was identified in the stratified squamous vaginal epithelium and connective tissue (fibroblasts, blood vessels and leucocytes). "H" scoring indicated that ir-ezrin staining is denser in the vaginal epithelium than in other layers, that the ir-ezrin staining was associated with increased keratinization and with the size of the tight junctions (p<0.01). Both the amounts and localization of ir-ezrin were associated with high levels of estrogen, identified by the menstrual history and keratinization of the superficial vaginal epithelium. The density of stromal ir-ezrin was increased in the presence of dense epithelial keratinization. Immuno-reactive-ezrin staining was most pronounced near the cell membranes of both keratinized and non-keratinized epithelium, indicating that ezrin activation (unfolding and movement to the membrane) had occurred. Ultra-structural examination of the epithelium showed intra-cellular ir-ezrin to be localized to junctional complexes that have been associated with decreased mucosal penetration by microorganisms. Ir-ezrin was widely distributed throughout stromal fibro-muscular cell, vessels and immunocytes.

CONCLUSIONS

MERM's, represented by ezrin, are widely present in the vaginal wall. This has implications for the strength and resilience of this tubular structure and may be the case in other internal genital tissues. Ezrin's localization and association with cell specializations indicate that in the vagina, as in other tissues, ezrin likely modulates vaginal cell-cell interactions including the changing vaginal cellular interface with the external environment, the regulation of the elasticity of the vagina, and the regulation of microbial and chemical traffic that determine the pH and microbial environment of the vagina. In other work we have shown that ezrin expression is induced by estradiol. The increase of ir-ezrin staining during the appearance of keratinization and maturation of the vaginal cytology indicates that estrogen may regulate vaginal ezrin and thereby the properties of the vaginal wall and epithelium.

New trainer for video-assisted thoracic surgery lobectomy

BACKGROUND

Only a few simulators are available which offer training in video-assisted thoracic surgery (VATS). We have developed a VATS training model for surgeons.

METHODS

The simulator consists of a training module housing three disposable components: the lung (made of polyurethane), the bronchus, and the artificial circulatory pulmonary vessels (made of polyvinyl chloride), connected to a pump. VATS procedures were videotaped and evaluated using a checklist assessment method.

RESULTS

This unique module has been tested at several VATS seminars in Japan. In the questionnaire, training participants strongly agreed that the trainer was helpful and prepared them well for VATS lobectomy prior to performing actual surgery. Evaluation of the dexterity score for thoracoscopic surgery with our simulator correlated with the surgeons' experience with actual surgery. Technical factors were well taught using this model.

CONCLUSIONS

Our unique trainer may enhance the skill of VATS surgeons at a national level.

Comparison between a Case-Matched Analysis of Left Upper Lobe Trisegmentectomy and Left Upper Lobectomy for Small Size Lung Cancer Located in the Upper Division

BACKGROUND

Although an increasing number of approaches for pulmonary segmentectomy to treat early lung cancer are being used, there have been few reports on left upper lobe trisegmentectomy, which is midway between single segmentectomy and lobectomy, for lung cancer.

METHODS

We retrospectively reviewed the medical charts of 86 clinical stage I case-matched patients with a tumor size of less than 2.0 cm in diameter located in the left upper division who underwent resection between June 1998 and December 2005. The patients were divided into two groups as follows: LTS (31), left upper lobe trisegmentectomy; LUL (55), left upper lobectomy. We evaluated these groups with respect to several factors.

RESULTS

The characteristics of the two groups (LTS vs. LUL) demonstrated no significant differences with respect to gender, histological type, tumor size, or upstaging of pathological node, or the mode of video-assisted thoracic surgery (VATS). Patients with LTS had a significantly lower pulmonary function compared to the LUL group. There were no significant differences between the two groups with respect to factors such as blood loss and duration of chest tube drainage. Morbidity and recurrence rates did not differ between the two groups, and there was no mortality in our series. The overall survival rate at 5 years was 69.7 % in the LTS and 72.5 % in the LUL group. There was no significant difference in survival rates between the LTS and the LUL group after resection.

CONCLUSION

LTS may be suitable as a standard treatment if the tumor is small and the suspected margins are well away from the lingula.

Biodegradation of methylthio-s-triazines by Rhodococcus sp. strain FJ1117YT, and production of the corresponding methylsulfinyl, methylsulfonyl and hydroxy analogues

A novel bacterial strain FJ1117YT was isolated from an enrichment culture with the herbicide simetryn. The isolate was capable of degrading the herbicide supplied as the sole sulfur source in an aquatic batch culture. The strain FJ1117YT was identified as that belonging to Rhodococcus sp. on the basis of comparative morphology, physiological characteristics and comparison of the 16S rRNA gene sequence. The biodegradation pathway of simetryn was established by isolating the methylsulfinyl analogue as the first metabolite and by identification of the methylsulfonyl intermediate and the hydroxy analogue by liquid chromatography-mass spectrometry (LC-MS) and/or nuclear magnetic resonance (NMR) analysis. The results indicate that the methylthio group was progressively oxidised and hydrolysed by the strain FJ1117YT. The same strain is also able to metabolise other methylthio-s-triazines such as ametryn, desmetryn, dimethametryn and prometryn through similar pathways.

Isolation and characterization of a novel simazine-degrading beta-proteobacterium and detection of genes encoding s-triazine-degrading enzymes

A moderately persistent herbicide, simazine, has been used globally and detected as a contaminant in soil and water. The authors have isolated a simazine-degrading bacterium from a simazine-degrading bacterial consortium that was enriched using charcoal as a microhabitat. The isolate, strain CDB21, was gram-negative, rod-shaped (0.5-0.6 microm x 1.0-1.2 microm) and motile by means of a single polar flagellum. Based on 16S rRNA sequence analysis, strain CDB21 was identified as a novel beta-proteobacterium exhibiting 100% sequence identity with the uncultured bacterium HOClCi25 (GenBank accession number AY328574). PCR using primers that were specific for the genes of the atrazine-degrading enzymes (atzABCDEF) of Pseudomonas sp. strain ADP showed that strain CDB21 also possessed the entire set of genes of these enzymes. Nucleotide sequences of the atzCDEF genes of strain CDB21 were 100% identical to those of Pseudomonas sp. strain ADP. Sequence identity of the atzA genes between these bacteria was 99.7%. The 398-nucleotide upstream fragment of the atzB gene of strain CDB21 was 100% identical to ORF30 of Pseudomonas sp. strain ADP, and the 1526-nucleotide downstream fragment showed 99.8% sequence similarity to the atzB gene of the pseudomonad.

