[Large cell neuroendocrine carcinoma of the lung].

Large cell neuroendocrine carcinoma (LCNEC) is a neuroendocrine tumor comprising a subgroup of large cell carcinoma and is a type of lung cancer showing a neuroendocrine characteristic similar to that of small cell lung carcinoma In our institution, we started to diagnose LCNEC by immunostaining in 2002, and we herein report 9 patients diagnosed with LCNEC from January 2002 to May 2008. The average patient age was 74.9, male/female ratio was 8/1, and all 9 patients had a smoking history. Pathological stages IA/IB/IIB/IIIA comprised 4/1/2/2, respectively. Peripherally located and lobulated tumors were noted on preoperative computed tomography (CT), and moderate uptake of fluoro-2-deoxy-D-glucose (FDG), which balanced with the size, was recognized on positron emission tomography (PET). All 9 patients underwent surgery and 7 underwent radical surgery. Postoperative adjuvant chemotherapy was performed for 4 patients. Three showed recurrence, and 2 of these 3 died of the primary disease. The remaining 7 patients have survived to date. The possibility of LCNEC must be considered when peripherally located lung cancer with lobulation is noted on CT and shows moderate uptake of FDG for its size on PET, and multimodal treatment is needed if the diagnosis is determined postoperatively.

Comparison in prognosis after VATS lobectomy and open lobectomy for stage I lung cancer: retrospective analysis focused on a histological subgroup.

BACKGROUND: Video-assisted thoracoscopic surgery (VATS) has become an attractive surgical procedure, but several issues remain to be resolved. Prognosis after VATS lobectomy is important to evaluate the adequacy of VATS lobectomy as a cancer operation. Interestingly, several investigators, including us, have reported that prognosis after VATS lobectomy was superior to that after open lobectomy in early non-small-cell lung cancer (NSCLC). One of the possible reasons is the low invasiveness of VATS lobectomy. But we considered that patient bias might have some influence favoring VATS lobectomy. To evaluate our hypothesis, we reviewed medical records of stage I NSCLC patients undergoing operation between 1993 and 2002. We compared and evaluated the relationship between patient characteristics and prognosis after VATS and open lobectomy. We focused particularly on histological type, classifying it into four subgroups; (1) bronchioloalveolar carcinoma (BAC), (2) mixed BAC + papillary adenocarcinoma (BAC + Pap), (3) other adenocarcinoma (Other adeno), (4) squamous cell carcinoma + others (Sq + others). RESULTS: A total of 165 patients underwent VATS lobectomy, and 123 patients underwent open lobectomy. The 5-year survival rate of the VATS lobectomy group was 94.5% and that of the open lobectomy group was 81.5%. Univariate Cox regression of survival revealed that male, CEA > 5, Other adeno, Sq + others, open lobectomy, and tumor size > 3 cm were significant negative prognostic variables. Multivariate Cox regression of survival revealed that histological subtype and tumor size were independent prognostic factors, but surgical procedure was not an independent prognostic factor. COMMENTS: Prognosis after VATS lobectomy was superior to that after open lobectomy, but patient bias influenced the prognosis in favor of VATS lobectomy, and the surgical procedure itself was not a prognostic factor.

Distribution dynamics of perfluorocarbon delivery to the lungs: an intact rabbit model.

Motivated by the goal of understanding how to most homogeneously fill the lungs with perfluorocarbon for liquid ventilation, we investigate the transport of liquid instilled into the lungs using an intact rabbit model. Perfluorocarbon is instilled into the trachea of the ventilated animal. Radiographic images of the perfluorocarbon distribution are obtained at a rate of 30 frames/s during the filling process. Image analysis is used to quantify the liquid distribution (center of mass, spatial standard deviation, skewness, kurtosis, and indicators of homogeneity) as time progresses. We compare the distribution dynamics in supine animals to those in upright animals for three constant infusion rates of perfluorocarbon: 15, 40, and 60 ml/min. It is found that formation of liquid plugs in large airways, which is affected by posture and infusion rate, can result in a more homogeneous liquid distribution than gravity drainage alone. The supine posture resulted in more homogeneous filling of the lungs than did upright posture, in which the lungs tend to fill in the inferior regions first. Faster instillation of perfluorocarbon results in liquid plugs forming in large airways and, consequently, more uniform distribution of perfluorocarbon than slower instillation rates in the upright animals.

