[Surgical resection of a pulmonary pleomorphic carcinoma involving the azygos vein].

We report a case of surgical treatment of pulmonary pleomorphic carcinoma invading the azygos vein. Chest computed tomography (CT) revealed a mass of 6 cm in size, in the upper lobe of the right lung. He underwent the right upper lobectomy and lymph node dissection with combined resection of the involved azygos vein. Histological examination revealed pleomorphic carcinoma (pT3N0M0, stage IIB). The postoperative course was uneventful, and he was alive without recurrence 26 months after the operation. Six cases of pleomorphic carcinoma have been surgically treated between June 2008 and August 2009 in our institute. Early diagnose with complete resection is suggested to be essential in the improvement of survival for this disease based on review of our experience.

[Multiple myeloma presenting as a solitary tumor of the rib; report of a case].

A 78-year-old man complained of right lateral chest pain. Chest X-ray showed an abnormal shadow in the right upper lung field and chest computed tomography (CT) scan showed a lateral chest wall tumor sorrouding the right 4th rib. Bone scintigraphy revealed only one lesion in the right 4th rib. Chest wall tumor resection was done. Histological analysis of the tumor specimen showed plasmacytoma. After the operation, the diagnosis of multiple myeloma was established by demonstration of myeloma by a bone marrow biopsy. Multiple myeloma should be taken into account as one of causes of a chest wall tumor even if it is a solitary tumor of the rib.

[Therapeutic strategy for spontaneous pneumothorax].

This study assesed the treatment of spontaneous pneumothorax from April 1998 to October 2004. Chest computed tomography (CT) was conducted on admission to judge the presence or absence of bulla and/or bleb. A total of 168 cases (112 patients) were treated. There were 93 men and 19 women with a mean age of 40.6 (range, 15 to 98) years. Of the total cases, 119 were the first pneumothorax, and 49 cases were recurrence. Video-assisted thoracoscopic surgery (VATS) was the first-choice surgical procedure. We compared a retrospective series of 168 cases treated by observation with chest tube drainage in 94 cases and bed rest in 3 cases (57.7%), VATS in 62 cases (36.9%), or limited thoracotomy (LT) conventionally in 9 cases (5.4%). The recurrence rate by observation, VATS, or LT was 42, 13, and 0%, respectively. The rate of recurrence in the observation group was higher than in the VATS group, and the rate of recurrence in the presence of bulla and/or bleb was 48% and that of recurrence in their absence was 20%. These results suggest that VATS or LT should be recommended for patients with bulla and/or bleb indicated by chest CT. In VATS, an auto-sutured line with a polyglycolic acid (PGA) sheet and the use of fibrin glue spray were thought to be effective in preventing the recurrence of pneumothorax. Futhermore, LT with primary suturing was thought to be useful in cases of skip and multiple, in consideration of the numbers, patterns, and properties of the bulla and/or bleb from the intraoperative findings through the thoracoscope.

[Evaluation of the proximal stenosis of native coronary vessels after coronary artery bypass grafting].

This study was designed to evaluate proximal native coronary stenosis (PNCS) after coronary artery bypass grafting (CABG). In 36 patients undergoing postoperative coronary arteriography, the PNCS bypassed with internal thoracic artery (ITA), saphenous vein graft (SVG) and right gastroepiploic artery (RGEA) progressed in 9 of 23 vessels (39%), in 15 of 28 vessels (53%), in 4 of 11 vessels (36%), respectively. Stenosis of no grafted coronary vessels progressed in 3 of 26 vessels (11%). Twelve native coronary vessels (9: 99% and 3: 90% stenosis vessels) bypassed with grafts were obstructed. This study confirms that the PNCS progresses significantly by CABG just after the operation and that it tends to progress highly with SVG in comparison with arterial grafts such as ITA or RGEA. Because operative mortality for repeated CABG is approximately twice as high as that for primary CABG, it is important to decide whether early postoperative percutaneous transluminal angioplasty is needed or not, in considering of future graft failure and stenosis progression of the native coronary vessels by CABG.

"Ring syndrome" involving chromosome 2 confirmed by FISH analysis using chromosome-specific subtelomeric probes.

