[Lung Cancer Associated with Hamartoma;Report of a Case].

A 65-year-old male was admitted to our hospital for evaluation of an abnormal shadow in the left lung field of chest roentgenogram. A chest computed tomography scan revealed an ill-defined nodule in the superior lingular segment of left lung and a calcified nodule in the left pulmonary apex region. A diagnosis of lung adenocarcinoma in the left lingular was made by transbronchial cytology and the left upper lobectomy with lymph node dissection was performed. Pathological diagnosis was primary lung adenocarcinoma in the superior lingular segment of left lung (pT1aN0M0, stage I A) and hamartoma in the left pulmonary apex region. It was considered to be important to discriminate a hamartoma from a metastasic lesion in order to conduct correct treatment.

[Descending Necrotizing Mediastinitis Survived by Two Operations;Report of a Case].

The patient, a 65-year-old woman, visited at her local doctor's office with the chief complaint of pharyngeal pain. After being administered antibacterial drugs, hyperthermia persisted and the pharyngeal pain became exacerbated. She was referred to our hospital and diagnosed as a retropharyngeal abscess and descending necrotizing mediastinitis (DNM). She was urgently hospitalized and surgery was performed. The mediastinal pleura was incised with thoracoscopic guidance and curettage, irrigation, and drainage were performed. Additional drainage was determined to be necessary based on findings from subsequent chest computed tomography and a prolonged inflammatory reaction. Therefore, on hospital day 7, 2nd surgery were performed, and tracheotomy was additionally performed with curettage of the neck abscess. The patient was taken off mechanical ventilation on hospital day 18, and discharged on hospital day 55.

Two cases of thymoma with pulmonary metastasis: a case report.

BACKGROUND: Pulmonary metastases of thymomas are relatively rare. We report on two patients who underwent surgery for resection of pulmonary metastases. METHODS AND RESULTS: One patient was a 74-year-old man. A chest CT scan showed a mediastinal mass and a hilar nodule in the left lung. The patient underwent surgical resection of both of these lesions. The histological diagnosis was type A thymoma with intrapulmonary metastasis, classified as stage IVb. He did not receive any adjuvant therapy following the operation because the resection was complete. There has been no evidence of recurrence in four years.The other patient was a 68-year-old man with myasthenia gravis. At the age of 61 years, he underwent extended thymectomy with combined resection of the surrounding involved structures. The histological diagnosis was type B3 thymoma, stage III. Adjuvant radiation (40 Gy) was administered postoperatively; however, a pulmonary nodule occurred seven years following the initial operation (patient age, 68 years). He subsequently underwent right lower lobectomy and a diagnosis of intrapulmonary metastasis of thymoma was made. There has been no evidence of recurrence in two years. CONCLUSIONS: Long-term follow-up is important to detect recurrence in any cases of thymoma. Lung metastases should be operated upon if they appear to be completely resectable and this can achieve long-term survival.

[Thymoma with extensive coagulative necrosis and high serum level of CYFRA 21-1; report of a case].

A 73-year-old woman complained of right chest discomfort. Chest X-ray during the follow-up for rheumatoid arthritis showed a mediastinal tumor. Chest computed tomography (CT) and magnetic resonance imaging (MRI) showed a 65-mm tumor in the right anterior mediastinum. A blood test showed high serum levels of CYFRA 21-1(29.8 ng/ml), white blood cells( WBC 10,800/µl), and C-reactive protein(CRP 16.1 mg/dl). Subsequently, inflammatory reactions improved, and the thymic tumor was resected. Histopathologically, the tumor was a type B2 thymoma with extensive coagulative necrosis. After resection, the serum CYFRA 21-1 level returned to the normal range.

[Surgically treated desmoid tumor of the chest wall which located at the previous thoracotomy site].

Desmoid tumor is a soft-tissue tumor of unknown cause. Since recurrence sometimes occurs even with complete resection, careful consideration of which portions to resect and close postoperative followup are recommended. Seventeen months after undergoing a right upper lobectomy for primary lung adenocarcinoma, a 65-year-old female patient experienced pleural tumor which located at the previous thoracotomy site, as revealed by chest X-ray and computed tomography (CT). While needle aspiration biopsy revealed no malignancy, recurrence of the cancer could not be ruled out clinically. The tumor was resected with chest wall and lung and the histopathological diagnosis was desmoid tumor. This case demonstrates the importance of conducting differential diagnosis with recurrence or desmoid tumor after operation to treat lung cancer. Five years after resection of the desmoid tumor, no recurrence is observed.

