[Surgical Repair without Ventriculotomy for Double-chambered Right Ventricle in a 61-year-old Man;Report of a Case].

A 61-year-old man with double-chambered right ventricle( DCRV) was operated on successfully without ventriculotomy. The patient presented with cardiac murmur and electrocardiogram abnormality with exertional dyspnea. Echocardiography demonstrated double-chambered right ventricle with severe tricuspid valve regurgitation. Cardiac catheterization data revealed a 110 mmHg peak-to-peak pressure gradient in the right ventricular cavity with normal pulmonary pressure. The tricuspid valve was repaired with an annuloplasty ring, and the abnormal muscle bands in right ventricular outflow tract were resected through both right atrium and pulmonary artery. No major complications occurred after surgery. Postoperative echocardiography demonstrated a pressure gradient of 18 mmHg between the pulmonary artery and right ventricle without tricuspid regurgitation, and his clinical symptoms were improved. Surgical repair without right ventriculotomy combined with tricuspid annuloplasty was effective and feasible for DCRV in an adult patient.

Correlation between neurological dysfunction with vitamin E deficiency and gastrectomy.

OBJECTIVE: We previously reported on vitamin E malabsorption after gastrectomy. In this study, we focused on neurological dysfunction due to serum vitamin E decrease during the postgastrectomy period in lager number of patients. METHODS: We examined the type of gastrectomy, type of reconstruction, serum vitamin E level, and neurological status for 96 gastrectomy patients. RESULTS: Low serum vitamin E levels were observed in 20 patients, and 10 of those patients suffered some neurological symptoms, i.e., peripheral neuropathy, limb or truncal ataxia. Vitamin E levels tended to decrease with time after gastrectomy, and the number of patients with low serum vitamin E levels increased at about 50 months after gastrectomy. This relationship was stronger in total gastrectomy patients than in subtotal gastrectomy patients. Ten patients were given oral vitamin E, and serum vitamin E levels normalized in 9 of the patients and neurological abnormalities improved in 8 patients. An oral intake of 300 mg or more of vitamin E was necessary for normalization of vitamin E levels. CONCLUSIONS: Gastrectomy should be considered a risk for vitamin E deficiency and neurological disturbance over the long-term clinical course. An oral vitamin E supply can improve serum vitamin E levels and neurological symptoms.

Evaluation of calorie intake according to age and sex in patients undergoing surgery for gastric cancer.

BACKGROUND/AIMS: We studied food intake in 107 patients undergoing gastric surgery, with emphasis on postoperative quality of life (QOL). The time course of food intake after surgery, sex- and age-related differences in food intake, and the relation of food intake to surgical procedure were evaluated retrospectively. METHODOLOGY: The following variables were studied: 1) the time required for stabilization of food intake, assessed on the basis of the time course of food intake after operation; 2) the relations of sex and age to postoperative food intake, assessed by comparing food intake according to sex and age; and 3) postoperative food intake according to surgical procedure, evaluated by calculating the ratio of postoperative food intake to the food intake of healthy individuals matched for sex and age. RESULTS: At 6, 12, and 24 months after operation, there was no difference in food intake among the three operative procedures; food intake was stable from 6 months onward. When food intake was analyzed according to age, similar trends were seen in men and women, and there were no significant differences in food intake among patients in their 40s, 50s, or 60s. Food intake was significantly lower in patients in their 70s than in patients in the other age groups. Food intake even in women with significantly decreased food intake or in patients 70 years or older was not necessarily low as compared with food intake levels in healthy individuals. CONCLUSIONS: Food intake is substantially affected by the period of time after surgery, as well as by sex, and age at the time of surgery.

Vitamin E malabsorption and neurological consequences after gastrectomy for gastric cancer.

BACKGROUND/AIMS: In order to clarify vitamin E malabsorption after gastric surgery, we evaluated serum vitamin E level and neurological consequences in patients who had undergone gastrectomy for gastric cancer. METHODOLOGY: We studied forty-eight patients (30 men, 18 women) with a mean age of 68.0 years, who had previously undergone gastrectomy for gastric cancer and had no evidence of recurrence. The types of operation consisted of subtotal gastrectomy in 26 patients and total gastrectomy in 22 patients. We measured postoperative body weight, white blood cells, red blood cells, hemoglobin, hematocrit, platelets, and serum levels of vitamins E, vitamin B12, folic acid, total cholesterol, triglycerides, total protein, and albumin. RESULTS: Serum vitamin E level was decreased in 7 (14.6%) of the 48 patients. The occurrence of low vitamin E level was significantly more frequent in the total gastrectomy group than in the subtotal gastrectomy group. In relation to reconstruction procedures, the incidence of low vitamin E level was significantly higher in patients without food passage through the duodenum. The low vitamin E level was significantly associated with low total cholesterol level. The incidence of neuropathy was significantly higher in patients with low vitamin E level. CONCLUSIONS: We assume that vitamin E deficiency more likely occurs after the reconstruction procedure in which food does not pass through the duodenum. Transport disturbance with loss of passage through the duodenum consequently may be the major cause of malabsorption. Differential diagnosis of neurological symptoms in post-gastrectomy patients should include hypovitaminosis E.