"Ring syndrome" is described as those cases with complete ring chromosomes showing, independently of the chromosome involved, severe growth failure, minor dysmorphic features, and mild-to-moderate mental retardation, without major malformations. We present a girl with ring 2 chromosome, exhibiting severe growth failure, minor dysmorphic features, spontaneously closed ventricular septum defect, and normal development. G-banding chromosome analysis and fluorescence in situ hybridization (FISH) analysis using chromosome-specific subtelomeric probes (2ptel, 2qtel) demonstrated the major karyotype as 46,XX,r(2)(p25.3q37.3).ish r(2)(2ptel+,2qtel+). We review the cases with "ring syndrome" confirmed by FISH using chromosome-specific subtelomeric probes, suggesting that this method might be useful to predict developmental prognosis in a case with an apparently complete ring chromosome.

[Clinical evaluation of risk factors for respiratory failure after coronary artery bypass grafting with cardiopulmonary bypass].

The relationship between the duration of postoperative mechanical ventilation and pre-, intra- and just post-operative factors was studied in 48 patients undergoing coronary artery bypass grafting with cardiopulmonary bypass. The patients were divided into 2 groups on the basis of the duration of mechanical ventilation: group A with less than 24 hours (n=35) and group B with more than 24 hours (n=13). Investigation of the perioperative parameters which significantly correlated with the duration of mechanical ventilation revealed that emergency case, cardiac dysfunction, high dose administration of cathecolamine, high left atrial pressure (LAP), low serum albmin, and renal dysfunction after transfer to intensive care unit (ICU) were found to be increased risks of postoperative respiratory failure.

[Prospective study of systemic inflammatory response syndrome after cardiac surgery as a effective indicator].

This prospective study was designed to elucidate the meaning of systemic inflammatory response syndrome (SIRS), the mechanisms that lead to the protraction of SIRS, and whether SIRS is potentially a simple and effective postoperative indicator or not in patients who are operated on with cardiopulmonary bypass (CPB). We studied the duration of SIRS in 90 patients. Our data showed that 83 (92%) of the 90 patients met 2 or more criteria for SIRS and that significant relationship between the protraction of SIRS and the duration of aortic clamping time, CPB time, operation time, and the risk of postoperative organ damage and complication. Those results suggest that SIRS after cardiac surgery with CPB can be regarded as right criteria and highly valuable indexes of preparatory state of organ dysfunction.

Thymic carcinoids in multiple endocrine neoplasia-type 1.

We report a case of a 45-year-old man with thymic carcinoids in multiple endocrine neoplasm-type 1. Extended total thymectomy was performed through a median sternotomy, and the mediastinal regional lymph nodes and fibroadipose tissue were dissected. Multiple endocrine neoplasm-type 1 related thymic carcinoids are rare and have a poor prognosis. The efficacy of radiotherapy and chemotherapy for prolonging survival is limited, and an aggressive surgical approach with complete excision of the tumor with resection of the peripheral tissues and dissection of the mediastinal lymph nodes seems to be the best available treatment today. We have found that this practice of thymectomy at an early stage in combination with genetic and effective radiological treatment can be effective for multiple endocrine neoplasm-type 1 patients.

Mitral valve plasty for mitral regurgitation after blunt chest trauma.

A 21 year-old woman was admitted to our hospital because of chest and back pain after blunt chest trauma. On admission, consciousness was clear and a physical examination showed labored breathing. Her vital signs were stable, but her breathing gradually worsened, and artificial respiration was started. The chest roentgenogram and a subsequent chest computed tomographic scans revealed contusions, hemothorax of the left lung and multiple rib fractures. A transthoracic echocardiography (TTE) revealed normal left ventricular wall motion and mild mitral regurgitation (MR). TTE was carried out repeatedly, and revealed gradually progressive MR and prolapse of the posterior medial leaflet, although there was no congestive heart failure. After her general condition had recovered, surgery was performed. Intraoperative transesophageal echocardiography (TEE) revealed torn chordae at the posterior medial leaflet. The leaflet where the chorda was torn was cut and plicated, and posterior mitral annuloplasty was performed using a prosthetic ring. One month later following discharge, the MR had disappeared on TTE.

Potential usefulness of solubility index for prediction of the skin permeation rate of 5-ISMN from pressure-sensitive adhesive tape.

