The PERCIVAL detector: first user experiments.

The PERCIVAL detector is a CMOS imager designed for the soft X-ray regime at photon sources. Although still in its final development phase, it has recently seen its first user experiments: ptychography at a free-electron laser, holographic imaging at a storage ring and preliminary tests on X-ray photon correlation spectroscopy. The detector performed remarkably well in terms of spatial resolution achievable in the sample plane, owing to its small pixel size, large active area and very large dynamic range; but also in terms of its frame rate, which is significantly faster than traditional CCDs. In particular, it is the combination of these features which makes PERCIVAL an attractive option for soft X-ray science.

[Intracavity drainage under local anesthesia for giant emphysematous bulla and infected bulla].

We performed a retrospective review of 9 patients who underwent intracavity drainage under local anesthesia for emphysematous bulla and infected bulla between 1996 and 2010. Three patients with giant emphysematous bulla were treated intracavity drainage. Pneumothorax occurred and was treated by chest tube in all cases. Radiographic and symptomatic improvement occurred in all patients. After that, bullectomy was performed safely in 2 patients and intrabullar suction with fibrin glue was performed in 1. There were 6 cases with infected bulla that was not improved by the administration of antibiotics. After intracavity drainage, control of infection was achieved, and all but 1 patient were discharged without drain and complications. Intracavity drainage under local anesthesia is a safe and effective treatment for giant emphysematous bulla and infected bulla.

[Lung cancer combined with idiopathic interstitial pneumonias].

It is known that patients with idiopathic interstitial pneumonias (IIPs) have an increased incidence of lung cancer. The purpose of this study was to evaluate the outcome of surgical treatment and to establish the surgical strategy for lung cancer with IIPs. Twenty-five patients with lung cancer and IIPs who were admitted in our hospital from 1996 to 2004 were examined. Eight patients underwent lobectomy with mediastinal lymph node dissection, while 17 patients underwent limited resection. The actuarial 3-year survival rate was 43%. There were no postoperative acute exacerbation of IIPs. We considered most patients were in a stable state of IIPs preoperatively, and we made effort to treat IIPs with limited resection. The prognosis of IIPs was poor. It is difficult to decide whether to carry out limited resection.

Recognition of artificial microstructures by sensory nerve fibers in culture.

Dissociated culture of adult mouse dorsal root ganglion cells on glass plates, on which grating-associated microstructures (a repetition of microgrooves [mGRV] and microsteps [mSTP] of 0.1-10 micron) are fabricated by the conventional lithographic techniques, represents a remarkable bi-directional growth of their nerve fibers in the axial direction of the grating. Microscopical observation shows that the nerve fibers prefer to grow in the mGRV (70%), while their growth cones exhibit an even distribution onto the mGRV and mSTP. The efficiency of the nerve fibers to grow along the grating-axis are highly sensitive to a fine alteration of the width and depth of the mGRV. The preferential growth of the nerve fibers is thus due to a mechanical recognition of the microstructures by the growth cones and neurites.

Single- and double-strand breaks in pBR322 plasmid DNA by monochromatic X-rays on and off the K-absorption peak of phosphorus.

Using a synchrotron irradiation system pBR322 plasmid DNA was irradiated under vacuum by monochromatic X-rays having five specific photon energies (2.147, 2.153, 2.159, 2.168 and 2.199 keV) both on and off the K-absorption peak (2.153 keV) of phosphorus. The single- and double-strand breaks (ssb and dsb) were measured as conversions of the closed circular form of DNA (form I) to open circular (form II) and linear (form III) forms respectively. Exposures to induce one strand break per molecule were lowest at the peak (2.153 keV), and highest at 2.147 keV; the ratios were 2.7 for ssb and 3.0 for dsb. The exposures for dsb were 21-26 times higher than those for ssb. When the exposures were converted to absorbed doses in grays the absorbed doses per ssb were almost independent of photon energy. This result indicates that a certain absorbed dose was necessary to induce a ssb, regardless of whether photons were absorbed by the K-shell of phosphorus or by other shells, or by other atoms. However, the absorbed dose per dsb at 2.147 keV was 1.17 times higher than that averaged over four X-ray energies above 2-153 keV, indicating that the K-shell absorption, and the subsequent Auger event, efficiently induce dsb. The results are also discussed concerning the number of photo-absorptions of the constituent atoms per DNA strand break.