[Successful treatment for descending necrotizing mediastinitis; report of a case]

A case of a 55-year-old man with descending necrotizing mediastinitis (DNM) after a tooth removal was reported. Chest computed tomography (CT) showed a fluid collection in the right thorax, in the cervical region and in the mediastinum. The patient underwent cervical drainage and thoracoscopic pleural dissective drainage. The cervical and right anterior thoracic drain was removed on the 6th day and posterior drain was removed on the 8th day after the operation. The patient was discharged on the postoperative day 13, and showed no recurrence.

[Clinical features of thoracic injury; special reference to diaphragmatic injury]

We investigated the clinical feature of thoracic injury patients, mainly with diaphragmatic injury. From 1993 to 2005, 739 patients with thoracic injury were treated at our life-saving emergency center. There were more blunt trauma patients than penetrating injury patients (693 cases vs 46 cases). Regarding the thoracic injury patients, the causes of trauma were traffic injury in 462 (62.5%), unexpected accident including work place accident in 153 (20.7%), suicide in 90 (12.2%), and assault in 34 (4.6%). As the numbers of injured organs increased, the mortality rate increased. Among 156 patients with cardiopulmonary arrest on admission, 155 patients died. This result suggested that saving the life of patients presenting with cardiopulmonary arrest on admission is extremely difficult. Thirty-eight cases (5.1%) required surgical treatment, and surgery to repair diaphragmatic injury was performed in 14 cases. In 6 cases of diaphragmatic injury, thoracoscopy was performed during the examination and/or surgery.

CONCLUSION

Urgently transporting thoracic injury patients to hospital before the onset of cardiopulmonary arrest is therefore essential in order to reduce the mortality rate of these patients. In addition, thoracoscopy is very useful for both examining and treating traumatic diaphragmatic injury patients.

Prognostic significance of subcarinal station in non-small cell lung cancer with T1-3 N2 disease

BACKGROUND

Surgical resection may continue to offer the best chance of long-term survival for patients with non-small cell lung cancer (NSCLC). Generally, patients with N2 NSCLC have a poor prognosis. However, the surgical treatment of patients with N2 remains controversial as in these patients, some N2 subgroups have better prognoses than others. The objective of the current study was to evaluate the factors associated with N2, and to determine whether such factors are reliable predictors of survival.

METHODS

We retrospectively reviewed 142 non-small cell lung cancer patients with T1-3 N2 in whom a curative approach had been attempted between January 1994 and December 2003. The patients were consequently divided into four groups (NS-1, no subcarinal involvement and without N1; NS-2, no subcarinal involvement and with N1; SI-1, subcarinal involvement and without upper mediastinal site; SI-2, subcarinal involvement and with upper mediastinal site). We also evaluated two groups for N2 stations (single-station N2 versus multiple-station N2). Multivariate analysis by Cox's proportional hazards regression model was performed to identify the prognosis.

RESULTS

Lobectomy was carried out in 105 of the patients; bilobectomy in 10, and pneumonectomy in 27. The patients with T1-3 N2 disease showed survival rates of 34.1 % at 3 years and 24.1 % at 5 years. The overall survival rates at 3 years and 5 years were as follows: NS-1, 56.3 % and 43.2 %; NS-2, 35.4 % and 29.5 %; SI-1, 16.7 % and 0 %; SI-2, 15.4 % and 0 %, respectively. The NS-1 group had better prognoses than the other groups. There was a significant difference in survival rates within each group ( p = 0.0005). In univariate analysis, the type of surgery, type of subcarinal involvement, and multiple-station N2 were significantly associated with prognosis. Multivariate analysis showed that NS-1 was only found to be an independent prognostic factor in cases of T1-3 N2 disease ( p = 0.0018). NS-2 was not an independent factor but tended toward significance ( p = 0.0681). But multiple-station N2 was not an independent factor ( p = 0.1549).

CONCLUSIONS

Surgery for patients with T1-3 N2 NSCLC might be acceptable if subcarinal lymph node metastasis is predicted to be absent.

Less Vigorous Surgery for Second Primary Lung Cancer

BACKGROUND

Patients with second primary lung cancer (SPLC) have a heterogeneous background. The optimum modality of treatment for SPLC patients has not yet been determined. The objective of this study was to attempt to identify the value of less vigorous therapies such as segmentectomy or video-assisted thoracic surgery (VATS) in SPLC.

METHODS

We retrospectively reviewed the medical records of 46 patients who underwent resection for SPLC in Fukuoka University Hospital between January 1994 and April 2005. Patients were separated into two groups (LVT: less vigorous therapy including segmentectomy or VATS lobectomy; LCT: lobectomy with conventional thoracotomy). The characteristics of each group were evaluated and survival rates were analyzed at 5 years after surgery.

RESULTS

The mean amount of blood loss was found to be significantly different ( P = 0.0062) with 59.44 +/- 14.00 ml for LVT cases and 254.48 +/- 63.62 ml for LCT. None of the LVT patients experienced postoperative complications. The 5-year survival rate was 62.7 % for LVT and 57.7 % for LCT. There was no significant difference in survival rates between these groups.

CONCLUSIONS

Although differences were seen in the characteristics, less invasive surgery such as VATS or segmentectomy may be a feasible treatment for SPLC.

A Completely Thoracoscopic Lobectomy/Segmentectomy for Primary Lung Cancer - Technique, Feasibility, and Advantages

INTRODUCTION

A completely thoracoscopic lobectomy/segmentectomy for primary lung cancer was designed to maximize the benefits of this type of minimally invasive surgery. The technique, feasibility, and advantages of this surgical modality over the conventional procedure were investigated.

