[Adult bochdalek hernia after playing at a tug of war]

A 38-year-old female was admitted to Shonai Hospital with severe abdominal pain and nausea after playing at a tug of war in the athletic meeting. The X-ray film showed air above the left diaphragm, and CT scan and barium enema revealed the incarcerated transverse colon to the left thoracic cavity. Operation was performed through a thoracotomy. Because of no evidence of trauma, the case was diagnosed as adult Bochdalek hernia. Repair could be done by direct suture and her postoperative course was uneventful.

Intravascular lymphomatosis diagnosed by transbronchial lung biopsy

Intravascular lymphomatosis is a rare lymphoma presenting a variety of symptoms due to proliferation of tumour cells within blood vessels in the brain, the skin and other organs. This disease is generally considered to be highly malignant, but to be relatively susceptible to combined chemotherapy, when diagnosed in the early stage. We describe a case of intravascular lymphomatosis, presenting with diffuse interstitial shadows on chest radiographic image, which could be diagnosed by transbronchial lung biopsy. The patient showed a good response to combined chemotherapy. We propose that transbronchial lung biopsy is a useful procedure for the diagnosis of intravascular lymphomatosis.

Intravascular lymphomatosis diagnosed by transbronchial lung biopsy

Intravascular lymphomatosis is a rare lymphoma presenting a variety of symptoms due to proliferation of tumour cells within blood vessels in the brain, the skin and other organs. This disease is generally considered to be highly malignant, but to be relatively susceptible to combined chemotherapy, when diagnosed in the early stage. We describe a case of intravascular lymphomatosis, presenting with diffuse interstitial shadows on chest radiographic image, which could be diagnosed by transbronchial lung biopsy. The patient showed a good response to combined chemotherapy. We propose that transbronchial lung biopsy is a useful procedure for the diagnosis of intravascular lymphomatosis.

Successful treatment of blunt trauma involving complete laceration of the pancreas and duodenum in a 7-year-old child: report of a case

The acute onset of peritoneal signs and shock in a 7-year-old boy who had been hit in the epigastrium by a log-seesaw mandated surgical treatment. Enhanced computed tomography (CT) demonstrated complete laceration of the pancreas as well as duodenal injury, and a duodenoduodenostomy with distal pancreaticogastrostomy was subsequently performed. Temporary external drainage of the stomach and distal pancreas led to an uneventful recovery in the early postoperative period. Although the patient's postoperative development was appropriate for his age, the orifice of the distal pancreas spontaneously closed 2.5 years following surgery. We present this report to stress the fact that every effort should be made to preserve the pancreas following abdominal injury in children.

Altered p16INK4 and retinoblastoma protein status in non-small cell lung cancer: potential synergistic effect with altered p53 protein on proliferative activity

p16INK4 protein (p16) and retinoblastoma protein (pRB), like p53 protein, are important tumor suppressors that regulate the cell cycle. We immunohistochemically examined fresh-frozen specimens of 114 resected non-small cell lung cancers (NSCLCs) for loss of p16 and pRB expression, together with aberrant accumulation of p53 protein and the proliferative activity determined by the Ki-67 index. Three pRB-positive tumors were uninterpretable for p16 status. Of the remaining 111 tumors, 30 (27%) lacked p16 expression, and 10 (9%) lost pRB expression. No tumors showed coincident loss of both proteins, supporting the hypothesis that they function in a single pathway. Of 25 tumors, including 4 p16-negative tumors, examined by Southern blot analysis, only 2 p16-negative tumors were considered to have reduced gene dosage consistent with possible homozygous deletion of the CDKN2 gene encoding p16, suggesting that immunohistochemistry is a sensitive and suitable method to screen for p16 alteration. Loss of p16 expression did not correlate with any clinical factors or p53 status, whereas loss of pRB expression correlated with heavy smoking (P = 0.03 by Fisher's exact test and P = 0.01 by the multivariate logistic regression analysis). Proliferative activity was considerably higher in p53-positive tumors than in p53-negative tumors (P < 0.001). Loss of p16 or pRB expression was associated with a further increase in proliferative activity in the p53-positive tumors (P = 0.009) but not with proliferative activity in the p53-negative tumors. These results suggest that alteration of the p16/pRB pathway is relatively frequently involved in the development and progression of NSCLCs and that its effect on the proliferative activity is potentially synergistic with altered p53 protein.

Virtual cancer image data warehouse

We previously developed a system with which we have created more than 100 virtual cancer images from CT or MR data of individual patients with cancer (Cancer Edutainment Virtual Reality Theater: CEVRT). These images can be used to help explain procedures, findings, etc. to the patient, to obtain informed consent, to simulate surgery, and to estimate cancer invasion to surrounding organs. We recently developed a web-based object-oriented database both to access these cancer images and to register medical images at international research sites via the Internet. In this report, we introduce an international medical VR data warehouse created using an object-oriented database.

