Long-term follow-up of collateral pathways established after lymphadenectomy in rats.

A collateral pathway established after lymphadenectomy could play an important role in long-term lymphedema treatment. The present study investigated alterations of lymph dynamics 1 year after lymphadenectomy using indocyanine green fluorescent lymphography to determine if a collateral pathway may be used for long-term lymphedema treatment. Wistar rats were anaesthetized and lymph nodes were excised at the inguinal and popliteal fossae. The treated hind limb was evaluated by fluorescent lymphography between 10 weeks and 6 months and between 6 months and 1 year postoperatively. Fluorescent lymphography demonstrated a lymphatic pathway to the ipsilateral axillary fossa in all rats 1 year after lymphadenectomy. Some capillary branches in the paths leading to the ipsilateral axillary fossa were dilated and tortuous. In addition, areas in which a fluorescent signal was not visible were increased in the thigh. In conclusion, the collateral pathway did not appear to be only for temporary use to compensate for drainage from the edematous limb but appears more stable as a component of a compensating lymphatic system. These new dilated vessels, although functional at this point, may still be susceptible to disturbance by further alteration to the lymph vessels.

Alterations of lymph flow after lymphadenectomy in rats revealed by real time fluorescence imaging system.

Secondary lymphedema is one of the sequella of cancer treatment that in inadequately understood. The purpose of the present study is to investigate lymphedema formation and to explore the escape routes for excess interstitial fluid using lymphadenectomy in a rat model. In twelve Wistar rats, lymph nodes in the right inguinal and popliteal fossas were completely removed and lymph vessels carefully ligated. After operation, treated hind limbs were evaluated by indocyanine green lymphography and circumferential measurement. Both evaluations were performed from day 3 to ten weeks. Approximately 2 to 3 weeks after operation, a network-like pattern of the fluorescent signal appeared around the surgical site which then transitioned into a linear pattern in the lower abdomen. Videorecordings identified fluorescent flow moving from the lower abdomen to the ipsilateral axillary lymph node and in some rats, the network-like pattern was also observed to pass transversely over the suprapubic region to the contralateral inguinal lymph nodes. The network-like pattern on the lower abdomen and the linear pattern to the axillary fossa were seen continuously to the end of observation. Circumferential measurements of the treated hind limbs increased initially and then declined over time. This imaging system may be useful to detect early changes in lymphatic flow before swelling occurs and further study is needed.

A novel immunomodulator KRP-203 combined with cyclosporine prolonged graft survival and abrogated transplant vasculopathy in rat heart allografts.

To find more effective and less toxic immunosuppressive strategies in long-term treatment for organ transplantation patients, we examined the effects on rat heart allograft survival of a novel sphigosine-1-phosphate receptor agonist, KRP-203, combined with a subtherapeutic dose of cyclosporine (CsA). Rat heart transplantation was performed across a major histocompatibility complex-incompatible (DA to LEW) rat combination. KRP-203 alone showed little or no effect on heart allograft survival. In contrast, KRP-203 combined with a subtherapeutic dose of CsA led to prolonged allograft survival. Histologic analyses showed that the combination completely suppressed acute rejection, as characterized by allograft vasculopathy, mononuclear cell infiltration, and myocardial necrosis in the heart allografts. RT-PCR analysis showed that the allografts treated with CsA or KRP-203 alone showed no suppression of IL-10, IFN-gamma, and TNF-alpha mRNA expression, but when combined with a subtherapeutic dose of CsA it completely suppressed their mRNA expressions. Furthermore, the combination treatment reduced donor-specific antibody production. KRP-203 combined with a subtherapeutic dose of CsA synergistically prolonged rat heart allograft survival. The combination of CsA with KRP-203 may provide an option to prevent allograft rejection and reduce adverse effects.

Thermoregulatory and aerobic changes after endurance training in a hypobaric hypoxic and warm environment.