MATERIALS AND METHODS

Between January 2003 and December 2004, 38 patients underwent a lobectomy (n = 30) or segmentectomy (n = 8) for clinical stage IA primary lung cancer. A resection using a standard thoracotomy (Thoracotomy Group) was performed in 19 patients, and a completely thoracoscopic resection was performed in 10 cases (CTR Group). Conventional video-assisted thoracic surgery with a mini-thoracotomy was performed in 9 cases.

RESULTS

All CTR lobectomies or segmentectomies were carried out safely without any major complications. The number of resected mediastinal lymph nodes was similar in both groups. There was a tendency for the hospital stay to be somewhat shorter in the CTR Group. With respect to postoperative pain as evaluated by a visual analogue scale (VAS), the CTR Group showed a significantly lower level of pain in comparison to the Thoracotomy Group ( P = 0.024 on day 2).

CONCLUSIONS

We concluded that a complete thoracoscopic lung resection is a safe and technically feasible surgical procedure which enables us to make thoracoscopic lung resections less invasive.

The value of tumor volume in surgically resected non-small cell lung cancer

BACKGROUND

The aim of this study was to evaluate whether or not tumor volume (TV) has an impact on survival in non-small cell lung cancer.

METHODS

In a retrospective analysis of 385 cases with NSCLC who underwent curative surgery between 1994 and 2003, we calculated the tumor volume by using an ellipsoidal formula. The patients were grouped according to TV as determined by histograms. Gender, age, histology, nodal involvement, size, and TV were analyzed. Multivariate analysis by Cox's proportional hazards regression model was performed to identify the prognosis.

RESULTS

Cases of N0 showed a significantly lower TV than cases with other N statuses (p < 0.05). A significant difference was also observed between TV and histology or gender. The 189 patients belonging to the small volume group (SVG) (range, 0.105 to 9.265 cm3) had a significantly better overall survival rate than the other 196 patients in the large volume group (LVG) (9.266-366.522 cm3). With univariate analysis, gender, age, nodal involvement, size, and TV were significantly associated with prognosis. Multivariate analysis showed that only gender (p = 0.0184) and nodal involvement (p = 0.0001) were significantly independent prognostic factors. The size factor was not significant (p = 0.5285). However, TV was not an independent factor, but trending toward significance (p = 0.0801).

CONCLUSIONS

Although TV provides no independent prognostic information with multivariate analysis, TV in NSCLC should be considered using volumetric measurement with a three-dimensional CT approach prior to surgery or treatment planning.

EPR spectrometer for clinical applications

This article describes an EPR spectrometer specifically designed and constructed for EPR spectroscopy in humans. The spectrometer is based on a permanent magnet, suitable for measurements at 1200 MHz. The magnet has a full 50 cm gap between the poles, which facilitates accurate and comfortable placement of the subject for the EPR measurement at any location on the human body. The bridge includes features to facilitate clinical operations, including an indicator for phasing of the reference arm and a 2 level RF amplifier. Resonators with holders for each type and site of measurement have been developed that comfortably position the resonator and the patient and prevent artifacts due to motion. The initial applications for which the spectrometer has been designed are for oximetry using loops on the surface, oximetry using implanted resonators for measuring deep sites, and measurements in the teeth for determination of exposures to clinically significant doses of ionizing radiation.

[Surgical treatment for primary non-small cell lung cancer with synchronous brain metastases]

The brain is one of the most common sites of metastasis from lung cancer. The strategies of treatment for non-small cell lung cancer patient with synchronous brain metastases (stage IV) is controversial. We evaluate retrospectively the effectiveness of surgical treatment for these patients. Forty patients were divided into 3 groups on the basis of surgical treatment, group A of patients received both lung and brain resection, group B of patients received lung resection plus gamma knife therapy, group C of patients received brain resection. Median survival from the date of diagnosis of brain metastasis was as follows: group A 331 days, group B 151 days and group C 92 days. Univariate analysis revealed that adenocarcinoma histology and serum LDH significantly affected survival. Multivariate analysis found that only adeocarcinoma histology also affected the survival. It is concluded that surgical treatment may acceptable in selected group of non-small cell lung cancer patients with synchronous brain metastases.

[Review of the surgical treatment in superior sulcus tumor]

The rarity of the superior sulcus tumor has led to varying treatment techniques. Generally, radiation therapy followed by surgery has been used. En bloc resection combined with lobectomy and nodal dissection remains standard therapy. The unique location of this tumor, surgical approach thought to be important. Involvement of the anterior areas such as subclavian vessels can be resected by anterior transcervical approach, and vertebral body or brachial plexus through the classic Shaw Paulson approach. Preoperative computed tomography (CT) or magnetic resonance imaging (MRI) is beneficial to the evaluation of the vessels, nerves, and surgical planning. Recent studies showed that induction concurrent chemoradiation therapy improved the resectability and curability. This article reviews the treatment of superior sulcus tumor.

Characteristic Differences between Patients Who Have Undergone Surgical Treatment for Lung Metastasis or Hepatic Metastasis From Colorectal Cancer

OBJECTIVE

The characteristic differences between patients with lung or liver metastases from colorectal carcinoma (CRC) have not yet been clarified. A small group of these patients demonstrate a better prognosis, and the selection criteria for resection of liver and/or lung metastasis are not well defined. It is important to compare and analyze the most common metastatic sites, which include liver metastases and lung metastases. The objective of this study was to compare the characteristics of the two groups in order to identify patients who benefitted from surgical resection of CRC.

METHODS

We retrospectively reviewed the medical charts of 80 patients who had undergone resection for liver or lung metastasis from CRC in Fukuoka University Hospital between June 1991 and December 2004. These patients were grouped according to surgical therapy received for the metastases, and separated into two groups, as follows: LUM, lung metastases resection; LIM, liver metastases resection. We evaluated these groups for a set of several factors.