[Competencies expected of labor and social security attorneys in harmonizing work with diseases treatment].

OBJECTIVES: Labor and social security attorneys (LSSAs) are involved in various positions in harmonizing work with disease treatment; however, their qualification requirements do not include knowledge about the same. Expectations of their involvement in harmonizing work with disease treatment are insufficient. This study aimed to identify the competencies expected of the labor and social security LSSAs in harmonizing work with disease treatment. METHODS: In step 1, semi-structured interviews were conducted with LSSAs in this field. In step 2, a draft competency list was created based on the interview results. In step 3, the Delphi method was used to conduct a questionnaire survey among LSSAs who had over 10 consultation cases on harmonizing work with disease treatment, and they were asked about the level of importance (how important they thought it was to promote harmonizing work with disease treatment) and level of achievement (how much they had achieved). We also asked them about the competencies they considered necessary and added them as additional items in the draft. In step 4, the results of the previous step were presented to the participants who had given valid answers in step 3, and they were asked whether they would adopt the items as competencies. Items with an agreement rate of 80% or higher were considered competency items. Additionally, we asked them about the level of importance and level of achievement of the additional items created in step 3. RESULTS: In step 1, 24 LSSAs participated, and in step 2, a draft competency list of six major items, 18 medium items, and 71 minor items was created. In step 3, 49 LSSAs participated and 41 cooperated (response rate: 83.6%). Five items were selected for the draft competency list to be newly added. In step 4, 30 LSSAs cooperated (response rate: 73.1%). None of the items had an agreement rate of less than 80%, and over 40% of the items had an agreement rate of 100%. As a result, six major items, 18 medium items, and 76 minor items were selected for the competency list. CONCLUSIONS: This study identified the competencies expected of labor and social security LSSAs in harmonizing work with disease treatment. The results of this study can be used as a reference for developing a systematic training curriculum for LSSAs in this field in the future.

Synthesis and SAR studies of bicyclic amine series GPR119 agonists.

We disclosed a novel series of G-protein coupled receptor 119 (GPR119) agonists based on a bicyclic amine scaffold. Through the optimization of hit compound 1, we discovered that the basic nitrogen atom of bicyclic amine played an important role in GPR119 agonist activity expression and that an indanone in various bicyclic rings was suitable in this series of compounds. The indanone derivative 2 showed the effect of plasma glucose control in oGTT and scGTT in the rodent model.

Synthesis and pharmacological profile of a new selective G protein-coupled receptor 119 agonist; 6-((2-fluoro-3-(1-(3-isopropyl-1,2,4-oxadiazol-5-yl)piperidin-4-yl)propyl)amino)-2,3-dihydro-1H-inden-1-one.

6-((2-Fluoro-3-(1-(3-isopropyl-1,2,4-oxadiazol-5-yl)piperidin-4-yl)propyl)amino)-2,3-dihydro-1H-inden-1-one is a potent drug-like G protein-coupled receptor 119 (GPR119) agonist. It is hoped that this compound would be instrumental in probing the pharmacological potential of GPR119 agonists.

Effectiveness and Challenges in Local Self-Governance: Multifunctional Autonomy in Japan.

Community organizing with government support, termed local self-governance (LSG), is a form of policy decentralization for community wellbeing through solutions tailored to local issues. One form of LSG is multifunctional autonomy, in which citizens can comprehensively manage their communities with government support. This study clarified the effect of multifunctional autonomy on healthy life expectancy by assessing related advantages and challenges in rural Japanese communities, using a mixed-methods approach. Disability-free life expectancy from 65 years (DFLE-65) was assessed to compare healthy life expectancies between two rural Japanese cities (with/without multifunctional autonomy). Comparisons revealed better DFLE-65 only among older men in a city with multifunctional autonomy. A cost-effectiveness analysis investigated the relationship between the budget and DFLE-65 change using questionnaire data. Cost-effectiveness analysis of multifunctional autonomy indicated 61,147 yen/DFLE-65. Thematic analysis revealed that multifunctional autonomy created new roles for older men, improving community relationships. However, sustainable multifunctional autonomy in LSG communities may be hindered by a generally aging society, generation gap, and lack of mutual understanding between rural communities and local governments. To ensure the sustainability of multifunctional autonomy, collaborations between local communities and governments and among various generations are critical.

