Qualitative analysis of the perception and acceptability of pathogen transport among housewives using focus group interviews.

We conducted focus group interviews to understand how residents of Japan feel about the transport of pathogens. Twelve randomly selected housewives, who had no special knowledge regarding the topic before the interview, expressed their opinions in 2 separate meetings regarding pathogen transport. The results of the interviews were analyzed by the KJ method. The analysis found that although the transport of pathogens is universally recognized to be necessary, there is not clear consensus on the exact methods of transport, the positive and/or negative value of such information, and how clearly and/or uniquely to label containers, packages, compartments, vehicles, and conditions used for such transportation. Further studies to improve the skills of both the providers and receivers of such information (a technique of risk communication) are necessary.

[Efficacy of inactivating viruses by photocatalytically reacting nonwoven titanium dioxide fabric].

Titanium dioxide (TiO2) photocatalysis causes oxidative destruction dependent on electrons excited by < or = 400 nm ultraviolet (UV) rays. Many studies have covered the destruction of organics and bacteria and bacteriophage inactivation by photocatalysis. We studied the inactivation by new nonwoven siliconized titanium dioxide fabric of the feline calicivirus F9 (FCV-F9), human adenovirus GB (HAdv3-GB), and influenza A and B virus (A/New Caledonia, B/Shandong, and 5 clinical strains). We spotted 10 microL of viral suspensions containing infectious 5 log10 50% tissue culture doses (TCID50) onto 1 cm2 pieces of TiO2-coated nonwoven control fabric treated or not treated with UV light (lambda(max), 365 nm, 1,100-1,300 microW/cm2). We then measured the virus titers of 50 microL of viral suspension recovered from these fabrics. FCV-F9 and HAdv3-GB infectivity titers were reduced by over 3.5 log10 TCID50 after 30 min of irradiation, but influenza viral titer was reduced to where it was undetectable even without UV irradiation. Comparing individual viral titer reduction due to nonwoven fabric contact without UV irradiation exposure, showed that FCV-F9 and HAdv3-GB titer infectivity was not reduced. In contrast, influenza A and B titer infectivity was reduced to 2 log10 TCID50 after 5 min of contact with the nonwoven fabric and to 3 log10 TCID50 after 30 min of contact. Titers of 6 of 7 influenza A and B strains were reduced by over 4 log10 TCID50 within 30 min. Siliconized TiO2-coated nonwoven fabric thus efficiently inactivated FCV-F9 and HAdV-GB and absorbed influenza viruses.

Laparoscopic appendectomy for complicated appendicitis: a comparison with open appendectomy.

BACKGROUND: Although laparoscopic appendectomy (LA) is widely performed in many countries, LA for complicated appendicitis, which includes perforated or gangrenous appendicitis with or without localized or disseminated peritonitis, has not become a common practice yet. METHODS: We retrospectively analyzed the clinical records of 230 patients who had undergone appendectomy for complicated appendicitis: 141 had undergone LA, 84 had conventional open appendectomy (OA), and 5 patients had conversion to the open procedure after laparoscopy. The LA group (total LA) was subdivided into "early experience (early LA: cases 1-56)" and "late experience (late LA: case 57 and higher)." We defined the early LA group as the comparison group to minimize selection bias. RESULTS: Patient demographics were similar in the early LA and OA groups (P > 0.05). Wound infection was significantly more frequent in the OA group (P < 0.05). Intra-abdominal infection was equally common in these two groups. The overall rate of postoperative complications was significantly higher in the OA group (32.1%) than in the early LA group (18%; P < 0.05). This incidence was 12.8% in the total LA group. Hospital stay was significantly shorter in the early LA group (10.6 +/- 3.9 days; P < 0.05), and 8.9 +/- 3.7 days in the total LA group. CONCLUSIONS: Our findings indicate that LA is safe and useful even for the treatment of complicated appendicitis if performed by an experienced surgeon.

Laparoscopy-assisted low anterior resection with a prolapsing technique for low rectal cancer.

