A trial of a method to trace metabolic pathways of nucleic acids in keratinocytes

It is well known that furocumarins produce a photoaddition compound with DNA, RNA, and certain kinds of amino acids upon exposure to long-wave ultraviolet light (UVA). It is also well known that both psoralens and psoralen photoconjugated compounds are fluorescent. After 8-methoxypsoralen was administered systemically and subsequently activated by UVA exposure, the hair and the epidermis were taken and observed under a fluorescent light microscope. The fluorescent materials appeared to be able to trace the metabolic pathway of psoralen-conjugated compounds such as DNA, RNA, and certain kinds of amino acids. Large amounts of nuclear proteins appeared to be transformed from nuclear proteins into certain structural proteins in keratinocytes.

Carbon dioxide insufflation vs. conventional saline irrigation for peroral video cholangioscopy

BACKGROUND AND STUDY AIMS

Recent studies have evaluated the efficacy of peroral cholangioscopy (POCS) for diagnosis of biliary diseases. In order to obtain clear images with POCS, saline irrigation, which is performed to replace yellow bile, is carried out for an extended duration. The aim of this study was to evaluate the feasibility of replacing saline irrigation with CO₂ insufflation during POCS.

PATIENTS AND METHODS

A total of 36 patients who had bile duct lesions and were due to undergo POCS were enrolled in the study. Of these patients, 18 underwent POCS using saline irrigation followed by CO₂ insufflation, and 18 patients underwent the reverse approach. The two methods were compared with regard to the time required to obtain a clear endoscopic image and the quality of the images.

RESULTS

The median time required to obtain a clear endoscopic image using CO₂ insufflation (5.0 min) was significantly shorter than that required for saline irrigation (22.5 min; P < 0.001). The quality of the endoscopic images obtained was similar in 27 cases. However, CO₂ insufflation provided better images in four cases that showed an abundance of mucin or biliary sludge, and saline irrigation was superior to CO₂ insufflation in five cases that showed severe stricture with bleeding and tall papillary lesions.

CONCLUSIONS

CO₂ insufflation during POCS can reduce procedure time and simplify cholangioscopy. The overall image quality was similar to that obtained with conventional saline irrigation.

[Bronchial injury due to double-lumen endobronchial tube]

A 68-years-old and 148 cm tall female with lung cancer was operated on a left lower lobectomy via posterolateral thoracotomy. A 35 Fr double-lumen endobronchial tube was smoothly inserted and the tip was placed in the left main bronchus whose position was confirmed by fiberoptic bronchoscope. After lobectomy and lymph node dissection were completed, 1-lung ventilation was terminated, the left chest cavity was filled with saline, and an air-leak test was performed. Immediately after the initiation of bilateral lung ventilation, massive air-leak was observed in the left hilar region and the saline in the chest regurgitated into the airway, and she fell into critical ventilatory insufficiency. After sucking the saline in the chest, thorough observation revealed a 3 cm-long rupture of the membranous portion of the left main bronchus. The rupture was manually occluded and ventilatory insufficiency was avoided, then the tip of the endobronchial tube was re-inserted into the right main bronchus and right single lung ventilation was initiated. The rupture was closed by a 4-0 polydioxanone (PDS) running suture with no coverage. The patient was extubated immediately after the operation. Ten days later, she had a tiny bronchial fistula, and it was cured by chest drainage only, and she discharged home on the 48th postoperative day.

Disease control using low-dose-rate brachytherapy is unaffected by comorbid severity in oral cancer patients

OBJECTIVE

The aim of this study was to evaluate the outcome and complications of low-dose-rate brachytherapy (LDR-BT) for oral cancer according to comorbidity.

METHODS

The records of a total of 180 patients who received LDR-BT for T1-2N0M0 oral cancers between January 2005 and December 2007 were analysed. The comorbidities of the patients were retrospectively graded according to the Adult Comorbidity Evaluation-27, and the relationships between the comorbidity grades and survival, disease control and the incidence of complications were analysed.

RESULTS

The 2 year overall survival rates of patients with no comorbidity, Grade 1, Grade 2 and Grade 3 comorbidity were 87%, 85%, 76% and 65%, respectively, and the reduction in the survival rate according to comorbid severity was significant in a univariate analysis (p = 0.032) but not in a multivariate analysis including other clinical factors. Cause-specific survival, locoregional control and local control were not related to the comorbidity grade, or any other clinical factors. Grade 2 or 3 complications developed in 27% of the patients. The incidence of complications was unrelated to the comorbidity grade.

CONCLUSION

The disease control of oral cancer and the incidence of complications after LDR-BT were not related to comorbid severity. LDR-BT is a useful and safe treatment for patients regardless of the presence of severe comorbidity.

Repair of huge left ventricular pseudoaneurysm after sutureless repair

A 72-year-old man underwent sutureless repair of an oozing-type left ventricular free wall rupture. Echocardiography 8 months after sutureless repair revealed a huge left ventricular pseudoaneurysm and severe mitral regurgitation (MR). Therefore, left ventricular reconstruction and restrictive mitral annuloplasty were performed. The patient's clinical condition was improved and no residual MR has been detected for 12 months. We conclude that left ventricular reconstruction and restrictive mitral annuloplasty could be useful for left ventricular pseudoaneurysm with MR.

Evacuation of aged persons from inundated underground space

Underground is an important space that supports function of cities, such as subways, shopping malls and basement parking. However in consequence a new type of disaster, the "urban flood" menaces these spaces. In the last decade, urban floods struck Tokyo, Nagoya and Fukuoka. When underground inundation occurs, people must evacuate to the ground as soon as possible. But, when such an inundation situation happens, aged persons may not be able to evacuate quickly to ground level. In this paper, the method of safety assessment for aged persons is discussed on the experimental results and flood simulation data in an underground space. As a criterion of the safety evacuation, the specific force per unit width is used in this study. From the result of experiments, it is difficult to implement safety evacuation when the specific force per unit width is over 0.100 m(2) for the aged male.