Induction chemoradiotherapy followed by surgery for locally advanced non-small cell lung cancer.

We examined the efficacy and toxicity of a divided schedule of cisplatin and vinorelbine with concurrent radiotherapy followed by surgery in patients with locally advanced non-small cell lung cancer (NSCLC). Patients with clinical stage IIIA or IIIB NSCLC were eligible if they had a performance status of 0 or 1, were 75 years or younger, and had adequate organ function. Patients were treated with cisplatin (40 mg/m2) and vinorelbine (20 mg/m2) on days 1 and 8 every 3 weeks. Thoracic radiotherapy (2 Gy per fraction; total dose, 40 Gy) was given concurrently. Surgical resection was performed after induction therapy had been completed. If disease was considered clinically inoperable after induction therapy, patients received 2 additional cycles of the chemotherapy and 20 Gy of additional radiotherapy. Twenty-three patients (20 men and 3 women; median age, 63 years; age range, 45-72 years) were enrolled. The overall response rate was 78.3%. Although grade 3-4 toxicities included neutropenia in 95.7% of patients and anemia in 39.1%, no grade 3-4 radiation pneumonitis or esophagitis occurred. Thirteen patients (56.5%) underwent thoracotomy and complete resection. There were no treatment-related deaths. The median survival time was 36 months (range, 4-78 months), the 2-year survival rate was 74%, and the median time to disease progression was 15 months (range, 2-59 months). This trimodality therapy is effective and well tolerated and is an acceptable therapeutic option for patients with locally advanced NSCLC.

Thymidine phosphorylase affects clinical outcome following surgery and mRNA expression levels of four key enzymes for 5-fluorouracil metabolism in patients with stage I and II non-small cell lung cancer.

The expression levels of thymidine phosphorylase (TP), dihydropyrimidine dehydrogenase (DPD), thymidylate synthase (TS) and orotate phosphoribosyltransferase (OPRT) may predict the clinical efficacy of 5-fluorouracil-based chemotherapy in patients with cancer. We herein investigated the differences in the mRNA levels of these enzymes in non-small-cell lung cancer (NSCLC) and evaluated their prognostic value for NSCLC treated by surgical resection. The intratumoral mRNA levels of TP, DPD, TS, and OPRT were quantified in 66 patients with pathological stage I and II NSCLC (adenocarcinoma or squamous cell carcinoma) following complete resection according to the Danenberg Tumor Profile method. The TP level was the only significant prognostic factor for disease-specific survival (DSS) following complete resection; the mean TP mRNA level differed significantly between the high and low mRNA expression groups. The DSS at 5 years was significantly higher in the low TP mRNA compared with that in the high TP mRNA expression group (83.4 vs. 58.6%, respectively; P=0.005). A Cox proportional hazards model revealed that pathological stage, sex, and TP expression were independent prognostic factors for DSS in patients with stage I and II NSCLC following complete resection. Thus, TP level may be used to monitor treatment efficacy and predict the outcome of NSCLC patients.

Video-assisted thoracic surgery for primary myelolipoma of the posterior mediastinum.

BACKGROUND: Myelolipoma is an uncommon tumor comprising adipose tissue and normal hematopoietic cells and mainly occurs in the adrenal cortex. Mediastinal myelolipoma is very rare; we report a case of posterior mediastinal myelolipoma that required surgical resection. CASE PRESENTATION: A 56-year-old male was diagnosed with a posterior mediastinal tumor by computed tomography. The tumor was originally noted in 2005, and during follow-up in March 2014, it was found to have increased in size. During consultation at our hospital, on magnetic resonance imaging (MRI), we considered the possibility that the tumor was malignant. Consequently, we resected the tumor by video-assisted thoracic surgery (VATS). The histopathological findings revealed that the tumor had undergone intrathoracic extramedullary hematopoiesis. However, after considering the patient's background and histopathological findings, we diagnosed the tumor as a thoracic extra-adrenal myelolipoma. CONCLUSIONS: Pathological analysis was instrumental in clarifying the diagnosis. We recommend surgery as a treatment option for posterior mediastinal tumors.