The validity of sentinel lymph node biopsy using dye technique alone in patients with gastric cancer.

BACKGROUND/AIMS: We investigated whether sentinel lymph node biopsy using dye technique alone is useful or not in decision-making for less invasive surgery in patients with gastric cancer. METHODOLOGY: The subjects were 43 patients who had undergone laparotomy for gastric cancer and consented to undergo sentinel lymph node biopsy using patent blue dye. The patients enrolled were 26 males and 17 females, with a mean age of 62.5 years. The tumor sites were upper third of the stomach in 14, middle third in 16, and lower third in 13 patients. The depth of invasion was mucosa in eight, submucosa in 19, muscularis propria in five, subserosa in five, and serosa in six patients. Total gastrectomy was performed in 12, subtotal gastrectomy in 28, and proximal gastrectomy in three patients. RESULTS: The mean number of sentinel lymph node biopsies per surgery was 3.5 +/- 4.1. We were able to perform blue node biopsy in 40 out of 43 patients, but could not find any blue nodes in three patients. Among the 40 patients in whom blue nodes were identified, 29 patients with no metastasis in blue nodes had no evidence of lymph node metastasis (NO). The depth of invasion was not deeper than subserosa in all these patients. Metastasis was observed in one out of the three patients in whom no blue nodes were found. CONCLUSIONS: When the depth of invasion was not deeper than the subserosa and blue nodes were identified, no metastases in either non-blue nodes or blue nodes could be found in the absence of metastatic blue nodes. Therefore, if the depth of invasion is not deeper than the subserosa in gastric cancer, metastatic search in blue nodes seems sufficient and less invasive surgery can be performed safely. Even when the invasion depth is not deeper than the submucosa, the tumor could be metastatic to Group 2 lymph nodes in patients in whom blue node biopsy revealed metastases. When metastasis is found in lymph nodes by intraoperative frozen section diagnosis, less invasive surgery for gastric cancer is not indicated.

[Neoadjuvant chemotherapy with combination of S-1 and CPT-11 in advanced rectal cancer - a case report].

We report a case of advanced rectal cancer successfully treated with a combination of S-1 and CPT-11 as neoadjuvant chemotherapy. The patient, a 61-year-old man, had a rectal cancer with pelvic viscera invasion and severe stenosis. After colostomy for removing stenosis, he was treated with a combination of S-1 and CPT-11 (S-1 120 mg/body day on day 1-14, CPT-11 120 mg/body/day on day 1 and day 15, every 4 weeks). Seven courses of treatment resulted in a marked reduction of the primary tumor and disappearance of invasion. Subsequently, rectal amputation for curative intent was done. No surgical complication was observed. On microscopic examination, only a few tumor cells were detected in the granulation tissue of the resected rectum and no tumor cells in dissected LNs. This case demonstrates the effectiveness and safety in a neoadjuvant setting of a combination of S-1 and irinotecan for rectal cancer.

The variations in the immunologic features and interleukin-6 levels for the surgical treatment of cardiac myxomas.

PURPOSE: In this study, we propose the existence of a relationship between cardiac myxomas and the immunologic features or interleukin-6 (IL-6), while also considering the optimal treatment of cardiac myxoma, especially "familial myxoma." METHODS: In a 19-year period at our hospital, 20 patients underwent 21 operations for cardiac myxomas. The immunologic features and the IL-6 levels were measured pre-operatively in 13 cases and post-operatively in 10 cases. A case of "familial myxoma" was diagnosed based on molecular genetic analyses. RESULTS: No patients died in the hospital. The tumor size correlated with the preoperative IL-6 and/or alpha1-globulin values (P < 0.05). In addition, all of the immunologic features and IL-6 levels normalized by 4 weeks after surgery. "Familial myxoma" demonstrated recurrence without showing increases in either the immunologic features, inflammatory signs, or serum IL-6 levels. CONCLUSIONS: Patients with cardiac myxoma should therefore be operated on immediately because the possibility that the tumor size might be large when IL-6 and/or alpha1-globulin values are high. In addition, cases of "familial myxoma" require careful observation and periodic echocardiography after surgery to identify any possible recurrence. Recently, molecular genetic analyses are therefore considered to be an important diagnostic tool for cardiac myxoma, especially "familial myxoma." Our "familial myxoma" case demonstrated a C769T PRKAR1a mutation, which has also been observed in other cases of "familial myxoma."

