Pulmonary epithelioid hemangioendothelioma with PlGF expression: report of a case.

Pulmonary epithelioid hemangioendothelioma (PEH) is a relatively uncommon neoplasm of vascular origin with a low or intermediate grade of malignancy. We present a case of a 28-year-old female with multiple pulmonary nodules which were diagnosed as PEH by video-assisted thoracoscopic surgery (VATS) biopsy. In addition, we performed an immunohistochemical analysis for placenta growth factor (PlGF) and a strong positivity for PlGF observed, suggesting that the PlGF may play some role in the tumorigenesis of PEH.

Comparison of the surgical outcomes of thoracoscopic lobectomy, segmentectomy, and wedge resection for clinical stage I non-small cell lung cancer.

BACKGROUND: Video-assisted thoracoscopic surgery (VATS) for clinical stage I non-small cell lung cancer (NSCLC) has been widely used as a less invasive surgical procedure, but the resection method is still controversial. We retrospectively compared the surgical outcomes of lobectomy, segmentectomy and wedge resection. PATIENTS AND METHODS: A total of 411 patients with clinical stage I NSCLC who underwent VATS (218 males and 193 females, aged 69.3 years; 345 adenocarcinomas, 57 squamous cell carcinomas, and 9 others) were investigated. The surgical procedure was lobectomy in 289, segmentectomy in 38, and wedge resection in 84. Surgical outcomes were compared among these 3 groups. RESULTS: Demographic characteristics showed that the rate of elderly and male patients was higher in the wedge resection group. The 5-year survival rates for the lobectomy, segmentectomy, and wedge resection groups were 82.1, 87.2, and 55.4%, respectively. In the wedge resection group, the 5-year survival rate was 83.3% in patients undergoing intentional low-risk operations for small tumors with ground glass opacity, and 41.1% in those undergoing conservative high-risk operations because of comorbidities. Using Cox's proportional multivariate analysis and sex differences, histology, and tumor size as co-influential factors, the surgical procedure was found to be a significantly poor prognostic factor, and the hazard ratio of wedge resection relative to lobectomy was 4.30. CONCLUSION: The outcomes of VATS lobectomy and segmentectomy procedures for clinical stage I NSCLC were equivalent, while the outcome for VATS wedge resection was inferior. VATS wedge resection for clinical stage I NSCLC should be carefully indicated and requires adequate patient selection.

Syndrome of inappropriate secretion of antidiuretic hormone (SIADH) following carboplatin-paclitaxel administration in a patient with lung cancer.

A 60-year-old female underwent right upper lobectomy of the lung and lymph node dissection under a diagnosis of cancer in the upper lobe of the right lung. Pathological examination showed stage IIIA adenocarcinoma with mediastinal lymph node metastasis. One month after the operation, adjuvant chemotherapy with carboplatin (CBDCA) and paclitaxel (PTX) was initiated. Four days after the chemotherapy, hyponatremia progressed, and central nervous system disorder developed. A diagnosis of syndrome of inappropriate secretion of antidiuretic hormone (SIADH) was made. She recovered after fluid intake restriction and electrolyte correction. SIADH was considered to be due to the adverse effects of anticancer drugs. In postoperative adjuvant chemotherapy, attention should be paid to the serum Na level.

A case of G-CSF-producing invasive apical cancer resected following preoperative adjuvant therapy.

The patient was a 47-year-old male with the chief complaints of right shoulder pain and fever. A 10-cm mass was found to be present in the right pulmonary apical region on chest X-ray examination. The mass was diagnosed as a G-CSF-producing invasive apical cancer and the patient underwent chemoradiotherapy followed by right upper lobectomy with combined resection of the chest wall, and lymph node dissection. A very small nodule was noted in the right frontal lobe on brain MRI before surgery, and the final diagnosis was pT3N0M1, stage IV lung adenocarcinoma. For the brain metastasis, gamma knife treatment and chemotherapy were performed after surgery, and there was no recurrence during 16 months after surgery. The prognosis for G-CSF-producing lung cancer and invasive apical cancer is poor. This was a rare and difficult case of lung cancer showing both characteristics of lung cancer.

Mediastinal tuberculous lymphadenitis with intractable fistula to the neck.

A 62-year-old female consulted our hospital due to an ulceration on the skin of her neck and a mediastinal tumor. Chest CT scan and MRI revealed a mediastinal tumor-like lesion with direct progression to the neck skin lesion. En bloc resection of the tumor including the neck skin ulcer was performed under a median sternotomy. Mediastinal tuberculous lymphadenitis was diagnosed histologically. This is a case of a very rare type of mediastinal tuberculous lymphadenitis that progressed to the neck with an intractable fistula.

