[Acute empyema with intraoperative intractable air leaks in a child; report of a case].

We report a case of acute empyema with intraoperative intractable air leaks in a child. A 4-year-old girl was admitted with parapneumonic empyema by Staphylococcus aureus. Conventional conservative therapies such as antibiotics, chest tube drainage were failed. Then we performed dissection and debridement with video-assisted thoracoscopic surgery in fibrinopurulent phase of acute empyema. Intraoperative findings showed that the parietal pleura was very weak by Staphylococcus aureus pneumonia. Air leaks occurred,but pleural defects could not be closed by sutures and ligations. We could seal intractable air leaks to use fibrin glue soaked bioabsorbable polyglycolic acid felt sheet. Lung expansion promptly recovered and the patient was discharged on the 34th postoperative day without complications.

[An autopsy case of primary lung leiomyosarcoma].

We report autopsy findings for a case of leiomyosarcoma originating in the right lung in an 86-year-old man. We surveyed current literatures and compared the immunohistochemical results in the present case with those reported previously in Japan. The solid tumor measured 6 x 7 x 7 cm sized and was located in the right lung. Its cut-surface appeared grayish to yellowish and contained areas of hemorrhage and necrosis. The lungs contained scattered nodular lesions less than 2 cm in diameter. Metastatic lesions were also confirmed in other tissues such as the heart, pericardium, liver, spleen, left adrenal gland and thyroid. Microscopically, 14 mitoses were detected in every 10 high-power fields. An immunohistochemical study revealed positivity for smooth muscle myosin and actin, and negativity for CEA, and appeared to be important in differential diagnosis and determination of histogenetic type.

[Detection of papilloma virus of the human uterine cervix by in situ hybridization method--comparison with immunohistochemistry].

The usual methods for pathological diagnosis of HPV infection of the uterine cervix include screening in cytodiagnosis and histodiagnosis and confirmation by immunohistochemistry (IHC) method. However, some institutes have recently begun to use in situ hybridization (ISH) method for definitive diagnosis using a DNA probe. We compared IHC with ISH with regards to the localization and rate of detection of HPV in lesions of the uterine cervix such as dysplasia and squamous cell carcinoma in the present study. The cases found positive by IHC showed brownish nuclei of the epithelium and those positive in ISH showed purple to purplish-black nuclei. The comparison of cases positive by both methods revealed that the number of cells positive by IHC was smaller than that by ISH, and the cells positive by IHC were localized in the superficial layer. HPV was detected by the IHC various lesions of the uterine cervix in 13 (12.3%) of 106 patients, while it was detected by the ISH in 39 (36.8%) of 106 patients. The results of both methods were in accordance in 66.0% (77 patients; positively in 8 and negatively in 62). The detection sensitivity of IHC is lower than that of ISH. IHC cannot be used to identify the type of HPV, and it is impossible to confirm the presence or absence of virus by this method in cases of malignant changes. ISH is therefore necessary for identification of HPV and investigation of a histopathological relationship between HPV type and malignant change.

[Detection of HPV-DNA in the various uterocervical lesions by in situ hybridization].

We detected HPV (Human Papilloma Virus) -DNA in various uterocervical lesions by in situ hybridization using biotinylated DNA probes. In cases positive for HPV, the nuclei of the epithelial cells was purple to blackish purple. In 2 of 6 cases of chronic cervicitis, HPV-DNA was detected in the outer layer of the squamous epithelium. Eleven of 19 with mild dysplasia (57.9%) showed a positive reaction in the upper one-third of the epidermis in a mainly consisting of koilocytotic cells. All 6 patients with moderate dysplasia had positive cells among the koilocytotic cells and atypical cells in the middle layer. Five of 11 patients with severe dysplasia had scattered positive cells. Two of them had atypical condylomatoid lesions. Eight of 32 patients with squamous cell carcinoma were positive for HPV-DNA, but there was no consistent distribution pattern of the positive cells.

[Significance of determination of the blood antibody level in Chlamydia trachomatis infection of the uterine cervix].

Kits for measurement of C. trachomatis specific antibody are not commercially available, but of the significance of determination of the serum antibody level has not been clarified. In this study, we first determined the C. trachomatis antibody level in patients considered to be free of C. trachomatis infection. Then, we evaluated the relationship between the presence or absence of antigen with the antibody level in patients at our department who were available for antigen examination. Anti-C. trachomatis IgA and IgG antibodies were detected in all age groups with a peak frequency in the 20's expect that IgA antibody was absent in the umbilical blood (IgG antibody was detected also in the umbilical blood). Concerning the relationship between the presence or absence of C. trachomatis antigen and the serum antibody levels, both IgA and IgG antibodies were significantly different (chi 2 test, p less than 0.01) between the antigen-positive group and the antigen-negative group. Because females infected by C. trachomatis were more often asymptomatic than infected males, and because antigen tests may produce false negative results, determination of the antibody level must be included in the clinical tests. Determination of the antibody level is considered to be valuable also in screening for mother-child infection and asymptomatic infection.

[Three cases of pulmonary dirofilariasis suspected of lung cancer].

We experienced with three patients with pulmonary dirofilariasis found in resected lungs. Two patients showed abnormal shadows on chest roentgenograms without symptoms. Another patients had chest discomfort. All patients underwent diagnostic thoracotomy. Histopathological examination showed necrotic granulomatous lesions surrounded by fibrous tissue and transverse section of Dirofilaria immits was found. It has been an increasing reported disease. It is important to keep in mind the possibility of dirofilariasis.

Capillary gas chromatographic-mass spectrometric determination of stable isotopically labelled and unlabelled theophylline in serum and urine and of 1,3-dimethyluric acid in urine.

A capillary gas chromatographic-mass spectrometric method for the determination of [13C,15N2]theophylline and unlabelled theophylline (TP) and of 1,3-dimethyluric acid (1,3-DMU), a major metabolite of TP, is described. TP and the metabolite were extracted separately from serum or urine, purified by high-performance liquid chromatography and converted into alkyl derivatives (monoethyl-TP and dibutyl-1,3-DMU). The internal standards used for the respective determinations were [2H6]TP and [2H6]1,3-DMU. Detection was performed by monitoring the molecular ions of the alkyl derivatives. The method needed no complex corrections for contributions and provides good accuracy and precision.