Plasma volume (PV) expansion by endurance training and/or heat acclimatization is known to increase aerobic and thermoregulatory capacities in humans. Also, higher erythrocyte volume (EV) fractions in blood are known to improve these capacities. We tested the hypothesis that training in a hypobaric hypoxic and warm environment would increase peak aerobic power (VO(2)(peak)) and forearm skin vascular conductance (FVC) response to increased esophageal temperature (T(es)) more than training in either environment alone, by increasing both PV and EV. Twenty men were divided into four training regimens (n = 5 each): low-altitude cool (610-m altitude, 20 degrees C ambient temperature, 50% relative humidity), high-altitude cool (2,000 m, 20 degrees C), low-altitude warm (610 m, 30 degrees C), and high-altitude warm (HW; 2,000 m, 30 degrees C). They exercised on a cycle ergometer at 60% VO(2)(peak) for 1 h/day for 10 days in a climate chamber. After training, PV increased in all trials, but EV increased in only high-altitude trials (both P < 0.05). VO(2)(peak) increased in all trials (P < 0.05) but without any significant differences among trials. FVC response to increased T(es) was measured during exercise at 60% of the pretraining VO(2)(peak) at 610 m and 30 degrees C. After the training, T(es) threshold for increasing FVC decreased in warm trials (P < 0.05) but not in cool trials and was significantly lower in HW than in cool trials (P < 0.05). The slope of FVC increase/T(es) increase increased in all trials (P < 0.05) except for high-altitude cool (P > 0.4) and was significantly higher in HW than in cool trials (P < 0.05). Thus, against our hypothesis, the VO(2)(peak) for HW did not increase more than in other trials. Moreover, slope of FVC increase/T(es) increase in HW increased most, despite the similar increase in blood volume, suggesting that factors other than blood volume were involved in the highest FVC response in HW.

[Increased intracranial pressure caused by obstruction of torcular herophili with hemangiopericytoma: a case report].

A 49-year-old male had experienced diplopia for half a year. The intracranial pressure was markedly elevated (450 mmH2O). Neuroimaging revealed a tumor incompletely occluding the torcular herophili and the bilateral transverse sinuses without cerebral or cerebellar compression by the tumor. Both cortical veins and cervical veins were enlarged, and the Sylvian vein and Rabbe's vein and the tentorial sinus were collateral vessels. Biopsy was performed and histologic examination proved hemangiopericytoma. The patient underwent Gamma-knife treatment and the tumor decreased in size 3 months after the treatment.

Plasma lactate concentration and muscle blood flow during dynamic exercise with negative-pressure breathing.

This study assessed the hypothesis that increasing cardiac filling pressure (CFP) would enhance contracting muscle blood flow (MBF) by stretching cardiopulmonary baroreceptors and attenuate the increase in plasma lactate concentration ([Lac(-)](p)) during dynamic exercise. Continuous negative-pressure breathing (CNPB) (-15 cmH(2)O) was used to increase the CFP by accelerating the venous return to the heart. In the first series of experiments, 10 men performed a graded exercise seated on a cycle ergometer with (N1) and without CNPB (C1). The increase in [Lac(-)](p) for N1 was attenuated at 60%, 90%, and 100% of maximal exercise intensity compared with that in C1 (P < 0.001). Also, the increases in mean arterial pressure (MAP) and plasma catecholamine concentrations were attenuated in N1 compared with those in C1 throughout the graded exercise (P < 0.05). However, heart rate and pulse pressure were not significantly influenced by CNPB. Second, we studied the impact of CNPB on forearm MBF during a rhythmic handgrip exercise in 5 of the 10 subjects. Forearm MBF was measured immediately after cessation of the exercise by venous occlusion plethysmography at rest, 30%, 50%, and 70% of maximal work load (WL(max)) with (N2) and without CNPB (C2). Forearm MBF and vascular conductance for both trials increased with the increase in intensity, but forearm skin blood flow measured by laser-Doppler flowmetry remained unchanged. MBF and vascular conductance in N2, however, increased more than in C2 at every intensity (P < 0.01) except for MBF at 70% WL(max), whereas the increase in MAP for N2 was attenuated compared with that in C2 (P < 0.05). Thus augmented active muscle vasodilation occurred in N2 with a lower increase in MAP compared with that in C2. These findings suggest that the stretch of intrathoracic baroreceptors, such as cardiopulmonary mechanoreceptors, by CNPB increased MBF by suppressing sympathetic nerve activity. The attenuation of the increase in [Lac(-)](p) might be caused, at least partially, by the increased MBF.

Present status of spontaneous pneumothorax in Japan.

Today, spontaneous pneumothorax (SPT) is a common disease in Japan. It is easy to diagnose but difficult to estimate how to manage it. The curative treatment of SPT is resection of the ruptured bulla. In Japan, almost all surgical cases of SPT are operated by video-assisted thoracic surgery (VATS). The recurrence rate after VATS is only a few percent in our center. The cause of recurrence is usually attributable to overlooking bullae and newly developed bullae. Newly developed devices in Japan which help to reduce the recurrence rate are presented, and the Japan Association for Pneumothorax (JASP) and the Pneumothorax Center are introduced.

Calcifying pseudotumor of the neural axis--case report.

