Emergent thyroidectomy with sternotomy due to acute respiratory failure with severe thyroid storm.

Huge cervical and mediastinal masses may lead to acute respiratory failure caused by laryngotracheal compression and airway obstruction. Thyroid storm is also a life-threatening endocrine emergency originating almost exclusively from uncontrolled Graves' disease. We report a case of a 42-year-old man with acute upper airway obstruction and tachycardia from progressive swelling of a giant thyroid, in conjunction with thyroid storm resulting from uncontrolled Graves' disease. Fibreoptic-assisted nasal intubation was performed while the patient was awake, immediately followed by emergency total thyroidectomy via a cervical and sternal approach. The patient had an uneventful postoperative course and recovered well. Respiratory failure due to swelling of a giant thyroid is a life-threatening condition and should be treated immediately with endotracheal intubation while the patient is awake following emergent total thyroidectomy, even with a sternotomy.

Survival outcomes after surgical resection of pulmonary metastases of head and neck tumours.

BACKGROUND: There is limited information available regarding the benefits and outcomes of resection of pulmonary metastases arising from head and neck cancers. METHODS: A retrospective review was performed of 21 patients who underwent resection of pulmonary metastases of primary head and neck malignancies at Hamamatsu University Hospital. Clinical staging, treatment methods, pathological subtype (particularly squamous cell carcinoma), disease-free interval and overall survival were evaluated. RESULTS: The 5- and 10-year overall survival rates of the study participants were 67.0 per cent and 55.0 per cent, respectively, as determined by the Kaplan-Meier method. The prognosis for patients with a disease-free interval of less than 24 months was poor compared to those with a disease-free interval of greater than 24 months (p = 0.0234). CONCLUSION: Patients with short disease-free intervals, and possibly those who are older than 60 years, should be categorised as having severe disease. However, pulmonary metastases from head and neck malignancies are potentially curable by surgical resection.

The B2 receptor of bradykinin is not essential for the post-exercise increase in glucose uptake by insulin-stimulated mouse skeletal muscle.

Bradykinin can enhance skeletal muscle glucose uptake (GU), and exercise increases both bradykinin production and muscle insulin sensitivity, but bradykinin's relationship with post-exercise insulin action is uncertain. Our primary aim was to determine if the B2 receptor of bradykinin (B2R) is essential for the post-exercise increase in GU by insulin-stimulated mouse soleus muscles. Wildtype (WT) and B2R knockout (B2RKO) mice were sedentary or performed 60 minutes of treadmill exercise. Isolated soleus muscles were incubated with [³H]-2-deoxyglucose +/-insulin (60 or 100 microU/ml). GU tended to be greater for WT vs. B2RKO soleus with 60 microU/ml insulin (P=0.166) and was significantly greater for muscles with 100 microU/ml insulin (P<0.05). Both genotypes had significant exercise-induced reductions (P<0.05) in glycemia and insulinemia, and the decrements for glucose (approximately 14 %) and insulin (approximately 55 %) were similar between genotypes. GU tended to be greater for exercised vs. sedentary soleus with 60 microU/ml insulin (P=0.063) and was significantly greater for muscles with 100 microU/ml insulin (P<0.05). There were no significant interactions between genotype and exercise for blood glucose, plasma insulin or GU. These results indicate that the B2R is not essential for the exercise-induced decrements in blood glucose or plasma insulin or for the post-exercise increase in GU by insulin-stimulated mouse soleus muscle.

[Surgical resection for T4 lung cancer invading thoracic aorta].

The prognosis of the lung cancer patients with aortic invasion is thought to be very poor in general. Thoracic aorta resection and reconstruction was performed in 6 patients, aortic arch in 2, descending aorta in 4. An intraoperative and a postoperative major complication occurred in each 1 patient. Five patients survived more than 1 year after operation, and 1 of them has been living without relapse for more than 5 years. Pulmonary resection with the involved aorta can be done safely using cardiopulmonary bypass, with encouraging long-term survivals in patients without N2 or N3 nodal metastasis.

[Extrapleural pneumonectomy after hyperthermo-chemotherapy for the lung cancer patients with malignant pleural effusion].

The prognosis of the lung cancer patients with malignant pleural effusion is extremely poor. Intrapleural perfusion hyperthermo-chemotherapy for the treatment of malignant pleural effusion was performed in 120 lung cancer patients and showed better prognosis than conventional treatment. After successful local control by hyperthermo-chemotherapy, extrapleural pneumonectomy was performed in 8 patients with clinical N 0 or N 1 and M 0 lung cancer. All patients survived for more than 1 year. The only 1 patient survived for more than 3 years and 3 months without recurrence. Almost all patients who died within 2 years had pathological n 2, carcinomatous pericarditis, cancer invasion beyond extrapleural space and so on. Extrapleural pneumonectomy after hyperthermo-chemotherapy can be a choice of surgical treatment if the n 2 disease, pericarditis, and extrapleural invasion of disseminated cancer cells should be excluded precisely.

Thymoma with osseous metaplasia.