13C-urea breath test in patients having undergone total gastrectomy.

BACKGROUND/AIMS: In this study, we performed 13C-urea breath test in patients who had undergone total gastrectomy and investigated the content of (13)CO2 in the CO2 gas expired after direct influx of 13C-urea into the small intestine. METHODOLOGY: 13C-Urea breath test was performed in 31 patients who had undergone total gastrectomy at this department for the treatment of stomach cancer and consented to participate in this study. The test was performed in two ways, i.e. with and without mouth washing (gargling) on taking 13C-urea. RESULTS: Among 41 measurements, the delta13C was less than 2.5% per hundred in 9 measurements (22.2%) and less than 2.0% per hundred in 6 measurements (14.6%). The delta13C exceeded 50% per hundred, in 4 subjects (9.8%). There were no differences between the methods with and without gargling. CONCLUSIONS: The results of this study suggested the possibility that 13C-urea is decomposed even in the jejunum or the lower part of intestine resulting in absorption of H(13)CO3 and another possibility that 13C-urea is directly absorbed from the intestine and decomposed in the blood.

Bone disorder and vitamin D after gastric cancer surgery.

BACKGROUND/AIMS: The present study was conducted to investigate the relationship between bone metabolic disorder after gastrectomy for gastric cancer and vitamin D metabolites or the hormones involved in calcium metabolism. METHODOLOGY: Twenty-one patients who had undergone gastrectomy for gastric cancer and had been followed for less than 10 years were assessed for bone disorder by microdensitometry. The levels of 1,25-dihydroxy vitamin D (1,25(OH)2VD), 25-hydroxy vitamin D (25(OH)VD), 24,25-dihydroxy vitamin D (24,25(OH)2VD), N-PTH, calcitonin, estradiol, osteocalcin, and ALP were measured and assessed for correlations with clinicopathological factors, including the operative procedure and the number of years since surgery. RESULTS: Bone disorder was found in 9 out of 21 patients (42.9%). The prevalence was significantly higher in patients who had undergone surgery more than 2 years before assessment, so there was a relationship between the period after surgery and bone disorder. Among the vitamin D metabolites, the level of 1,25(OH)2VD was normal in all patients, whereas 25(OH)VD was reduced in 6 out of 21 patients (28.6%) and 24,25(OH)2VD was reduced in 17 patients (81.0%). The 1,25(OH)2VD was significantly higher in the patients with Grade I to III bone disorder compared to the patients with normal bones or early bone disease. The 1,25(OH)2VD/25(OH)VD ratio was significantly higher in the patients without passage of food through the duodenum due to the reconstructive method, while the 25(OH)VD/24,25(OH)2VD ratio was significantly higher in the patients with remaining of duodenal food passage. PTH was decreased in about 50% of the patients, while calcitonin was normal in all patients. Estradiol was decreased in one female patient, while it was elevated in 10 of the 17 men (58.8%). The osteocalcin level was high in all patients irrespective of the period after surgery. CONCLUSIONS: After gastrectomy, the incidence of bone metabolic disorder increases with time. Changes of vitamin D metabolites, particularly 25(OH)VD and 24,25(OH)2VD, seem to be closely associated with post-gastrectomy bone disease.

Platelet activation in patients after splenectomy with total gastrectomy for gastric cancer.

OBJECTIVE: We investigated change in platelet activation using flow cytometry in patients before and after splenectomy with total gastrectomy for gastric cancer. METHODS: Six patients who underwent splenectomy for lymphadenectomy with total gastrectomy for gastric cancer were the subjects in this study. In the patients, platelet count and platelet activation were evaluated before the operation, 1 week after the operation, and 1 month after the operation. Expression of CD62P (P-selectin) was analysed as a marker of platelet activation using flow cytometry. RESULTS: Although platelet count significantly increased 1 week after the operation, the platelet count 1 month after the operation did not increase significantly. Expression of CD62P (P-selectin) significantly decreased at 1 week and 1 month after the operation, compared with the level before the operation. No postoperative complications occurred in any patient. CONCLUSION: In the present study, platelet activation did not progress after the operation. The results mean that the risk of thrombosis after splenectomy does not increase.