Multifocal nodular lymphoid hyperplasia of the lung differently identified by 18F-fluorodeoxyglucose positron emission tomography (FDG-PET).

Nodular lymphoid hyperplasia (NLH) is a rare lung disease classified as a non-neoplastic pulmonary lymphoid lesion. It is believed that 36 % of cases present with multifocal lesions, and although there are some reports in which (18)F-fluorodeoxyglucose positron emission tomography (FDG-PET) results are positive, the FDG uptakes vary and the imaging findings are very similar to those of lung cancer or malignant lymphoma. We present a case of surgically resected multifocal NLH which was differently identified by chest computed (CT) tomography appearance and FDG-PET findings.

[Analysis of invasive variation according to the different approaches of thoracoscopic resection for lung cancer].

There have been great variations among institutions in the approach of thoracoscopic surgery for lung cancer. However, we could not have found reports regarding the comparison study about operative invasion according to the thoracoscopic approach. We attempted to examine the differences of operative invasion in the various thoracoscopic approaches for lung cancer. We analyzed 158 cases of clinical stage I lung cancer by classifying thoracoscopic surgery into 3 different approaches. Specifically, group A (n=16) had less than 10 cm access with enlarged intercostal space by using rib-spreader, group B (n=84) had 4 to 8 cm access with soft material instrument and group C (n=50) had 2 to 3 cm access with soft material instrument. In each group, 2 or 3 thoracoports were added. Conversion to open thoracotomy were 8 cases. Operation time was significantly long in the conversion group, bleeding was significantly small in group C. Postoperative 48 hours drain discharge showed no differences in 3 groups, however, C-reactive protein (CRP) and creatine phosphokinase (CPK) with times showed significantly low level in group C, and both group A and conversion group were very close. Our results suggested the difference of the surgical invasiveness in thoracoscopic resection for lung cancer under various thoracoscopic approach.

[Huge mediastinal mature teratoma with combined resection of adjacent structures; report of a case].

We report a case of a 64-year-old woman with an anterior mediastinal tumor on a chest computed tomography (CT) before operation of uterine cancer. After the radical surgery and a chemotherapy for uterine cancer, surgical resection of mediastinal tumor was performed in July 2005 because of gradually progression in tumor size. Under the median sternotomy, the tumor revealed intensive adhesion to the right lung and the left brachiocephalic vein. We performed a complete resection of the tumor with combined resection of adherent parts of them. The tumor was 9 x 8 cm in size, containing with yellow cream-like fluid and hair. Histologically, the tumor was diagnosed as a mature teratoma with the tissue of bone, digestive tract epithelium, bronchial epithelium and so on. In benign teratoma, it is not rare to perforate to the adjacent structures. So, we concluded if the mediastinal teratoma was suspected, long-term observation had the risk for adhesion and perforation to adjacent tissue, and in case of operation, we should keep in mind the possibility of combined resection of involved organs.

Magnetic field energy dissipation due to particle trapping in a force-free configuration of collisionless pair plasmas.

It is shown by using a two-dimensional, fully relativistic, electromagnetic particle-in-cell simulation code that a force-free magnetic configuration in collisionless, electron-positron (pair) plasmas becomes unstable against current-driven Buneman instability and subsequently there occurs a strong magnetic field energy dissipation associated with collisionless magnetic reconnection, which can be driven by particle trapping due to two-dimensional electric potentials remaining in the nonlinear stage of the initial current-driven Buneman instability. About 43% of the initial magnetic field energy dissipates and is transformed to plasma heating as well as high-energy particle production. The energy spectrum in the high-energy region is given by an exponential type with two temperatures. We also show the simulation results for the electron-ion plasma to compare the effect of the mass ratio of the electron and proton.

Cutaneous metastasis of renal cell carcinoma: an electron microscopic study.

A case of cutaneous metastasis of renal cell carcinoma in a 67-year-old man is described. Right side nephrectomy had been performed three years earlier, and a renal cell carcinoma was diagnosed. Following a bruise, the patient noticed an erythematous nodule on the scalp. Histological examination of this skin lesion showed atypical tumor cells consisting predominantly of clear cells with a honeycomb-like or adenoid structure. Electron microscopic examination revealed that the tumor cells were divided into three groups: clear cells with abundant glycogen, dark cells with abundant mitochondria, and intermediate cells containing both glycogen and mitochondria in varying proportions. Some of the tumor cells with an adenoid pattern had a brush border-like structure in the lumen. These results support the diagnosis of metastatic renal cell carcinoma. An electron microscopic approach may aid in diagnosis of cutaneous metastasis from renal cell carcinoma.