A 22-year-old female presented with a calcifying pseudotumor of the neural axis manifesting as generalized convulsive seizure twice within 1 year. Computed tomography revealed a small, calcified mass lesion located in the right parietal lobe adjacent to the skull. The tumor was composed of an extensively calcified mass with accompanying peripheral epithelioid cells and focal mature bone structure, consistent with the diagnosis of a calcifying pseudotumor of the neural axis. Following complete excision of the tumor, the patient has been free from seizures for 8 years.

Vertebral arteriovenous fistula that developed in the same place as a previous ruptured aneurysm: a case report.

BACKGROUND: Aneurysms of the extracranial vertebral artery (VA) and vertebral arteriovenous fistulas (VAVFs) are relatively rare diseases. The most frequent cause of both diseases is trauma. Atraumatic lesions are less common. Presented here is a case of atraumatic AVF of the extracranial VA that developed in the same location as a previous ruptured aneurysm of the ipsilateral VA that was originally treated by proximal occlusion 11 years earlier. METHODS: A 40-year-old woman presented with a massive hematoma in the upper posterior neck region caused by the rupture of an extracranial VA aneurysm. Proximal occlusion of the VA was performed by use of a detachable balloon. She enjoyed good health for 11 years, then she noticed a pulsatile bruit. Angiograms revealed an AVF between the left VA that was fed by collateral circulation and the paravertebral venous plexus. Incidentally found were soft tissue masses in the left retroauricular and the right suboccipital regions. Also, skull X-ray films showed multiple bony defects. Biopsy of the subcutaneous mass was performed in the hope of obtaining clues as to which pathological processes had weakened the artery. RESULTS: As direct transarterial access to the fistula was out of the question, the fistulous compartment of the paravertebral venous plexus was tightly packed with multiple platinum coils effected by the transfemoral approach. A histological examination of the specimen revealed features of a neurofibroma, and a diagnosis of neurofibromatosis Type 1 was established. CONCLUSIONS: In this case, transvenous embolization of the VAVF was successfully performed. The fragility of the arterial wall, related to neurofibromatosis Type 1, was considered to contribute to the development of the aneurysm and AVF.

[Successful eradication of H. pylori in an elderly patient with gastric cancer after effective UFT-E therapy].

The patient was a 83-year-old female with 2' T2-type gastric cancer associated with positive H. pylori in the lesser curvature of the stomach. The patient was treated with oral UFT-E alone in a daily dose of 400 mg. The tumor exhibited an O' IIa + IIc-like appearance 4 weeks after the start of administration and became scarred 8 weeks later, revealing marked tumor reduction in a short period of time. At 8 weeks, biopsy showed marked polymorphonuclear cells infiltration of gastric mucosa with no evidence of malignancy. In an attempt to eradicate H. pylori, 30 mg of lansoprazole, 400 mg of clarithromycin, and 2.0 g of ecabet-Na (3.0 g of Gastrom) were administered for 2 weeks. H. pylori was found to have been successfully eradicated, and the inflammatory lesions were no longer visible histologically. UFT-E was highly effective in this patient, and the eradication of H. pylori may contribute to the prevention of cancer recurrence.

[Meigs syndrome presenting as diaphragmatic pleural nodules].

A 52-year-old woman was admitted to our hospital because of non-productive coughing and dyspnea on exertion. A chest X-ray film revealed a moderate pleural effusion. The effusion was persistent and progressive in spite of repeated thoracentesis. Because examinations of the effusion did not result in a specific diagnosis, thoracoscopy was done under local anesthesia. Two nodules were found in the surface of the diaphragmatic pleura. Examination of biopsy specimens revealed mesothelial hyperplasia and lymphatic duct proliferation without malignant or granulomatous lesions. Systemic examinations revealed a tumor in the right ovary. The tumor was removed, and examination revealed that it was a serous adenofibroma without malignant lesions. Meigs syndrome was diagnosed. The pleural effusion disappeared quickly, two weeks after the operation. We know of no previous report of diaphragmatic pleural nodules in a case of Meigs' syndrome. Meigs' syndrome should be considered in the differential diagnosis of pleural nodules.

Variation in appearance of glioma on serial thallium-201 single photon emission computed tomography--case report.

A 63-year-old female presented with recurrent glioblastoma at the site of a right parietal glioblastoma which was diagnosed 1 year before. She was treated at that time by total removal of the tumor, irradiation, and chemotherapy. Four months after the initial treatment, serial thallium-201 single photon emission computed tomography (201Tl SPECT) showed increased uptake at the edge of the original tumor site. The index, the ratio of 201Tl uptake in the lesion to the normal brain, was 2.9 which suggested a recurrent tumor. Magnetic resonance images with gadolinium over the next 7 months demonstrated an enhanced mass lesion at the site of primary tumor resection and a new enhanced mass in the right temporal lobe. The lesion in the right parietal lobe had a 201Tl uptake index of 2.5, while the lesion in the right temporal lobe had an index of 1.5. Re-craniotomy and total resection of the tumors in the right parietal and temporal lobes were performed. The histological diagnosis of both tumors was glioblastoma. The proposed use of 201Tl SPECT for the differential diagnosis of recurrent glioma and radiation necrosis should be carefully considered because the 201Tl uptake index can vary in tumor with the same malignancy grade.