RESULTS

The characteristic factors between the two groups (LUM vs. LIM) demonstrated significant differences according to histological differentiation, venous invasion, and lymphatic permeation. There was a statistical difference in the disease-free interval (DFI) between the two groups (947.06 +/- 840.39 days in LUM vs. 246.03 +/- 229.26 days in LIM). Although serum CEA levels at resection of metastasis showed significant differences between the groups (LUM, 13.25 +/- 31.55 ng/ml; LIM, 55.21 +/- 99.52 ng/ml), the primary serum CEA levels were not significantly different. Overall survival rates at 5 years were 37.0 % for LUM and 42.8 % for LIM. There was no significant difference in the survival rate of the LUM vs. the LIM group after resection of metastasis. The Cox proportional hazards regression model was used to determine serum CEA status at the time of the metastases and showed a significant difference indicating poor prognosis for patients with LUM, but the results were not significant for LIM cases.

CONCLUSIONS

Candidates for surgical treatment for lung or liver metastases from CRC may be an acceptable for the same valuable approach, even if characteristic differences were observed in each group.

Extended Resection of T4 Lung Cancer with Invasion of the Aorta: Is It Justified?

BACKGROUND

We report our 10-year experience of performing surgical resection of T4 lung cancer invading the thoracic aorta.

PATIENTS AND METHODS

From 1994 to 2004, sixteen patients with T4 primary lung cancer with local invasion of the thoracic aorta underwent tumor resection. Surgical resection included 8 pneumonectomies and 8 lobectomies. The histologic type was squamous cell carcinoma in 7 patients, adenocarcinoma in 7, large cell carcinoma in 1, and small cell carcinoma in 1. Complete resection of the tumor with mediastinal lymph node dissection was achieved in 8 patients (50 %), while the resection was incomplete in the other 8 cases.

RESULTS

The overall cumulative survival of the 16 patients at 3 and 5 years was 34.7 % and 17.4 %, respectively. The survival of the patients in the complete resection group was found to be 36.5 % at 5 years, with 2 patients surviving more than 5 years without a recurrence, which was significantly better than that of the incomplete resection group ( p = 0.005).

CONCLUSIONS

Extended aortic resection with primary lung cancer is complex and possibly high risk, but can achieve long-term survival in selected patients. Surgical resection should be considered as a treatment option for T4 lung cancer for this T4 subcategory.

Penetration to the aortic wall by a metallic airway stent. A successfully treated case with left pneumonectomy and aortic repair

Metallic airway stents were used widely at the beginning of airway stent use, but an accumulation of cases has revealed complications due to their use. A patient who received a Gianturco Z stent for bronchial tuberculosis suffered massive haemoptysis due to stent migration into the aortic wall. Left pneumonectomy with aortic repair was successfully performed. We suggest that metallic stents should not be used for benign airway palliation, as they may later cause life-threatening complications.

[Treatment strategy for patients, with locally advanced non-small cell lung cancer]

A total of 89 patients with locally advanced lung cancer (pT3-4N0-1) underwent pulmonary resection from April 1994 to April 2003 at our institutions. The overall 5-year survival rate of the 89 patients was 35.5%. No significant difference in the 5-year survival rate was found according to the following variables: histologic type, type of operation, number of resected organs, performance of adjuvant therapy and pulmonary function. In patients with pN1 disease, when patients with nodal metastasis were divided into patients with hilar (# 10) or lobar (# 11 approximately 13) metastasis, the survival rate of lobar metastasis group was superior to those of hilar metastasis group, but not significantly. In patients with pN1 disease, 5 patients were survived for more than 1,000 days. The histology was squamous cell carcinoma in 4 cases. According to the characteristics of pN1 involvement, all cases was involved only a single station.

Peyer's patch dendritic cells as regulators of mucosal adaptive immunity

The mucosal immune system maintains a delicate balance between providing robust defense against infectious pathogens and, at the same time, regulating responses toward innocuous environmental and food antigens and commensal microbes. The Peyer's patch (PP) has been studied in detail as a major inductive site for mucosal immunity within the small intestine. While the mechanisms responsible for the induction of mucosal immunity versus tolerance are not yet fully understood, recent studies have highlighted mucosal dendritic cells (DCs) as regulators of the immune responses to orally administered antigens. Here we discuss recent studies that describe the role of PP DCs in immune induction and speculate on the mechanism by which the resident DCs regulate T cell and immunoglobulin A (IgA) responses in the gastrointestinal mucosa.

Microbial synthesis of chiral amines by (R)-specific transamination with Arthrobacter sp. KNK168

Arthrobacter sp. KNK168 shows (R)-enantioselective transaminase [(R)-transaminase] activity, which converts prochiral ketones into the corresponding chiral (R)-amines in the presence of an amino donor. The cultural conditions and reaction conditions for asymmetric synthesis of chiral amines with this microorganism were examined. The transaminase was inducible, and its production was enhanced by the addition of sec-butylamine and 3-amino-2,2-dimethylbutane to the culture medium. (R)-1-Phenylethylamine was a good amino donor for amination of 3,4-dimethoxyphenylacetone with Arthrobacter sp. KNK168. Under the optimum conditions, 126 mM (R)-3,4-dimethoxyamphetamine (DMA) [>99% enantiomeric excess (ee)] was synthesized from 154 mM 3,4-dimethoxyphenylacetone and 154 mM (R)-1-phenylethylamine through the whole cell reaction with an 82% conversion yield. (R)-Enantiomers of other amines, such as (R)-4-methoxyamphetamine, (R)-1-(3-hydroxyphenyl)ethylamine and (R)-1-(3-hydroxyphenyl)ethylamine, were also synthesized from the corresponding carbonyl compounds through asymmetric amination with Arthrobacter sp. KNK168.

[Primary pulmonary meningioma; report of a case]

Primary pulmonary meningiomas are quite rare, and their occurrence has been reported only sporadically. A 49-year-old, asymptomatic female was hospitalized for the evaluation of a coin lesion in the left lung radiography. She has no history of previous neoplasm or symptom referable to the central nervous system. Chest computed tomography (CT) demonstrated a 9 x 14 mm, round, noncalcified, well-demarcated lesion in the left upper lobe of the lung (S(1+2)). For diagnostic purposes, enucleation of the tumor was performed. The resected specimen revealed histologically classical typical meningioma. Because postoperative magnetic resonance imaging (MRI) of the brain did not show any intracranial mass, this case was and diagnosed as a primary pulmonary meningioma. The patient was discharged with no complication, and alive without recurrence of disease 14 months after surgery.