Pulmonary complications after surgical treatment of lung cancer in octogenarians.

OBJECTIVE: The purpose of this study was to analyze the risks associated with pulmonary resection for primary non-small cell lung cancer in octogenarians to help better management in these patients. METHODS: We reviewed the outcome in our 35 patients aged 80 years and older who underwent pulmonary resection between 1981 and 1998. RESULTS: The 5-year survival rate was 39.8%. The operative mortality rate was 0% and the morbidity 60%. There were ten major pulmonary complications, including respiratory insufficiency following bacterial pneumonia and sputum retention. Preoperative arterial pO(2) was significantly lower, A-aDO(2) was significantly higher, and operation time were significantly longer in patients with pulmonary complications after surgical treatment than in patients without complications (P<0.05). CONCLUSIONS: Surgical treatment was not contraindicated for octogenarians with lung cancer. However, a relatively preoperative low arterial pO(2), high A-aDO(2), and long operation time may be risk factors for postoperative pulmonary complications in such patients. Surgeons must assess the preoperative data prudently to determine appropriate surgical strategy.

Single- and double-strand breaks in pBR322 DNA by vacuum-UV from 8.3 to 20.7 eV.

Solid pBR322 DNA was irradiated in a vacuum by monochromatic photons from 8.3 eV (150 nm) to 20.7 eV (60 nm), and the formation of single- and double-strand breaks (ssb and dsb) was determined using agarose gel electrophoresis. The action cross sections increased 20 times (ssb) and 43 times (dsb) from 8.3 eV to 20.7 eV; the quantum yields increased 5.4 times (ssb) and 12 times (dsb). The cross sections for dsb were 0.0059 at 8.3 eV and 0.013 at 20.7 eV of those of ssb; these values were smaller than about 0.04 for 2.1 keV photons, or about 0.18 for 60Co gamma-rays. Although vacuum UV photons were proved to induce dsb, they had a lower efficiency than when using soft X-rays or gamma-rays.

Cloudy nodule on HRCT: a new clinico-radiologic entity of pulmonary adenocarcinoma.

We propose cloudy nodule (CN) on HRCT as a special type of pulmonary adenocarcinoma. CN was defined as a cloudy nodular shadow in the peripheral part of the lung with lower density than pulmonary vessels on HRCT. Radiologic images of nine CNs in eight cases were correlated with the pathological findings of the resected specimen. All CNs were clearly demarcated on HRCT. They were pathologically composed of well differentiated adenocarcinoma, mainly bronchioloalveolar type with little or no central scar. Plain films were negative in six of nine cases. CN on HRCT may indicate well-differentiated adenocarcinoma with good prognosis.

[Limited resection for small peripheral lung cancer using intraoperative pathologic examination].

From 1996 to 2002, we performed intentional limited resection for small peripheral lung cancer using intraoperative pathologic examination. Wedge resection was performed in patients who had small peripheral adenocarcinoma (< or = 20 mm), suspected of being Noguchi type A or B, and confirmed by intraoperative pathologic examination. Extended segmentectomy was performed in the rest of patients (tumor diameter < or = 20 mm), and not suspected of being Noguchi type A or B. Hilar and mediastinal lymph nodes sampling was performed in this group. If lymph node metastasis was detected by the intraoperative pathologic examination, the surgical procedures was converted into a lobectomy with lymph node dissection. Limited resection was performed in 27 patients, wedge resection in 8, and extended segmentectomy in 19. All patients received wedge resection are alive without sign of recurrence. In extended segmentectomy, 17 patients are alive with no evidence of disease, 1 patient died of non-pulmonary disease, and 1 patient is alive with recurrent disease. The overall survival rate at 5 years was 100% in wedge resection, 91% in extended segmentectomy, and 79% in standard lobectomy. We conclude that limited resection for small peripheral lung cancer using intraoperative pathologic examination may be safe and effective procedure.

[Successful surgical repair of tracheo-innominate artery fistula in a case of ALS patient with long-term mechanical ventilation].

A 59-year-old man with ALS developed dyspnea and was performed tracheostomy in September 1987. The cuff volume of a tracheostomy tube increased gradually in four years of mechanical ventilation. His chest X-ray in December 1992 showed a marked enlargement of the cuff. In March 1993, massive hemorrhage suddenly occurred through the tracheostomy site. This was controlled by hyperinflation of the cuff. He was diagnosed as tracheo-innominate artery fistula. An emergent operation was done by median sternotomy and right oblique cervical incision. The innominate artery, the subclavian artery and the common carotid artery were severed and occluded with sutures. The tracheal fistula was closed with a suture of monofilament. The postoperative course was satisfactory, however he died of respiratory failure ten months after the surgery.