Laparoscopy-assisted low anterior resection (LAR) for low rectal cancer is a difficult procedure, presenting problems with rectal washout, selecting the appropriate distal transection line, and achieving safe anastomosis. To resolve these problems, we used a prolapsing technique to perform laparoscopy-assisted LAR. Total mesorectal excision (TME) is performed laparoscopically. The proximal colon is transected laparoscopically with the aid of an endoscopic stapler, and the distal rectum, including the lesion, are everted and pulled transanally to outside the body. Only washout of and wiping off the distal rectum and intestinal resection are performed extracorporeally. The distal rectum is pushed back through the anus into the pelvis, and intracorporeal anastomosis is completed laparoscopically with a double-stapling technique. Our limited experience suggests that the prolapsing technique helps to prevent problems with laparoscopy-assisted LAR in selected patients with low rectal cancer.

Association between the severity of sepsis and the changes in hemostatic molecular markers and vascular endothelial damage markers.

It is well known that disorders of coagulation and fibrinolysis play a major role in the development of organ dysfunction during sepsis. Furthermore, the importance of the early initiation of anticoagulation therapy for severe cases has been emphasized based on the success of recent clinical trials. The purpose of this study is to search for useful markers for predicting organ dysfunction. Plasma samples were prospectively collected from 78 patients within 48 h after the onset of sepsis. Hemostatic markers and endothelial damage markers were compared between the patients with and without organ dysfunction. The WBC and platelet counts were not different between the groups. In contrast, fibrin/fibrinogen degradation products, D-dimer, thrombin-antithrombin complex, plasmin alpha2-antiplasmin complex, soluble fibrin, and total plasminogen activator inhibitor-1 were significantly higher, and the antithrombin activity and protein C levels were lower in the patients with organ dysfunction. Thus, the changes in the hemostatic molecular markers were associated with organ dysfunction from an early stage of sepsis, and antithrombin and protein C activities were found to be the most reliable markers.

The efficacy of long-term oral chemotherapy with 5'-deoxy-5-fluorouridine and cyclophosphamide for recurrent breast cancer.

BACKGROUND: 5'-Deoxy-5-fluorouridine (5'-DFUR) is a prodrug of 5-fluorouracil (5-FU), which is known to be converted by thymidine phosphorylase (dThdPase). A recent preclinical study revealed that cyclophosphamide (CPA) upregulated dThdPase activity, specifically in tumor cells. The purpose of the present study was to examine the efficacy of long-term administration of 5'-DFUR/CPA for patients with recurrent breast cancer. METHODS: Fifteen breast cancer patients with recurrent tumors entered this study. Ten patients had bone metastasis, five had lung metastasis, and two had liver metastasis. Three patients had multiorgan metastases. All patients had had previous exposure to standard chemotherapy such as CAF (CPA, doxorubicin, and 5-FU) and CMF (CPA, methotrexate, and 5-FU). The patients were orally administered with daily doses of 5'-DFUR at 800-1200 mg and CPA at 200 mg for 2 weeks as induction therapy, followed by 2 weeks' rest (one to two cycles). Daily doses of 800 mg of 5'-DFUR and 100 mg of CPA (as maintenance therapy) were continuously administered thereafter. Ten of the 15 patients received the maintenance therapy alone. The treatment was continued for at least 24 months (average, 35.2 months). RESULTS: The main findings included a significant decrease in pain in nine patients with bone metastasis, and this effect continued for more than 2 years. As the pain decreased, the patients' quality of life (QOL) was improved. Liver metastasis was diminished in two out of two patients. Hematological toxicity of more than grade 3 was recognized in three patients, but only during the induction therapy. CONCLUSION: Oral administration of 5'-DFUR/CPA is well tolerated and useful for patients with recurrent breast cancer.

Laparoscopic surgery for left paraduodenal hernia.

Paraduodenal hernia is a rare condition but the most common internal hernia. We describe the case of a 51-year-old man who was admitted with a complaint of 2 months' duration of recurrent left lower abdominal pain. Left paraduodenal hernia complicated by bowel malrotation was diagnosed, and the patient underwent laparoscopic surgery since no bowel necrosis was observed. The bowel incarcerated in the hernial sac was reduced, and an Endostitch was used to close the hernial orifice with continuous sutures. The postoperative course was good, and the patient was discharged 7 days after surgery. For paraduodenal hernia without bowel necrosis, particularly a left hernia, reduction of the incarcerated bowel and closure of the hernial orifice are relatively easy in terms of technique, and laparoscopic surgery may be the surgical method of choice because of its minimal invasiveness and aesthetic advantage.