[Multiple synchronous intrathoracic neurilemmomas who had a past history of neurilemmoma on the abdominal wall; report of a case].

A 66-year-old female, who had received a surgery of the neurilemmoma on the abdominal wall 6 years ago, was referred to our hospital because of a chest X-ray abnormality. Chest computed tomography (CT) revealed 3 tumors in the left chest wall. One tumor arised from the 7th intercostal nerve and 2 tumors from 8th nerve. These tumors were surgically removed by video-assisted thoracic surgery. These tumors are histopathologically diagnosed as neurilemmoma and have the same characteristics with previously resected abdominal wall tumor.

(15)N and (31)P NMR Insights into Lactam-Lactim Tautomerism Activity Using cyclo-µ-Imidopolyphosphates.

The effects of the molecular structure and solution pH on compounds prone to lactam-lactim tautomerism have been evaluated by (15)N NMR spectroscopy. The lactam-lactim tautomerism activities of cP3O6(NH)3(3-) and cP4O8(NH)4(4-) showed a significant pH dependence, with the process being inactivated under alkaline conditions because of the decrease in the number of hydrogen atoms by the deprotonation of the anions. The tautomerism was activated under the acidic conditions by the increase in the number of dissociative hydrogen atoms resulting from the protonation of the anions. cP3O6(NH)3(3-) has much more of a planar molecular structure than cP4O8(NH)4(4-), meaning that the hydrogen atoms in cP3O6(NH)3(3-) would be delocalized over the entire structure to a greater extent than those in cP4O8(NH)4(4-). This difference in the distribution of hydrogen atoms would result in the lactam-lactim tautomerism activity of cP3O6(NH)3(3-) being higher than that of cP4O8(NH)4(4-). The results have shown that the following factors are critical to the achievement of an efficient anhydrous proton conductor: (1) the regular molecular arrangement of highly planar molecules; (2) the existence of a large number of dissociative protons in a molecule; and (3) a molecular structure with a small energy barrier for the structural rearrangement required of the tautomerism process.

Spontaneous regression of bronchogenic cyst accompanied by pneumonia.

Bronchogenic cysts arise from abnormal budding of the ventral diverticulum of the foregut or tracheobronchial tree during embryogenesis, are the most common cystic masses in the mediastinum, and are generally asymptomatic. A spontaneous regression in a mediastinal bronchogenic cyst (MBC) with pneumonia is rare. A 30-year-old male had a tumor shadow in the middle mediastinum. When he visited our hospital, he had a mild fever with coughing and sputum. A chest computed tomography (CT) scan showed a decrease in the tumor size and the existence of right pneumonia. MBC may be involved in the etiology of pneumonia; therefore, bronchogenic cysts need to be resected as soon as possible.

The indirect pathogenicity of Stenotrophomonas maltophilia.

Stenotrophomonas maltophilia has at least two inducible beta-lactamases, L1 and L2, which can hydrolyze almost all classes of beta-lactam antimicrobial agents. This study was done to verify the indirect pathogenicity of S. maltophilia that could promote the growth of other beta-lactam agent-susceptible bacteria in a mixed culture. We counted CFU of beta-lactam agent-susceptible bacteria under the presence of imipenem or ceftazidime in a pure culture and mixed culture with S. maltophilia. Our results showed that beta-lactamase leaking from S. maltophilia can encourage the growth of Serratia marcescens and Pseudomonas aeruginosa even if imipenem or ceftazidime was supplemented. This study discovered a blind spot in chemotherapy against an indirect pathogen such as S. maltophilia.

Pre- and post-operative serum carcinoembryonic antigen in primary lung adenocarcinoma.