Oral morphology and tongue habits.

Human beings ingest food, transform the food into the energy needed for existence, and communicate through speech, thus forming society. The oral cavity plays an essential role in these functions. When ingesting food, appropriate biting, mastication and swallowing must be conducted, and when speaking, words must be pronounced accurately. There is no doubt that the cooperative movements of the lips, teeth and tongue form the principal axis for each of these activities. The positions into which the teeth naturally erupt and align themselves are the points of balance between the opposing forces exerted by the tongue and by the lips. For instance, if the forward extension of the tongue is strong and the tension of the lips is weak, the teeth will protrude slightly forward; conversely, if the strength of the lips is strong and that of the tongue is weak, it is believed that the teeth will be inclined toward the direction of the tongue. Also, as the tongue is a mass of muscle, its shape at rest is often a manifestation of its functional characteristics. Likewise, the lips are composed of tissue surrounding muscle, and thus the shape of the lips can often reveal their function. Based on these observations, we conducted a survey of the relationships between the shape and form of the tongue and lips, versus the inclinations of the dental axes of the front teeth of the upper and lower jaw.

Early versus late treatment of crowded first premolar extraction cases: postretention evaluation of stability and relapse.

The purpose of this study was to evaluate the differences in the long-term stability of orthodontically induced changes in arch form between patients who receive early orthodontic treatment (Hellman's dental age III B, mixed dentition, n = 36) and those who are treated later (Hellman's dental age III C or after, permanent dentition, n = 47). Dental casts were evaluated before treatment, after treatment, and at a minimum of 10 years after retention. All patients had received routine edgewise orthodontic treatment that included maxillary and mandibular first premolar extraction. There were no significant differences between these groups at pretreatment and posttreatment. In the majority of cases, some degree of mandibular crowding occurred during the postretention period. There was a significant difference in the mandibular irregularity index at postretention between these groups. Regarding the deviation of the midline of the central incisors, there were no significant differences between these groups at pretreatment and posttreatment, but there was a significant difference at postretention. At the postretention stage, the late treatment group had greater mandibular anterior irregularity and deviation of the midline.

[Snacking behavior among elementary and junior high school students and its relationship to stress-coping].

The aim of the present study was to investigate current problems of snacking behavior and their relationship to stress coping among 1,486 fourth through ninth grade students from 10 elementary schools and six junior high schools. An anonymous self-completed questionnaire was utilized which included items about 1) selection of snack foods, which were classified into healthy, popular, complementary and western-style snacks, 2) problems of snacking behavior, which included external and emotional eating scores, and 3) stress coping scale. The stress coping scale contained two sub-scales; problem-focused and emotion-focused coping. The results were as follows: 1) Students who frequently went without breakfast did not select healthy foods, i.e., fruits and dairy products, but popular snacks, i.e., potato chips, pop corn and sweet beverage. 2) Both external and emotional eating scores increased by age in girls but was not apparent in boys. 3) Students who preferred either western-style or popular snacks showed higher score of external and emotional eating. 4) The score of problem-focused coping was positively correlated with preference for health snacks, but emotion-focused coping was positively correlated with external and emotional eating scores. The close relationship between snack food selection and problematic aspects of eating behavior suggests that modification of eating behavior is necessary to develop healthy snack habits in early adolescents. Also, it is interesting that snacking behavior is closely related to stress coping, which suggested the behavioral intervention for healthy eating habit should be included in development of stress-coping skills against various kinds of demands in life.

Case of thoracoscopic right upper lobectomy for lung cancer with tracheal bronchus and a pulmonary vein variation.

A 58-year-old woman visited our hospital with the chief complaint of an abnormal chest shadow. Chest CT showed an 18-mm ground-glass opacity in the right upper lobe, which became enlarged over time, and lung cancer was suspected. At the same time, a tracheal bronchus originating directly from the trachea was observed. She underwent thoracoscopic right upper lobectomy and mediastinal lymph node dissection. During surgery, in addition to the tracheal bronchus, a pulmonary vein variation was seen running dorsal to the pulmonary artery. Her postoperative course was uneventful. Tracheal bronchus is a rare anomaly, with an incidence of 0.1%-5%. Since tracheal bronchus is often accompanied by pulmonary vessel variations and may be associated with repeated previous infections, care should be taken when performing thoracoscopic lung resection.

Intrapulmonary schwannoma in the right middle lobe: a case report.