[A benign clear cell tumor of the lung that grew gradually over five years]

A 38-year-old man was found to have an abnormal shadow in his chest X-ray film during a general medical examination. A nodule with a homogeneous density and a clear margin was seen in the upper lobe of the right lung. Since this shadow gradually enlarged during a five-year follow-up period, he was admitted to our hospital. Chest contrast and dynamic CT scans and aortography showed characteristics of a benign tumor with somewhat rich vascularity. The doubling time of this tumor was about 430 days. Transbronchial brushing for cytologic study and a transbronchial biopsy showed no malignancy. However, the tumor was surgically resected because of its gradual growth over the five years. The resected tumor was histologically diagnosed as a benign clear cell tumor of the lung. This disease was first described by Leibow and Castleman in 1963, as a benign pulmonary tumor similar to metastatic renal cell carcinoma. This disease is extremely rare and only 61 cases have been reported: twenty cases, including the present case, in Japan and 41 in other countries.

[Evaluation of clinical efficacy and safety of cefpodoxime proxetil (CPDX-PR) in acute uncomplicated cystitis]

One hundred and fifty female patients with acute uncomplicated cystitis were given 200 mg of CPDX-PR twice daily for 3-7 days to evaluate both its overall clinical efficacy and its adverse effects. In 82 cases (Group I) in which it was administered for 3 days, the overall clinical efficacy, evaluated by the criteria proposed by the Japanese UTI committee, was excellent in 64 cases, moderate in 17 and poor in one, with the effective rate being 98.8%. In 35 cases (Group II) in which it was administered for 4-7 days, the overall clinical efficacy was excellent in 18 cases, moderate in 15 and poor in 2, with the effective rate being 94.3%. The overall clinical evaluation was not performed in another 33 cases because they were given CPDX-PR for more than 8 days or 300 mg/day. Subjective adverse effects such as hoarseness and lingual inflammation were observed in only one of the 150 cases, but they disappeared spontaneously after the cessation of administration of CPDX-PR. These findings suggest that CPDX-PR is one of the most effective and safe antibiotic in the treatment of acute uncomplicated cystitis.

[A case of ectopic vas deferens with a chief complaint of male sterility]

A case of ectopic vas deferens in a 40-year-old male was reported. He visited our clinic with a complaint of male sterility for the past 10 years. Urological examinations revealed azoospermia, right renal aplasia and the ectopic insertion of right vas deferens into the right lower ureter with a blind-ending ureterocele. Bilateral testicular histological studies showed normal spermatogenesis in right testis and no spermatogenesis in left one. A vasovasostomy was performed. Sperm were seen in the semen 3 weeks after the operation. Including this patient, 54 cases (74 ectopic vas deferens) have been reported in the literature to date. The characteristics of age, subjective complaints, accompanied anomalies, diagnosis, treatment and the embryology are discussed.

[Prostatic weight estimation by the regression equation using transrectal ultrasonotomography]

The prostatic weight was evaluated in 264 patients with benign prostatic hyperplasia before transurethral resection of the prostate (TUR-P) by transrectal ultrasonotomography. In the first group of 121 among 132 patients, the weight of both the total prostate (EPWt) and the internal prostatic gland (EPWi) was estimated and compared to the actual weight of resected specimens (RPW). In the remaining 11 patients, EPWt was obtained but not EPWi because their prostatic gland echograms were obscure. The correlations between RPW and EPWi, and between RPW and EPWt in 121 patients were proved to be RPW = 0.999 EPWi-0.586 (r = 0.851), RPW = 0.537 EPWt-1.914 (r = 0.766), respectively. In the second group of 132 patients, the weight of the prostatic adenoma to be resected was estimated preoperatively by the measurement of EPWt and the application of the latter formula (CRPW). The correlation between RPW and CRPW was proved to be RPW = 0.930 CRPW-1.570 (r = 0.824). It is presumed from this study that preoperative estimation of EPWi or EPWt may be useful not only for selection of the treatment modality for BPH, namely TUR-P or open surgery, but also for prediction of an operation time in TUR-P.

[Clinical statistics on outpatients at Mishina urological office between July, 1984 and December, 1990]

The total number of outpatients was 6,298. There were 4,293 males and 2,005 females, the male to female ratio being 2.1:1. The major diseases seen in the outpatients were benign prostatic hypertrophy, bladder dysfunction, chronic prostatitis, prostatic stones, ureteral stones, chronic cystitis, urethral stricture, and essential renal bleeding. The 102 (5.1%) patients with urethral diverticulum among 2,005 female patients were discovered by high pressure urethrography. There were 373 cases of urogenital malignancies including 205 of bladder tumor, 85 of prostatic carcinoma and 29 of renal tumor, 11 of which were incidentally found. Twenty of the 205 bladder tumors were found among the 703 cases of microhematuria.

Intravesical instillation of adriamycin for bladder tumors

In the present series of trials, Adriamycin (ADM) intravesical instillation therapy was found to be effective against tumors of papillary morphology measuring less than 10 mm in diameter that were of low pathological stage and low histological grade. The rate of complete disappearance increased in proportion to the concentration of ADM and the duration of retention of the drug, although the efficacy rates were almost the same in each trial. On the other hand, side effects on the bladder were reduced when the instilled solution was lower in concentration and the retention time was short.