Therapeutic experience of venomous snakebites by the Japanese viper (Agkistrodon halys Blomhoffii) with low dose of antivenin: report of 43 consecutive cases.

Forty-three consecutive patients of venomous snakebite by the Japanese viper (Agkistrodon halys Blomhoffii, "Mamushi" in Japanese) were treated with an uniformly scheduled therapy from 1990 and 1994. The therapy was mainly composed of minimal dose of antivenin, methylprednisolon and cepharanthin. There were two clinical courses, i.e., the minimal envenomation course (Group A, n = 14) and the severe one (Group B, n = 29). Our treatment was so satisfactory that all patients of both groups fully recovered activities of daily living with neither organic disorders nor sequelae of the bitten extremities. The high appearance ratio of atypical lymphocytes (P < 0.05) and the increased ratio of lymphocyte count to White blood cell count (P < 0.02) could be indicators that predict which clinical courses the patients take.

A method for evaluating skeletal relapsing force during maxillomandibular fixation after orthognathic surgery: a preliminary report.

Although skeletal relapse after orthognathic surgery can be considered primarily the results of unbalanced tension in the surgically modified stomatognathic system (i.e., skeletal relapsing force [SRF] acting on the mandibular segment), no study of SRF has been reported and its nature still remains unclarified. This article presents a practicable method for evaluating SRF during the fixation period with the use of a foil strain gauge fixed to the upper arch wire between the central incisors, with a preliminary result after mandibular advancement by sagittal split ramus osteotomy to demonstrate the value of this method for studying SRF. The pattern and degree of SRF were shown to vary during the postoperative period and in accordance with experimental situations, including the mandibular resting posture, swallowing, clenching, and speaking. On day 3, a constant SRF of 550 gm existed even in the resting posture and was increased by 450 gm to a maximum of about 1 kg on swallowing; clenching and speaking also produced an increase. Thus it was inferred that SRF arose not only from surgically stretched perimandibular connective tissues but also from intermittent physiologic muscle actions. The constant SRF subsided gradually with time, and after day 33, swallowing as well as clenching no longer increased the SRF, which indicates that the critical period for postoperative skeletal stability was the first few weeks, during which muscle readaptation and primary bone healing occurred. It was concluded that this method of evaluating SRF, which is capable of immediately revealing any tendency to relapse or the progress of soft tissue adaptation and bone healing, could be used as an effective research tool.

Cause of early skeletal relapse after mandibular setback.

The present study was undertaken to examine the factors that might be responsible for the skeletal relapse occurring during the period of intermaxillary fixation after mandibular setback osteotomy. Fifteen patients, treated for absolute mandibular prognathism by modified sagittal split ramus osteotomy and fixation by skeletal suspension wiring, were evaluated cephalometrically by reference to the degree of postsurgical superior shift of the gonial region of the distal segment as a parameter of relapse since such a shift was evident despite the use of wiring. It was found that the degree of inadvertent anteroposterior rotation of the proximal segment at surgery, rather than the extent and pattern of surgical repositioning of the distal segment, was significantly correlated with the degree of shift. This result emphasizes the justification of preserving the proximal segment in its exact original anatomic site, in addition to the use of skeletal fixation, to ensure predictable stability after mandibular setback osteotomy.

Ectopic pneumosinus maxillaris dilatans. A case report.

An abnormal topical expansil condition of the paranasal sinuses due to dyspneumatizing development is called pneumosinus dilatans. A recent case of pneumosinus maxillaris dilatans causing an apparent alveolar swelling is reported in this paper. No such case has previously been described to our knowledge.

Skeletal fixation versus skeletal relapse.

The use of skeletal fixation was evaluated for skeletal stability during the period of intermaxillary fixation following a modified sagittal split ramus osteotomy for mandibular prognathism. A combination of bilateral maxillary peralveolar wires and circummandibular wires in the canine region was used for the fixation. One group of patients with this method of fixation (S group) and a second group without the fixation (C group) were compared cephalometrically. Statistically significant differences existed in the amount and pattern of relapse; the fixation produced a significant effect on retention of the corrected chin position. As a consequence, downward and backward rotation of the distal fragment of the mandible and compensatory incisor extrusion were notably controlled. However, upward shift of the posterior end of the distal fragment occurred persistently even in the S group, causing considerable intrusion of the posterior teeth in comparison with the C group. This seems to indicate that tension, probably exerted by the pterygomasseteric sling, is important in postoperative skeletal instability.