Surgical Treatment for Lung Cancer with COPD Based on the Global Initiative for Chronic Obstructive Lung Disease (GOLD)

OBJECTIVE

The surgical indications for non-small cell carcinoma (NSCLC) with chronic obstructive pulmonary disease (COPD) are not well known. A classification of severity in COPD has been newly recommended by the US National Heart, Lung, and Blood Institute (NHLBI) and the World Health Organization (WHO). Therefore, based on this new system of classification, we review here a series of NSCLC patients with COPD who underwent lung resection at our hospital and attempt to identify the survival and morbidity of such patients.

METHODS

We retrospectively reviewed the patients with NSCLC treated at our hospital between January 1994 and December 2002. Among these 640 patients, a curative approach was attempted in 50 with COPD (31 lobectomies, 11 segmentectomies, 8 bilobectomies). The patients were consequently divided into two groups (moderate group and severe group) according to the Global Iinitiative for Chronic Obstructive Lung disease (GOLD). Lung function was evaluated by FEV1 and FVC, and the survival rates were analyzed at 5 years. Postoperative morbidity was also compared between the two groups.

RESULTS

FEV1 was 1.527 +/- 0.311 L in the moderate group compared with 1.025 +/- 0.224 L in the severe group ( p < 0.001). Postoperative decrease in FEV1 was lower compared to the predicted data of patients who underwent surgery for NSCLC with COPD. Postoperative pulmonary support such as mechanical ventilation or tracheotomy were necessary more frequently in the severe group. A significant difference was observed between the two groups in respiratory support ( p = 0.0102). Overall 5-year survival rate for NSCLC with COPD was 73.9 %, although there was no statistically significant difference between the moderate and severe groups in terms of survival. Lobectomy and segmentectomy show a remarkable advantage for the patients with bilobectomy, although this difference was not statistically significant. On the other hand, gender, degree of COPD, and histological type were shown to be not significant factors. Survival rate of these NSCLC patients with COPD were demonstrated to be comparable to those of the NSCLC patients without COPD in stages I and II.

CONCLUSION

Stringent selection of candidates among NSCLC patients with a severe grade of COPD based on GOLD could be an acceptable and valuable approach compared to conventional patients without COPD, although NSCLC with severe COPD patients more frequently needed respiratory support.

Micropapillary pattern: a distinct pathological marker to subclassify tumours with a significantly poor prognosis within small peripheral lung adenocarcinoma (<=20 mm) with mixed bronchioloalveolar and invasive subtypes (Noguchi's type C tumours)

AIMS

A micropapillary pattern (MPP) in lung adenocarcinoma, characterized by papillary structures with epithelial tufts lacking a central fibrovascular core, has been reported to be a new pathological marker of poor prognosis. However, its clinicopathological and prognostic significance in small lung adenocarcinomas (</=20 mm) remains undetermined. A new histological classification of small lung adenocarcinoma proposed by Noguchi et al. has been found to be useful since it has defined surgically curable bronchioloalveolar carcinoma (BAC)-type tumours (Noguchi's type A and B) based on the absence of active fibroblastic proliferation. However, BAC-type tumours with active fibroblastic proliferation (Noguchi's type C), which is adenocarcinoma with mixed subtypes including BAC and invasive carcinoma in the new World Health Organization (WHO) classification, account for most of the small adenocarcinomas and represent a heterogeneous group ranging from minimal to overtly invasive cancer with variable prognoses. Therefore, in this study the aim was to investigate whether MPP can be an additional histological marker(s) to subclassify this heterogeneous group in small lung adenocarcinoma.

METHODS AND RESULTS

One hundred and twenty-two cases of small lung adenocarcinomas (</=20 mm in maximum dimension) classified according to the new WHO classification and Noguchi's proposal were analysed with reference to the presence of MPP. Of the 122 cases, 67 (55%) were MPP-positive and 55 (45%) were MPP-negative. Lymph node metastasis and pleural invasion were significantly more frequent in the MPP-positive group: 74% and 66% in the positive group versus 26% and 34% in the negative group, respectively. The 5-year survival of the MPP-positive group was 54%, whereas that of the MPP-negative group was 81% (P=0.024). The 5-year survival rates of BAC (Noguchi's type A and B) (n=14), mixed BAC and invasive adenocarcinoma (Noguchi's type C) (n=85) and invasive adenocarcinoma (Noguchi's type D and F) (n=23) were 100%, 68% and 36%, respectively. In patients with mixed BAC and invasive adenocarcinoma (Noguchi's type C tumours), the 5-year survival of the MPP-positive group (n=51) was 54%, significantly lower than that of the MPP-negative group (n=23) of 100% (P=0.02).

CONCLUSIONS

MPP is a simple and distinct pathological marker to subclassify tumours with a significantly poor prognosis within small (</=20 mm) mixed BAC and invasive adenocarcinoma (Noguchi's type C tumours).

[Thoracoscopy and intraoperative upper gastrointestinal endoscopy was effective for Boerhaave syndrome; report of a case]

Boerhaave syndrome is a rare disease and needs an exact diagnosis and a proper treatment plan because of its terrible clinical course. We experienced a case of Boerhaave syndrome that thoracoscopy and intraoperative upper gastrointestinal (GI) endoscopy was very effective. Sixty-four-year-old man realized chest and back pain after vomitting. Esophageal perforation was suspected, but 64 hours had passed already when we started a surgical treatment. By the thoracoscopy and intraoperative endoscopy, lower esophageal perforation and infectious pleural effusion were found. Therefore, we selected a surgical treatment under the assistance of thoracoscopy. Secondly, a simple closure and intracostal muscle overlapping was performed with small incisional thoracotomy. Postoperative complication, such as mediastinal abscess, has not occurred. Thoracoscopy and intraoperative upper GI endoscopy was effective for an appropriate diagnosis and treatment of Boerhaave syndrome.