Skin permeation of 5-ISMN from pressure sensitive adhesive (PSA) tape was evaluated using thermodynamic activity of the drug in PSA. Three acrylic adhesives (Gelva 737, Gelva 1430 and Gelva 1753) were used as PSA. Since the drug activity in PSA is difficult to determine, however, a solubility index was defined. Several PSA tapes containing different amounts of 5-ISMN were prepared, and heat of fusion at the dissolution of 5-ISMN in each PSA was determined by DSC. No exothermic peak was found when the drug concentration was less than the solubility in PSA, whereas the heat of fusion increased proportionally with amount of solid drug in the PSA when the drug concentration was above the solubility. The bending point in the profile of heat of fusion versus 5-ISMN content in PSA was defined as the solubility index. In vitro skin permeation was determined using excised hairless rat skin from 5-ISMN-saturated PSA tapes. The obtained skin permeation of the drug decreased with increases in the solubility index. These profiles were confirmed by a theoretical approach using the differential equation corresponding to Fick's second law of diffusion. These results suggested that the solubility index can be utilized for prediction of the skin permeability of drugs from PSA tape.

Efficient production of menaquinone (vitamin K2) by a menadione-resistant mutant of Bacillus subtilis.

Efficient production of menaquinone (MK) by Bacillus subtilis was achieved. An edible strain of B. subtilis, isolated from the traditional Japanese food natto, was mutated to improve MK productivity. A menadione-resistant mutant producing 30% more MK than its parent strain was obtained. Soybean extract and glycerol were the best nitrogen and carbon sources, respectively, among the sources tested. Addition of yeast extract also increased MK productivity. The maximum concentration of MK reached about 35.0 mg/l after 4 days of culture in a jar fermenter. The pH of the medium decreased to 5.5 after the start of cultivation, then spontaneously increased to 7.7-8.0. This pH change might be important in the production of MK because only small amounts of MK were obtained when pH was controlled at 5.7, 6.0, 7.0, 7.5 or 8.0.

High-output heart failure caused by a huge renal arteriovenous fistula after nephrectomy: report of a case.

Postnephrectomy renal arteriovenous fistula (AVF) with an aneurysmal lesion is a rare clinical entity that may cause high-output heart failure. In this report, we describe the case of a 68-year-old man who had undergone nephrectomy for renal tuberculosis 43 years previously, in whom an acquired large renal AVF presenting as an aneurysm caused congestive cardiac failure. We also discuss the hemodynamic, hormonogenic (human arterial natriuretic polypeptide; hANP), and radiographic findings before and after surgery for the AVF. The AVF with an aneurysmal lesion was clearly visualized by three-dimensional-computerized tomographic (CT) scanning, and proximal ligation of the renal artery was followed by an uneventful recovery. This procedure can produce good results when a fistula is too large to allow safe embolization and when excision would be hazardous due to inflammation surrounding the fistula.

Syk protein-tyrosine kinase is involved in neuron-like differentiation of embryonal carcinoma P19 cells.

Syk has been implicated in activated immunoreceptors to downstream signaling events in hematopoietic cells. Here we report that Syk is expressed in neuron-like cells and involved in neuron-like differentiation of embryonal carcinoma P19 cells. Immunoblot, RT-PCR, and Northern analysis indicated that Syk is expressed in mouse brain, PC12 and P19 cells. In addition, Syk was found to be tyrosine phosphorylated during neuron-like differentiation of P19 cells. Furthermore, adenovirus-mediated overexpression of Syk induced supernumerary neurite formation and extracellular signal-regulated kinase (ERK) activation in P19 cells. These results suggest that Syk plays an important role in signaling steps leading to ERK activation in P19 cells.

Production of menaquinone (vitamin K2)-7 by Bacillus subtilis.

Menaquinone-7 (MK-7) is a highly bioactive homologue of vitamin K. We obtained a diphenylamine-resistant mutant strain D200-41 from Bacillus subtilis strain MH-1 which was isolated from fermented soybeans, natto. The mutant strain exhibited decreased production of MK-6. Using strain D200-41, efficient production of MK-7 was achieved. We found that, compared with an agitated and aerated culture, production of MK-7 was increased by static culture. The sporulation of the cells progressed more slowly in a static culture than in an agitated culture. The maximum concentration of MK reached about 60 mg/l in a medium containing 10% soybean extract, 5% glycerol, 0.5% yeast extract and 0.05% K2HPO4 (pH 7.3) when D200-41 cells as well as MH-1 cells were statically cultured at 45 degrees C for 5 d after being cultured with shaking at 37 degrees C for 1 d.