Long-term results of breast-conserving treatment for early-stage breast cancer in Japanese women from multicenter investigation.

BACKGROUND: Although many clinical data regarding breast-conserving treatment have already been reported from European and North American countries, few clinical data with long-term follow-up have been reported from Japan. METHOD: We collected information on therapeutic and possible or developed prognostic factors and follow-up data for Japanese women who had received breast-conserving treatment consisting of wide excision of the primary tumor, axillary dissection and radiotherapy for unilateral breast cancer considered suitable for breast-conserving treatment from 18 Japanese major breast cancer treating hospitals; 1561 patients were registered. RESULTS: The median follow-up period was 77 months. Five-year disease-free and overall survival rates were 89.4 and 95.9%, respectively. The 5-year local recurrence-free rate was 96.3%. The patients with histologically positive margins (P < 0.0001) or estrogen receptor negative tumor (P = 0.0340) or younger than 40 years old (P < 0.0001) developed statistically significantly more local recurrences. Adjuvant endocrine therapy was essential for the estrogen receptor positive patients to have a lower local recurrence rate. Endocrine therapy did not change the local recurrence rate among estrogen receptor negative patients at all. Multivariate analysis showed histological margin status and the combination of estrogen receptor status and endocrine therapy were independent prognostic factors for local recurrence. CONCLUSION: The 5-year local recurrence rate of Japanese breast cancer patients who were treated with breast-conserving treatment using radiotherapy was 3.7%. Independent prognostic factors for local recurrence were histological margin status and the combination of estrogen receptor status and adjuvant endocrine therapy.

[Effect and mechanism of orally administered leucovorin/5-fluorouracil on colon cancer].

UNLABELLED: Leucovorin (LV)/5-fluorouracil combination is one of the first-line forms of chemotherapy for colorectal cancer, and in this regimen it was recommended that 5-FU be infused continuously from the venous route. However, since this regimen limits the patients' ADL, oral administration is preferable. The purpose of this study is to elucidate the mechanisms of orally-administered LV/5-FU. MATERIAL AND METHODS: The Gastrostomy was performed, and 1 x 10(6) of colon 26 was transplanted subcutaneously in CDF1 mice. In the continuous administration group, either 10, 20, 40 mg/kg of 5-FU and 100 mg/kg of LV were continuously infused for 7 days following gastrostomy using a microinfusion pump (n = 6). In the single infusion group, either 10, 20, 40 mg/kg of 5-FU was infused once a day for 7 days after gastrostomy concomitant with LV (n = 6). The other 6 animals served as the control, and LV alone was infused in this group. Tumor volume, thymidylate synthase inhibition rate (TSIR), incorporation of 5-FU into RNA (F-RNA) and body weight were measured at the end of the treatment. During the experimental period, mice were given free access to chow and water. RESULTS: The tumor volume suppression rate was significantly higher along with the amount of 5-FU. However, there was no significant difference between continuous and single infusion groups. TSIR was higher in the continuous group at the dose of 20 and 40 mg/kg. In contrast, F-RNA was higher in the single group at the dose of 20 and 40 mg/kg. Significant body weight loss was not recognized in any group. CONCLUSION: From these data, single administration of 5-FU is more effective for RNA dysfunction. On the other hand, continuous infusion is more damaging to DNA duplication. In summary, since the mechanism of the antitumor effect differs with the administration method, it is important to understand this mechanism.

Secretory carcinoma of the breast: an immunohistochemical and ultrastructural study.

Abstract We report a rare case of secretory carcinoma of the breast in a 50-year-old Japanese woman. The patient had been aware of a right breast tumor for 8 years, but had left it untreated. The tumor enlarged in size and became painful, and she visited our hospital. Breast carcinoma was diagnosed, and mastectomy was performed. Histopathological examination revealed features of a secretory carcinoma characterized by prominent secretory activity in the glandular and microcystic spaces, with some areas showing a follicular pattern resembling the thyroid gland. The secretory material was PAS-positive and immunohistochemically alpha-lactalbumin-positive. Ultrastructurally, the tumor cell contained many secretory vacuoles in the cytoplasm. In addition, extracellular and intracytoplasmic lumina were conspicuous; these were lined by microvilli projection and contained secretory material. By flow cytometric analysis, the DNA index was 1.14, which was diploid, showing relatively low proliferative activity.