[Diaphragmatic eventration resulting from phrenicectomy treated with surgical method; report of a case]

The case was a 59-year-old man who has a history of left mediastinal tumor resection with left phrenicectomy. The elevated diaphragm revealed by chest X-ray 7 years after the operation led to diagnosis of diaphragmatic eventration. Since any symptom was seen in the early period, "wait and watch" strategy was done for management. Both the abdominal enlarged feeling and the dyspnea on effort were appeared 10 years after the operation. Under the speculation of these symptoms related to the elevated abdominal organs came up with diaphragmatic eventration, surgical method the plication of the diaphragm was performed. The diaphragm was plicated by interrupted suture as opening the diaphragm to avoid injury the abdominal organs, and reinforced with the Marlex mesh. We used artificial mesh to reinforce the thin diaphragm with exceptation of prevent the postoperative recurrence, because a result of the etiological process of the case was considered as disuse atrophy of diaphragm after phrenicectomy.

Randomized placebo-controlled trial assessing the effect of bifidobacteria-fermented milk on active ulcerative colitis

BACKGROUND

Probiotics are efficacious for treating and maintaining remission of ulcerative colitis.

AIM

To conduct a randomized placebo-controlled trial of bifidobacteria-fermented milk supplementation as a dietary adjunct in treating active ulcerative colitis.

METHODS

Twenty patients with mild to moderate, active, ulcerative colitis randomly received 100 mL/day of bifidobacteria-fermented milk or placebo for 12 weeks with conventional treatment.

RESULTS

Clinical and endoscopic activity indices and histological scores were similar in the two groups before treatment. Although improvements were significant in both groups, the clinical activity index was significantly lower in the bifidobacteria-fermented milk than in the placebo group after treatment. The post-treatment endoscopic activity index and histological score were significantly reduced in the bifidobacteria-fermented milk, but not the placebo group. Increases in faecal butyrate, propionate and short-chain fatty acid concentrations were significant in the bifidobacteria-fermented milk, but not the placebo group. No adverse effects were observed in either group.

CONCLUSION

Supplementation with this bifidobacteria-fermented milk product is safe and more effective than conventional treatment alone, suggesting possible beneficial effects in managing active ulcerative colitis. This is a pilot study and further larger studies are required to confirm the result these preliminary results.

Biosorbable poly-L-lactide rib-connecting pins may reduce acute pain after thoracotomy

OBJECTIVE

Conventional thoracotomy is currently used as a standard procedure, and is often required to treat numerous diseases. Additionally, rib resections are occasionally required to maintain an adequate field of view for surgery. The benefits of using rib pins for chest closure following such procedures have not yet been established. This study sought to evaluate the usefulness of rib pins in reducing acute postoperative pain.

METHODS

Thirty-three consecutive patients with lung cancer underwent lobectomies using the posterolateral approach. The patients were rib-resected and reconstructed with two techniques: 21 patients with absorbable rib pins (ARP group) and 12 patients by ligation with absorbable sutures (LAS group). Intensity of pain was assessed during the 3 days immediately following surgery. The two groups were assessed using the visual analogue scale (VAS) as a pain scale, amounts consumed of patient-controlled analgesics (PCA), and additional chest x-rays.

RESULTS

On the first day following surgery, the mean VAS intensity of the ARP group for patient motion was 2.71 +/- 2.14, compared to 5.33 +/- 2.99 in the LAS group. After three days, the mean score for the ARP group was 1.98 +/- 1.89, compared to 4.60 +/- 1.97 in the LAS group. Scores in the ARP group were significantly lower than in the LAS group one day and three days following thoracotomy. The LAS group (55.0 +/- 15.9 times) made more frequent requests than the ARP group (16.1 +/- 10.3 times). The PCA requirement was also significantly lower in the ARP group. Excessive derangement of the rib (grade 2) was found in one case (4.7 %) in the ARP group compared to five cases (41.6 %) in the LAS group. Rib shifts were seen in numerous cases in the LAS group compared to the ARP group as measured by chest x-rays.

CONCLUSIONS

Use of absorbable rib pins reduced postoperative pain and may improve long-term prospects for the post-thoracotomy course.

Results of Surgical Treatment for Non-Small Cell Lung Cancer of 20 mm or Less in Diameter

BACKGROUND

Surgical efficacy is still unsatisfactory for small lung cancer; accordingly, minimal resection has recently been the focus of increased study. The objective of the current study was to evaluate the factors associated with small lung cancer, and to determine whether such factors are reliable predictors of long-term survival.

METHODS

We retrospectively investigated 130 patients with histologically confirmed non-small cell carcinoma, whose treatments were primarily surgical, with no chemotherapy or radiotherapy prior to surgery. All tumors were located peripherally and were less than 20 mm in diameter. Follow-up was performed for five-year and eight-year survivors and multivariate analysis with Cox's proportional hazards regression model was performed.

RESULTS

Of all 130 patients, the 5-year survival rate among patients with tumors less than 15 mm was 82.5 %, vs. 57.4 % of patients with tumors with a diameter of 16 - 20 mm. The 5-year survival rate of patients who were node negative was 73.9 % while it was 28.5 % for node-positive patients. Status of nodal invasion was also significantly associated with survival in small-size tumors ( p < 0.0001). Furthermore, the 5-year survival rate among patients with pleural involvement was 55 % vs. 83.8 % for patients without pleural involvement. Using multivariate Cox analysis, lymph node involvement ( p = 0.0004), size ( p = 0.0475), and pleural invasion ( p = 0.0482) were found to be independent prognostic factors in cases of tumors 20 mm or less in diameter.

CONCLUSIONS

The results of this study at least demonstrate that the optimal therapy for patients with nodal involvement or patients with tumors of 16 - 20 mm must be carefully determined even in cases of small lung cancer.

Video-assisted thoracoscopic surgery (VATS) segmentectomy for small peripheral lung cancer tumors: intermediate results

BACKGROUND

We investigated the feasibility and suitability of video-assisted thoracoscopic surgery (VATS) segmentectomy for curing selected non-small cell lung cancer (NSCLC) with this less invasive technique.

METHODS

We performed VATS segmentectomy for small (< 20 mm) peripherally located tumors and pathologically confirmed lobar lymph node-negative disease by frozen-section examination during surgery. Of the 34 patients who underwent this limited resection, 22 were treated with complete hilar and mediastinal lymph node dissection (intentional group), whereas 12 patients who were deemed to be high risk in their toleration for lobectomy underwent VATS segmentectomy with incomplete hilar and mediastinal lymph node dissection (compromised group). The surgical and clinical parameters were evaluated and compared with those of segmentectomy under standard thoracotomy to evaluate the technical feasibility of VATS segmentectomy.