A 69-year-old woman with a 15-year history of abnormal chest shadow was referred to our hospital. An enhanced chest CT scan of the anterior mediastinum revealed a mass containing a high-density area. The preoperative radiologic diagnosis was thymoma. Operation was performed in October 2000. Histologically, multiple ossified areas were observed within the tumor. Intratumoral ossification has never been reported in thymoma. Therefore, we report the first case of thymoma associated with multiple foci of osseous metaplasia.

[Renal function of ectopic ureteral opening repaired by ureterocystoneostomy].

Two girls (4 and 3-year old) visited our out-patient service complaining of daytime and nighttime enuresis. Both were diagnosed as ectopic ureteral opening to the vagina with a concomitant dysplastic kidney on the left side. These anomalies were repaired by ureterocystoneostomy according to a modified Grégoir's method. In the first case, three months later, DIP visualized left upper urinary tract which had not been seen before, but enhanced CT scan, renogram and scintigraphy with Tc-DMSA showed no change. In the second case, three years later, examination results were the same as in the first case. There was no renal development. Surgical repair of ureterocystoneostomy was valuable, with small surgical damage and cosmetic merit for the girls. Furthermore, renal function will be maintained at the same level or slightly higher than that before the operation.

[A case of transitional cell carcinoma in a pyelocaliceal diverticulum].

A 63-year-old man visited our hospital because of painless macrohematuria. Drip infusion pyelography and retrograde pyelography revealed a space-occupying lesion with extravasation of contrast medium to upper caliceal system. A computed tomographic study revealed an intrarenal solid moiety and further more, arteriography showed the arterial encasement and fine neovascularity of the lesion. On gross section of the extirpated kidney, a cystic cavity measuring 3 by 3 cm existed at the upper pole and apparently channeled to the upper caliceal system. Small stones were found in the cystic cavity. Histopathologically, the wall of the cavity was covered with layered squamous cells and a part of the wall developed metaplasic transitional cell carcinoma proliferation which invaded into the renal parenchyma and renal pelvis, as well.

[Study on effectiveness of carmofur (Mifurol) in urogenital carcinoma, especially bladder cancer, as a post-operative adjuvant chemotherapeutic agent].

This study was carried out to evaluate the effects of carmofur (Mifurol), a masked compound of 5-fluorouracil (5-FU), in preventing postoperative recurrence of urogenital carcinoma (especially in bladder cancer). Carmofur was given orally at the dose of 300 approximately 600 mg/day to 134 patients (90 males and 44 females) after the resection. Out of 134 patients, 121 patients were evaluable and the rate of their recurrence was 10.7%. The rate of cumulative nonrecurrence for 65 patients it was 96.0, 73.0 and 60.8% in 1, 2 and 3 years, respectively. The group of curative resection demonstrated a higher cumulative nonrecurrence rate than that of noncurative or palliative resection group. In considering the resection methods, transurethral resection of bladder tumor group demonstrated a higher rate than partial or total cystectomy. The average concentration of 5-FU in serum was 0.65 microgram/ml at 120 minutes after oral administration of 200 mg of carmofur. Moreover, the concentration of 5-FU (15 approximately 35 micrograms/ml) in urine was higher than that of carmofur. The rate of side effects that appeared was 19.6%. The side effects were hot feeling (12.2%), pollakisuria (4.3%), anorexia (4.3%), an antabuse-like reaction by drinking (3.8%) and so on. These results were similar to those already reported.

[Clinical effects of estramustine phosphate disodium (Estracyt) on prostatic cancer].

Estramustine phosphate disodium (Estracyt) was used in the treatment of 40 patients with prostatic carcinoma. Of these 20 patients 18 were treated with Estracyt as primary treatment and 22 had been treated with diethyl stilbestrol dephosphate and/or bilateral orchiectomy for more than 4 months before the Estracyt treatment. The drug was given orally in a dose of 560 mg/day in 2 divided oral doses. The clinical evaluation was done after 3 months treatment. The response in subjective symptoms and objective signs were documented and evaluated according to 5 criteria. In this study, Estracyt showed 80% improvement of dysuria, 60% of nykturia, 35% of pain and 55% of general condition. In objective signs, it showed 52.5% improvement of size of the prostate, 42.5% of consistency and 70% of residual urine. It would be emphasized that Estracyt had almost equal efficacy in both the primary treatment group and secondary treatment group. As side effects of this drug, gynecomastia, gastro-intestinal disturbance, angina pectoris like chest pain were observed.

[Study of the local use of amikacin].

Amikacin sulfate (AMK) was used against urinary tract infections (UTI) as local administration such as bladder lavage, renal pelvic lavage and vesical instillation. Forty four patients with UTI were treated by this method, 32 patients having Foley catheter indwelling in the bladder and 12 patients having drainage catheter indwelling in the renal pelvis. The overall clinical effect under UTI judgment was 3 excellent cases, 24 good, 11 fair and 6 poor, with an efficiency of 61.4%. A total of 100 bacteria, 47 gram positive, 33 gram negative, 6 anaerobes and 14 fungi, were found in the urine and bacteriological effect was 68.8% and 57.1% in single and combined bacterial infection, respectively. The serum concentration of AMK was measured in 9 patients by radioimmunoassay, and the maximum concentration was 0.38 micrograms/ml which is a low absorption rate. There were no adverse reactions during or after treatment with AMK.