Identification of CRAM, a novel unc-33 gene family protein that associates with CRMP3 and protein-tyrosine kinase(s) in the developing rat brain.

Four members of collapsin response mediator proteins (CRMPs) are thought to be involved in the semaphorin-induced growth cone collapse during neural development. Here we report the identification of a novel CRMP3-associated protein, designated CRAM for CRMP3-associated molecule, that belongs to the unc-33 gene family. The deduced amino acid sequence reveals that the CRAM gene encodes a protein of 563 amino acids, shows 57% identity with dihydropyrimidinase, and shows 50-51% identity with CRMPs. CRAM appears to form a large complex composed of CRMP3 and other unidentified proteins in vivo. Indeed, CRAM physically associates with CRMP3 when co-expressed in COS-7 cells. The expression of CRAM is brain-specific, is high in fetal and neonatal rat brain, and decreases to very low levels in adult brain. Moreover, CRAM expression is up-regulated during neuronal differentiation of embryonal carcinoma P19 and PC12 cells. Finally, immunoprecipitation analysis of rat brain extracts shows that CRAM is co-immunoprecipitated with proteins that contain protein-tyrosine kinase activity. Taken together, our results suggest that CRAM, which interacts with CRMP3 and protein-tyrosine kinase(s), is a new member of an emerging family of molecules that potentially mediate signals involved in the guidance and outgrowth of axons.

Minimally invasive direct coronary artery bypass grafting using the saphenous vein in redo CABG.

We describe a patient who underwent minimally invasive direct coronary artery bypass (MIDCAB), who had previously undergone coronary artery bypass grafting (CABG) through a median sternotomy with a left internal mammary artery (LIMA) graft to the left anterior descending artery (LAD) and a right gastroepiploic artery (GEA) graft to the posterior descending artery. MIDCAB was less invasive and was an effective alternative procedure for the second operation. Because the patient had no LIMA or GEA available for a graft because of prior use, we used a saphenous vein graft (SVG) for bypassing from the left subclavian artery to the coronary artery by MIDCAB via a left minithoracotomy. The left subclavian artery was selected as the proximal anastomotic site because this artery was less diseased and was easier to reach. The SVG-to-coronary artery anastomosis was facilitated by firm adhesion between the epicardium and the pericardium, which reduced the motion of the epicardium itself. These results suggest that the procedure is safe and promising in selected cases of redo CABG.

Acute dissection of the abdominal aorta.

A 64-year-old man presented with sudden lower abdominal pain and diffuse lumbago. He was diagnosed as having primary dissection of the abdominal aorta. Entry closure and aneurysmal wall plication was performed, and the subsequent course was satisfactory. Surgical intervention is recommended for patients with abdominal aortic dissection in the infrarenal segment, where the extent of dissection is limited and access is comparatively easy. Enhanced computed tomography is useful both in diagnosis and follow-up of this aortic disease.

Toward the best treatment for uncomplicated patients with type B acute aortic dissection: A consideration for sound surgical indication.

BACKGROUND: In the treatment of type B acute aortic dissection without complications, better results are obtained if surgery is performed before enlargement of the aorta in patients who are predicted to show aortic enlargement and if drug-based treatment is continued for patients who are predicted to show no enlargement. The purpose of this study was to predict the acute-phase factors that may affect chronic-phase aortic enlargement by studying chronic-phase enlargement of dissections in patients without complications during the acute phase. METHODS AND RESULTS: In 101 patients with type B acute dissection who had no complications, univariate and multivariate factor analyses were performed to determine the predictors for chronic-phase enlargement (>/=60 mm) of the dissected aorta. The independent predominant predictors for aortic enlargement in the chronic phase were a maximum aortic diameter of >/=40 mm and a patent false lumen during the acute phase. The values of actuarial freedom from aortic enlargement for the patients with a maximum aortic diameter of 40 mm and a patent false lumen at 1, 5, and 10 years were 43%, 33%, and 22%, respectively, whereas in patients with a maximum aortic diameter of <40 mm and a closed false lumen, the values were 97%, 94%, and 84%, respectively. CONCLUSIONS: These results suggest that patients with type B acute aortic dissection who show a maximum aortic diameter of >/=40 mm and a patent false lumen should undergo surgery earlier during the chronic phase before enlargement of aorta, whereas patients with a maximum aortic diameter of <40 mm and a closed false lumen should continue to receive hypotensive therapy.