Herein, we report a patient with a rare disease, intrapulmonary schwannoma. The patient was a 61-year-old woman who had a 20 mm × 18 mm nodule, with a clear boundary and homogeneous content, on the central side of S4 in the right lung on chest CT. On PET with 18- fluorodeoxyglucose scanning, 18-fluorodeoxyglucose accumulations with a maximal standardized uptake value of 2.5 and 3.3 were observed in the early and late phases, respectively, suggesting a malignant tumor. A thoracoscopic right middle lobectomy was performed because the tumor was present in the segmental bronchial region of the middle lobe. Intrapulmonary schwannoma accounts for 0.2% of lung tumor cases, and cases involving patients who have undergone preoperative PET with 18- fluorodeoxyglucose scanning have rarely been reported.

The 19Fr Blake drain versus the 28Fr conventional drain after a lobectomy for lung cancer.

BACKGROUND: Small silastic flexible drains (Blake drains, Ethicon, Somerville, NJ, USA) are now widely used for drainage after thoracic surgery. Despite their increasing use, their advantages are still unclear. METHODS: We examined 134 cases who underwent lobectomy and lymph node dissection for primary lung cancer and retrospectively compared the changes in the amount of postoperative drainage and wound healing at the drainage sites between 87 cases using a 19Fr Blake drain and 47 cases using a 28Fr conventional drain. RESULTS: The amount of postoperative drainage was higher in the conventional drain group between 0 to 12 hours and became higher in the Blake drain group between 12 to 24 hours, but there were no significant differences in amounts between the two groups. There was, however, a significant difference between the two groups, with good wound healing at the drainage sites observed in all cases with the Blake drain group. CONCLUSION: The use of a 19Fr Blake drain instead of a 28Fr conventional drain as a means of performing drainage after a lobectomy for primary lung cancer appears to have no disadvantages.

The differences in the chronology and calcification of second molars between angle Class III and Class II occlusions in Japanese children.

The purpose of this study was to examine the differences in the times of eruption and calcification of the permanent dentition between skeletal class III and class II groups. (And also to examine the relationship between the time of eruption and the type of malocclusion) Fifty-three children, ages seven to ten years, were selected. Of these, twenty-six children (twelve boys and fourteen girls) were Angle class III with minus ANB and twenty-seven children (eleven boys and sixteen girls) were Angle class II with five or more ANB. Panoramic radiographs and cephalometric radiographs were used. The panoramic radiographs showed that the calcification of the maxillary second molars in class II were earlier than in class III using Nolla's classification. There was no statistically significant difference, however, for mean values of calcification stages, using Nolla's classification, between boys and girls. The cephalometric and panoramic radiographs showed that the times of eruption and calcification were earlier in the maxillary second molars than in the mandibular second molars for class II. In contrast, the times of eruption and calcification were earlier in the mandibular second molars than in the maxillary second molars for class III. The times of eruption and calcification of the maxillary molars were significantly related to the length of the ANS-PNS. The longer the ANS-PNS, the earlier were the times of eruption and calcification. There was a significant relationship between the ANB angle and the time of eruption, as well as the ANB angle and calcification. The larger ANB had earlier calcification and chronology of maxillary second molars.

The importance of orofacial myofunctional therapy in pediatric dentistry: reports of two cases.

It is essential that the practitioner determine the factors that are etiologically operative in oral myofunctional therapy in order to establish effective methods of intervention. Of these methods, cephalometrics and facial analysis are especially valuable in revealing and differentiating open-bite syndrome. We indicated two cases treated with only the theory of myofunctional therapy and evaluated with cephalometric radiographs and intraoral photos. This is the first report to evaluate for treatment change of myofunctional therapy with cephalometric radiographs.

Magnetic flux generation and wave emissions during coalescence of magnetic islands in pair plasmas.

It is shown by using a two-dimensional fully relativistic electromagnetic particle-in-cell code that the tearing instability in a current sheet of pair plasmas is caused by Landau resonances of both electrons and positrons. Strong magnetic flux can be generated during coalescence of magnetic islands in the nonlinear phase of the tearing instability. The magnetic flux produced in an O-type magnetic island is caused by the counterstreaming instability found by Kazimura et al. [Astrophys. J. Lett. 498, L183 (1998); J. Phys. Soc. Jpn. 67, 1079 (1998)]. It is also shown that charge separation with a quadrupole-like structure is generated from the localized strong magnetic flux. During the decay of the quadrupole-like charge structure as well as the magnetic flux, there appear wave emissions with high-frequency electromagnetic waves and Alfvén waves as well as Langmuir waves.