RESULTS

We found that VATS segmentectomy could be performed safely with a nil mortality rate and acceptably low morbidity. The mean period of observation was relatively short at 656.7 +/- 572.1 and 783.4 +/- 535.8 days in the intentional and compromised groups, respectively. At the time of writing, all intentional patients remain alive and free of recurrence. There were two cases of non-cancer-related death in the compromised group. Clinical data indicated that VATS segmentectomy caused the same number or fewer surgical insults compared with segmentectomy under standard thoracotomy.

CONCLUSIONS

The present results are intermediate only; the rate of long-term survival and the advantages of the less invasive procedure still need further investigation. Nevertheless, we believe that VATS segmentectomy with complete lymph node dissection is a reasonable treatment option for selected patients with small peripheral NSCLC.

Mediastinal Solitary Fibrous Tumor: Report of a Case with Direct Invasion to the Trachea

The solitary fibrous tumors in the pleura are a rare entity that is usually adhesive and sometimes invasive. Because of its benign feature, complete surgical resection is generally considered. We describe a very rare case of mediastinal solitary fibrous tumor arised or invaded into the tracheal wall, which was surgically resected with combined cylindrical resection of the trachea.

Assessment of exposure to magnetic fields in occupational settings

OBJECTIVE

It is important to have data about occupational magnetic field intensity to consider the contribution of occupational magnetic field exposure on the human body. We conducted research on exposure to occupational magnetic fields and tried to qualify data on the distribution of magnetic field' intensity in certain general working environments with individual measurements.

SUBJECTS AND METHODS

We performed sample research on the exposure to low-frequency magnetic fields of workers in certain occupations and in the working environment. We also assessed the relationship between working environmental magnetic field distribution and individual exposure.

RESULTS

Some occupations were found to be exposed to high magnetic fields. We observed that some workspaces, such as the transformer substation, generally had a uniform and high magnetic field measurement but employees were exposed to a lower intensity. We also found that welders were exposed to high magnetic fields at about 600 microT in a very short time but with a geometrical value of 0.08 microT.

CONCLUSION

The determination of administrative levels and control levels, not only of the time weighted average of threshold limits or short term exposure limits, but also ceiling limits should be considered. More systematic research is necessary to determine variables such as operating conditions, measuring position, and frequency bands. Also, further studies will be needed to make a job-exposure matrix for the magnetic fields for each occupation type and to combine it with exposure in non-occupational settings such as commuting and ordinary life situations to explore the causal relationship between exposure to magnetic fields and disease.

Evaluation of lung volume reduction surgery (LVRS) based on long-term survival rate analysis

OBJECTIVE

Lung volume reduction surgery (LVRS) is an effective therapy for some patients with end-stage emphysema. In most cases, functional improvement is maximized during the first 6 months after surgery and decreases steadily afterwards. This study was aimed at gaining further understanding of the optimal candidates for LVRS and survival rates.

METHODS

62 patients with LVRS were selected according to the inclusion criteria. Changes in lung function were evaluated by FEV1, VC, RV, TLC, DLCO, PaO2, and PaCO2, and survival rates were analyzed at 12, 24, 36, and 48 months. Patients with LVRS were divided into two groups--those surviving after 48 months and those not surviving after 48 months--and analyzed according to group.

RESULTS

The overall survival rate at 2 years and 4 years was 81.0 % and 67 %, respectively, with LVRS. VC, FEV1, TLC, DLCO, PaO2, and PaCO2 were potential factors leading to mortality according to univariate analysis. Multivariate analysis demonstrated that DLCO was the only independent factor that could predict the post-LVRS prognosis; the other factors failed as independent factors. Preoperatively, the FEV1 percentage predicted gave a good index for post-LVRS survival.

CONCLUSIONS

Patients with higher preoperative FEV1 values had higher survival rates. These favorable long-term survival rates might justify LVRS for treating selected patients with severe emphysema. Additionally, DLCO turned out to be the only predictive factor for high mortality risk 4 years after LVRS. DLCO may thus be a very important marker in surgical planning.

Laterality of the performance of glaucoma mass screening using frequency-doubling technology

PURPOSE

This study investigated laterality during the performance of glaucoma mass screening with a frequency-doubling technology perimetry test.

MATERIALS AND METHODS

A frequency-doubling technology screening mode (C-20-1, version 2.6) test was performed on both eyes of 14,784 persons. Subjects with visual field abnormalities detected by the frequency-doubling technology test or with fixation error underwent retesting without a specified interval for rest. Consequently, 206 subjects who fulfilled the screening criteria of the frequency-doubling technology-based glaucoma screening protocol [FDT-GSP(+)] were further investigated using the Humphrey visual field analyzer (30-2). As a result, 74 right eyes and 57 left eyes were shown to have definite glaucoma.

RESULTS

Frequency-doubling technology data for the left eye demonstrated a significantly (P<0.001) higher rate of artifacts, such as no reproducibility of results between the first and second tests (left/right: 2.4%/1.7%) as well as fixation errors (left/right: 2.8%/1.0%). The false-positive rate of the FDT-GSP for glaucoma was more than 1.5-fold higher in the left eye than in the right eye (16.3%/9.8%). In the case that either eye exhibited FDT-GSP(+), the positive predictive value of the FDT-GSP for definite glaucoma in the left eye was almost half of that in the right eye (28.4% vs. 53.8%). Specificity of the FDT-GSP for detection of definite glaucoma also exhibited a lower trend (P = 0.097) in the left eye (44.6%) than in the right eye (55.3%), but the sensitivity of the test was similar in both eyes (91.2% vs. 90.5%, respectively).

CONCLUSIONS

When frequency-doubling technology-based mass screening is performed on the general population, performance is lower for the left eye than for the right eye. This performance disparity is likely to be primarily associated with a difference in specificity.