[Surgical treatment of advanced (p-stage III.IV) lung cancer less than 2.0 cm in size].

We treated surgically 567 patients with primary lung cancer from June 1975 to December 1989. There were nine patients with advanced (p-stage III.IV) lung cancer less than 2.0 cm in size. The five year survival rate was 50.8%. The histological diagnosis was adenocarcinoma in 6, squamous cell carcinoma in 3. A curative resection was performed in seven of nine patients. Six patients had one level metastasis of mediastinal lymph node. Three patients in whom relative curative resection was performed at surgery later developed regional recurrence. However, distant metastasis was not evident in all but one of nine patients. In conclusion surgical resection is considered to be significant in patients with advanced (p-stage III.IV) lung cancer less than 2.0 cm in size.

[Surgical management of multiple rib fractures: a case report of rib stapler].

A 66-year-old woman with multiple rib fractures was successfully treated with the use of Rib Staplers (Judet's struts made of titanium). Rib Staplers are effective for the stabilization of fractured ribs even if fracture lines are oblique.

[Surgical management of desmoid tumors of the chest wall: a case report and review of literature].

A 45-year-old man without special predispositions showed a chest wall tumor with tenderness. A needle biopsy revealed a desmoid tumor which had invaded the muscles. A wide resection from the second to fifth rib was carried out and 4 years have passed without recurrence. A resection, at least 3 cm away from the lesion, is necessary for desmoid tumors which seem to have clear margins.

[Invasive thymoma involving the liver: a case report of transdiaphragmatic extension].

A 38-year-old woman had an invasive thymoma which disseminated into the thoracic cavity and infiltrated the lateral liver surface. Such transdiaphragmatic extension by an invasive thymoma is rare, however, routine abdominal CT should be performed in invasive thymoma cases to avoid underestimating the extent of disease.

[A concomitant operation of aorto-coronary bypass graft and lung cancer: report of a case].

A case of a 66-year-old man with ischemic heart disease and lung cancer is reported. Chest roentgenogram revealed an irregular 2.8 x 2.0 cm mass in the right upper lobe. Coronary angiography showed 75-90% stenosis of the left anterior descending artery, and these lesions was suspected to cause perioperative myocardial infarction. A concomitant operation of aorto-coronary bypass graft and right upper lobectomy was performed through median sternotomy. A concomitant operation must be considered to be definitive and ideally preferable in selected cases.

[Reoperation for recurrent or second primary lung cancer].

From 1975 to July 1994, twenty patients underwent second or third pulmonary resections for 7 recurrent lung cancers and 14 second primary lung cancers. The initial surgical procedures were lobectomy in 18, pneumonectomy in 1 and bilateral segmentectomy in 1. The procedures at the second operation were completion pneumonectomy in 4, ipsilateral wedge resection in 3, contralateral lobectomy in 1, contralateral segmentectomy in 4, contralateral wedge resection in 7 and resection of left main bronchus in 1. At the third operation, wedge resection was done in one 28 months after completion pneumonectomy. There was no operative death following second and third operations. Five-year survival rate following second operation in 20 patients was 32.3%, and it was 28.6% for patients with recurrent lung cancers, and 31.2% for multiple primary lung cancers. In conclusion, an aggressive surgical approach for reappearing lung tumor should be performed. At the reoperation, wedge resection for recurrent lung cancers, completion pneumonectomy for ipsilateral primary lung cancers and segmentectomy for contralateral primary lung cancers should be chosen for the standard surgical procedure.

[How extensive should lymph node dissection be done for the surgery of the left lung cancer?].

Mediastinal lymph node dissection for cancer of the left lung is more difficult than for cancer of the right lung because of the presence of aorta. Location and frequency of lymph node metastasis were examined for 231 left lung cancer patients who underwent pulmonary resection and mediastinal lymph node dissection, and survival rate of them was evaluated. Subaortic (# 5), paraaortic (#6), subcarinal (#7), tracheobronchial (#4) lymph nodes were the most frequently involved N 2 nodes. 5-year survival rate of the patients who had #4, #5, #6, #7, #8 or #9 lymph node metastasis was 20.7%. #4, #5, #6, #7, #8 and #9 should be dissected for the surgery of the left lung cancer.