The clinical value of pre- and post-operative serum carcinoembryonic antigen (CEA) concentration (mean +/- SEM, ng/ml) in surgically treated primary lung cancer patients with adenocarcinoma (n=97) was studied. Preoperative CEA in pT2 patients (18.3+/-8.0) was higher than in pT1 (10.5+/-6.4, p<0.05) but was not different from pT3 patients (19.7+/-6.7). Preoperative CEA in pN1 patients (5.9+/-1.6) was lower than in pN2 (28.2+/-13.2, p<0.05) but not different from pN0 patients (8.8+/-3.8); p-stage II patients (8.2+/-4.7) had lower values than p-stage III patients (26.7+/-10.5, p<0.05), but not p-stage I patients (7.9+/-3.9). The CEA was not different between p-stages IA and IIA (3.5+/-0.6, 6.1+/-3.2) and IB and IIB (17.0+/-11.8, 11.7+/-7.8), but was different between IA and IB (p<0.05) and IIA and IIB (p<0.05). Preoperative CEA did not differ between patients who received complete (12.7+/-4.7) versus incomplete (9.5+/-6.0) resections, nor between patients who developed recurrence after surgery (21.9+/-10.4) versus those who were disease-free (30.9+/-21.7). CEA obtained 2 months after surgery in patients who recurred or metastasized after surgery (63.1+/-47.0) was higher than in disease-free patients (4.8+/-1.6, p<0.05). The post-/pre-operative CEA ratio in patients who recurred or metastasized after surgery (146.6+/-53.3%) was also higher than in disease-free patients (91.0+/-10.9%, p=0.05). In conclusion, CEA reflected tumor size but not the tumor invasion nor hilar lymph node disease; patients with mediastinal lymph node involvement had higher CEA values. Preoperative CEA did not reflect the likelihood of complete resection nor postoperative metastasis, but postoperative CEA obtained 2 months after surgery did reflect postoperative metastasis.

Resection of thymic carcinoma in a patient with thoracic aortic aneurysm.

A 72-year-old man with a history of brain infarction presented with left sided anterior chest pain secondary to a thymic carcinoma. He received induction radiotherapy, 45 Gy. Preoperative computed tomography showed the tumor was adherent to a thoracic aortic aneurysm (TAA) which had extensive mural thrombus and calcification. To obtain adequate exposure without exerting tension on the fragile aneurysmal wall, ribs were resected to allow us to separate the tumor from the TAA, after which median sternotomy was performed uneventfully, creating generous exposure. The tumor had invaded the sternum, ribs, innominate vein, phrenic and recurrent laryngeal nerves, and lung. The tumor was removed en bloc, and the chest wall was reconstructed. Intra- and post-operative brain infarction and rupture of the TAA were avoided. The patient is alive and well without recurrence 10 months after surgery.

[The results of antibiotic susceptibility of gram-negative rods at Tottori University Hospital--the possibility of the sensible use of narrow-spectrum antimicrobial agents].

The control of hospital-acquired infections is a matter of social concern, especially in the proper use of antimicrobial agents. The fundamentals of treatment for infectious diseases involve the exact identification of the responsible bacteria, and the minimum essential use of narrow-spectrum antimicrobial agents for the identified bacteria. We tested the antimicrobial susceptibility of 13 species which belong to the gram-negative rod type and isolated 50 or more strains at Tottori University Hospital in 2001. We evaluated the susceptibility pattern for every species, and have proposed a plan for the sensible use of narrow-spectrum antimicrobial agents. The resistant frequency in the present study was equal to or lower than previously reported. We think that it is possible to use narrow-spectrum antimicrobial agents more often, because the susceptible frequency to these agents was fairly high for some species. It is not too much to say that the history of the development of antimicrobial agents has been a road to broad-spectrum. Though the proper use of antimicrobial agents seems to go against this view, we should remain farsighted. Not only is the publicity of proper use indispensable but excellent surveillance is also highly necessary. We hope for the establishment of a good surveillance system gifted with simplicity, universality, high reproduction and continuity.

[Experience with invasive thymoma presenting pleural dissemination].

A 61-year-old man was admitted to Showa University Hospital because of a myasthenia gravis. Chest computed tomography revealed a mediastinal invasive tumor. During surgery, invasion to the pericardium and dissemination on the left visceral pleura and the left diaphragm were observed. Extended thymo-thymectomy and partial resection of the pericardium, left lung, and diaphragm were performed. Incomplete resection was achieved because of the dissemination on the diaphragm. Chemotherapy using ADOC and radiotherapy for mediastinum and left diaphragm were done. Four years after surgery, neither recurrence of the tumor nor myasthenia gravis was observed.