Maffucci's syndrome associated with intracranial chordoma: case report.

This report discusses Maffucci's syndrome associated with intracranial chordoma. Of the 170 reported cases of this syndrome, only 27 have been associated with intracranial lesions and none was involved with intracranial chordoma. Chordomas are occasionally difficult to differentiate from chondroma and chondrosarcoma. An immunohistochemical analysis was able to prove, however, that the chordoma of this case significantly differed from chondroma and chondrosarcoma.

[Thoracoscopic surgery].

The length of incision for the thoracotomy has been shorten relatively to the past. Para-scapular bow incision was over 30 cm in length but the axillary incision is a half of it. Now we have the minithoracotomy in 3 cm and the thoracoscopic treatment in 1 cm. Spontaneous pneumothorax is the best indication of thoracoscopic treatment because of the followings: 1. Pneumothorax is a benign disease. 2. Cause of air leak is rupture of the bulla which is located on visceral pleura. 3. Thoracic cavity is already opened in patients with pneumothorax. In our Center we have over 2,800 cases of spontaneous pneumothorax and we have treated thoracoscopically over 2,000. Electro-coagulation and/or YAG-LASER were used to destroy bullae within 1 cm in diameter. Looping and/or ENDO-AUTO-SUTURE devices has been used for bullae over 1 cm in diameter. Today recurrence rate is under a few% and no complications. Thoracoscopic treatment is the best way to cure the spontaneous pneumothorax and now it is the finest choice to manage of it.

Health problems among Vietnamese refugees resettled in Japan.

A medical examination of 932 Vietnamese refugees was conducted within 1 month of their resettlement in Japan between 1989 and 1991. A variety of abnormalities were detected, including parasitic disease (78% prevalence), anemia (12%), HBsAg positive state (14%), liver dysfunction (10%), hypertension (0.8%), active pulmonary tuberculosis (2%) and syphilis (0.7%). These rates were still as high as the prevalence in previous studies of earlier immigrants from Vietnam. The high frequency of infectious diseases in recent Vietnamese refugees compared with the Japanese community leads to a recommendation for continuing medical examinations and treatment for new Vietnamese refugees.

Thoracoscopic treatment of spontaneous pneumothorax.

In 1973, I tried a new thoracoscopic treatment for the management of spontaneous pneumothorax. Adhesive agents, electrocoagulation, hot air, the neodymium: yttrium-aluminum garnet laser, intrathoracic devices, or various combinations of these have been used in the repair of more than 2,800 cases of ruptured bullae. Today, because the indications are sensitively defined by thoracography, the recurrence rate has decreased to less than 2%.

[Clinical studies on the intercostal minithoracotomy method in spontaneous pneumothorax].

The thirty patients with spontaneous pneumothorax were selected and treated with intercostal minithoracotomy (MT). To study the extent of surgical damage and recurrence rate and total hospital cost in this approach, we compared MT to axillary thoracotomy (AT) with respect to nine variables: (1) operative time (2) feverish period (more than 37 degrees C) (3) total drainage volume for two days after operation (4) white blood cell counts in the 1st postoperative day (POD) (5) CRP in the 3rd POD (6) PSTI (pancreatic secretory trypsin inhibitor) in the 3rd POD (7) period of hospital stay after operation (8) total hospital cost (9) postoperative recurrence rate. A control group of twenty patients undergoing AT over the same period was selected. The average length of operation (recorded in minutes) in the MT group was 25 (SD +/- 10) as compared to 41 (SD +/- 12) in the AT group. The difference between two groups proved to be statistically significant (p < 0.005). The average volume of drainage after operation (recorded in ml) in the MT group was 51 (SD +/- 45) versus 114 (SD +/- 93) in the AT group (p < 0.025). The average period of postoperative fever (recorded in days) in the MT group was 2.6 (SD +/- 1.2) versus 3.6 (SD +/- 1.6) in the AT group (p < 0.01). The average value of WBC (recorded in counts/mm2) in the MT group was 10,955 (SD +/- 2,564) versus 9,966 (SD +/- 3,034) in the AT group.(ABSTRACT TRUNCATED AT 250 WORDS)