[A case of advanced esophageal carcinoma successfully treated with chemoradiation therapy with low-dose cisplatin and 5-fluorouracil].

We have experienced a case of advanced esophageal carcinoma successfully treated with chemoradiation therapy together with low-dose cisplatin and 5-fluorouracil, having only minor toxicity. A 55-year-old man was admitted to our hospital because of dysphagia. Cervical esophageal carcinoma was found to have invaded the larynx through endoscopy, and invasion to thyroid gland and trachea was suspected from a cervical CT. We diagnosed the condition as advanced esophageal carcinoma (A2N(-)M0Pl0 Stage III). We then treated the patient by chemoradiation therapy. After the treatment, the carcinoma could not be detected by CT and endoscopy, and endoscopic biopsy revealed there were no active carcinoma cells. The side effects of the therapy were very mild, therefore the patient could be discharged after a short time. No evidence of a tumor relapse was found 5 months after the therapy. We treated 4 patients with esophageal carcinoma using the same regimen, and the results of the therapy were 2 CR, 1 PR, and 1 PD, with an overall response rate of 75%.

[A case of advanced gastric cancer showing complete disappearance of cancer cells in multiple liver metastases due to low-dose PMUE therapy].

A case of gastric cancer with liver metastasis who responded well to low-dose PMUE (CDDP, MMC, UFT, etoposide) therapy is reported. A 65-year-old man underwent distal partial gastrectomy with D2 lymph node dissection under the diagnosis of type 5 gastric cancer with multiple liver metastases. Pathological findings revealed papillary adenocarcinoma in the primary lesion and metastatic lymph nodes (No. 8a). Low-dose PMUE therapy after resection of primary lesion was effective for the liver metastases. Exacerbation was suspected, so the lesions of metastases were resected again after 2 years and 11 months postoperative course. All 4 resected lesions of metastases became old fibrous tissue with hyalinization, and 2 of 4 lesions were necrotic and surrounded by fibrous connective tissue. None of these 4 lesions included viable cancer cells. The patient has now been followed with no evidence of exacerbation. It was suggested that low-dose PMUE therapy was effective for liver metastasis of gastric cancer, especially the differentiated type.

[The role of IL-1 beta in murine model of otitis media with effusion].

Recent studies have demonstrated the presence of inflammatory cytokines such as IL-1 beta, TNF-alpha, IL-6, and IL-8 in the middle ear effusion (MEE) of patients with otitis media with effusion (OME). IL-1 beta is known to be produced from macrophages and monocytes in an early stage of inflammation by stimulation with microorganisms and endotoxins. Also, these studies have shown that endotoxins frequently are found in MEE and can induce OME in experimental animal model. These findings suggest that endotoxins in MEE cause a chain reaction of cytokines through IL-1 beta. However, the precise role of IL-1 beta in the pathogenesis of OME has not yet been clarified. In the present study, a murine model of OME was developed by intra-tympanic injection with endotoxin or recombinant mouse IL-1 beta (rIL-1 beta) and the effects of IL-1 beta on the production of MEE were investigated. OME was induced in specific pathogen-free male BALB/c mice by intra-tympanic inoculation with endotoxin purified from nontypeable Haemophilus influenzae or with rIL-1 beta. The presence of MEE in the subjects was observed through the ear drum under a microscope and samples of MEE were collected by aspiration and washing with phosphate-buffered saline. The concentrations of IL-1 beta in each sample of MEE were determined by ELISA and the histological changes were compared. The mice inoculated with endotoxin showed signs of the production of MEE and it was noted that the levels of IL-1 beta in MEE were significantly increased on day 3. Intra-tympanic inoculation with rIL-1 beta also produced MEE and these cytological findings of MEE as well as the histological findings of middle ear mucosa were similar to those found in the endotoxin-induced OME. Further, the influence of anti-IL-1 receptor antibodies on the production of OME was examined 3 days after intra-tympanic injection with anti-IL-1 receptor antibodies together with endotoxin or rIL-1 beta. The incidence of OME was lower in mice injected with anti-IL-1 receptor antibodies than that in mice injected with endotoxin or rIL-1 beta only. These findings suggest that IL-1 beta may play an important role in the pathogenesis of OME.