Video-assisted thoracic needle aspiration cytology for malignancy of the peripheral lung

BACKGROUND

The technique of video-assisted thoracic fine-needle aspiration cytology (VAT-FNA) to the lung has been described in very few publications, and its diagnostic role has not been evaluated so far. Thus current studies focus on whether the diagnostic role could be applied usefully to VAT-FNA of peripheral lung lesions.

METHODS

Between January 1995 and January 2000, a total of one hundred and twenty-eight cases of VAT-FNA on lung tumors were reviewed retrospectively. The superficial lung was visualized a part of directly or indirectly by scope and a 22-gauge needle inserted for FNA. Material was expressed onto glass slides, and smears were stained by our modified quick-stain method. The cytological diagnoses based on VAT-FNA were reviewed and compared with the final histopathological diagnoses.

RESULTS

The cytological diagnosis was true positive in 100 cases (93.5% sensitivity), whereas the true negative result in 20 cases was 95.2% specificity. The false-positive rate was 4.8%, and false-negative results were 6.5%. The accordance in all malignant cases between cytology and histology was 73.8%. VAT-FNA caused no difficulties in any of the cases.

CONCLUSION

The application of VAT-FNA to the peripheral lung lesion is not only useful, cost-beneficial, safe and minimally invasive but also accurate. Especially, this method may play an important role in cases of suspected malignancy in peripheral cases.

Performance of glaucoma mass screening with only a visual field test using frequency-doubling technology perimetry

PURPOSE

To report the performance of glaucoma mass screening with only a visual field test utilizing frequency- doubling technology (FDT) perimetry in general populations.

DESIGN

Hospital and population-based cross-sectional study.

METHODS

This study took place in a multicenter setting. One hundred three consecutive glaucomatous patients and 14,814 persons were randomly selected. We had created a glaucoma screening protocol (GSP) using FDT perimetry (FDT-GSP). Frequency-doubling technology-glaucoma screening protocol was tested on consecutive glaucoma patients diagnosed with Humphrey visual field analyzer (30-2 SITA standard), and then FDT-GSP was applied to general populations. Frequency-doubling technology-glaucoma screening protocol positive subjects were ophthalmologically diagnosed. Detection ability of FDT-GSP was determined in consecutive patients, and the positive predictive value (PPV) of FDT-GSP to detect definitive glaucoma was estimated in general populations.

RESULTS

Frequency-doubling technique-glaucoma screening protocol detected 83.3% and 100% of definitive glaucoma patients with an early (mean deviation [MD] > -6 dB) and more advanced stage (MD < or = -6 dB), respectively. In the population-based screening, there were 660 (4.5%) subjects who had positive FDT-GSP, including 512 in whom no visual field abnormalities (VFA) had been pointed out previously. Of them, 370 subjects underwent ophthalmologic diagnosis. Then, 266 (71.9%, 266/370) subjects had a glaucomatous disk and 167 had definitive glaucomatous VFA. Fifty-five (14.9%) and 39 (10.5%) subjects were diagnosed as having other diseases and as normal, respectively. The PPV of FDT-GSP ranged from 32.6% (167/512)-45.1% (167/370).

CONCLUSIONS

Frequency-doubling technology-based screening with only a visual field test showed reasonable performance on mass screening for detection of definitive glaucoma in this study population, considering the glaucoma prevalence.

Third-harmonic generation and self-channeling in air using high-power femtosecond laser pulses

It is shown, both theoretically and experimentally, that during laser pulse filamentation in air an intense ultrashort third-harmonic pulse is generated forming a two-colored filament. The third-harmonic pulse maintains both its peak intensity and energy over distances much longer than the characteristic coherence length. We argue that this is due to a nonlinear phase-locking mechanism between the two pulses in the filament and is independent of the initial material wave-vector mismatch. A rich spatiotemporal propagation dynamics of the third-harmonic pulse is predicted. Potential applications of this phenomenon to other parametric processes are discussed.

Affinity improvement of the high-affinity immunoglobulin E receptor by phage display

The immunoglobulin E (IgE)-binding site of its high-affinity receptor is localized in the second immunoglobulin-like domain (D2) of the alpha-subunit (Fc epsilon RI alpha). In this study, the randomized pentapeptides were introduced between Glu(132) and Ile(138) of Fc epsilon RI alpha D2 and displayed on a filamentous phage. After eight rounds of panning, a phage clone having a mutation of Asp(135)Tyr(136)Met(137) in Fc epsilon RI alpha D2 was obtained. The binding affinity of the mutant phages to immobilized IgE was approximately 500 times higher than that of the wild type. The mutant phages competitively inhibited the binding of IgE to the soluble receptor at a 50% inhibition (IC(50)) value of 116 pM. The mutant Fc epsilon RI alpha D2, which had been expressed as a fusion protein with glutathione S-transferase in Escherichia coli, also showed higher IgE-binding capacity than the wild type. The mutant Fc epsilon RI alpha D2 is expected to manifest its improved IgE-binding affinity together with any fusion partner.

Immunological protection induced by bacillus Calmette-Guérin treatment in a murine bladder tumor model

BACKGROUND

It has been previously reported that MBT-2 tumor growth is completely inhibited when mice are inoculated with bacillus Calmette-Guérin (BCG). In this study it was examined whether or not vaccination with a mixture of BCG and MBT-2 cells also induces immunological protection against murine bladder tumors.

METHODS

Seven hundred thousand MBT-2 cells and 1 mg of BCG (Tokyo 172 strain) per mouse were injected subcutaneously into female C3H/HeN mice. Four and eight weeks after vaccination with this mixture, animals were reinoculated with MBT-2 cells alone or MBT-2 cells cocultured with BCG.

RESULTS

Animals vaccinated with a mixture of BCG and MBT-2 cells showed MBT-2 tumor growth but completely rejected the MBT-2 cells cocultured with BCG. MBT-2 cells cocultured with BCG developed into tumors when they were inoculated into the control animals. Splenocytes prepared from vaccinated animals showed specific cytocidal activity against MBT-2 cells precultured with BCG.

CONCLUSIONS

The results suggest that a mixture of BCG and MBT-2 cells induces antitumor immunological protection against BCG- or MBT-2-associated antigens presented on MBT-2 cells precultured with BCG.