Aortic root necrosis after surgical treatment using gelatin-resorcinol-formaldehyde (GRF) glue in patients with acute type A aortic dissection.

BACKGROUND: Although gelatin-resorcinol-formaldehyde (GRF) glue is used for surgical repair of acute type A aortic dissections, late complications possibly ascribed to toxic effects of GRF glue have been reported. We analyzed the benefits and risks of using GRF glue. PATIENTS AND METHODS: Between January 1990 and August 2003, 269 consecutive patients underwent emergency operations for acute type A aortic dissection. GRF glue was not used in 47 patients (non-GRF group) who were operated on until May 1995 and was used in the 222 (GRF group) who underwent operation subsequently. RESULTS: The rate of in-hospital mortality was significantly higher in the non-GRF group (31.9%) than in the GRF group (12.6%) (p<0.0001). In the GRF group, false aneurysms were found in 31 patients (31/194 survivors, 16.0%) 1-65 (mean, 30+/-18) months after initial operation. Reoperation was done in 24 of these patients. At reoperation, the site to which GRF glue was applied had degenerated, and the anastomosis between the aortic root and prosthesis had opened widely, creating a false aneurysm and resulting in aortic regurgitation with prolapse of the coronary cusps. The mortality rate of reoperation was 4.2% (1/24). CONCLUSION: The use of GRF glue improved the short-term outcome of surgery for acute type A aortic dissection, but was associated with a high incidence of false aneurysms forming at the site of proximal anastomosis, where GRF glue had been applied. Patients in whom GRF glue has been used should be carefully followed up after surgery.

Long-term outcome after hernia repair with the prolene hernia system.

PURPOSE: We evaluated the long-term outcome and symptoms after inguinal hernia repair using the Prolene Hernia System (PHS). METHODS: We reviewed the medical records of all patients who underwent PHS surgery at our hospital to assess the postoperative complications and recurrence rates. Late symptoms were evaluated by a standardized interview using a questionnaire. RESULTS: A total of 395 hernias in 367 patients were studied. Postoperative complications developed after 20 repairs (5.1%), including a severe mesh infection in one patient. Seven (1.8%) patients suffered recurrence. Of 395 cases, 363 (91.9%) responded to the interview. After a median follow-up interval of 19.3 months (range 1.0-55.8), moderate pain and moderate discomfort were reported by only 1.9% and 0.8% of patients, respectively. CONCLUSIONS: Prolene Hernia System surgery is a safe and feasible procedure with low rates of complication, recurrence, and late symptoms.

Successful treatment of multiple small-bowel perforations caused by cytomegalovirus in a patient with malignant lymphoma: report of a case.

We report the successful management of multiple small-bowel perforations caused by cytomegalovirus (CMV) infection in a 60-year-old man, 1 day after CHOP (cyclophosphamide/doxorubicin/vincristine/prednisone) therapy induction for malignant lymphoma. Emergency laparotomy was performed for perforative peritonitis, but we did not resect the lesions at this time. Instead, we exteriorized the small bowel and then irrigated the peritoneal cavity and intestinal tract. His white blood cell count was low, at 200 cells/microl, so this therapy was continued until it recovered. The intestine was highly edematous, but it improved after irrigation with peritoneal dialysis solution. In the second-stage procedure, we resected the small bowel with the perforations, and constructed a jejunostomy and colostomy, then closed the abdominal cavity. Although the patient needed central venous hyperalimentation, he had a favorable postoperative course and started treatment again for the malignant lymphoma.

[Clinical results of single therapy with TS-1 for advanced/recurrent gastric cancer].

In cases with advanced/recurrent gastric cancer undergoing single therapy with TS-1, we retrospectively discussed the antitumor effects and adverse events and considered the clinical utility of TS-1. The subjects consisted of 131 cases with advanced/recurrent gastric cancer who received one or more courses of therapy with TS-1 alone between July 1999 and August 2003. We carried out 4-week administration of 80-120 mg/day of TS-1 according to body surface area, followed by a 2-week discontinuation, then repeated administration which adjusting the dosage according to the incidence of side effects, and discussed the antitumor effects and adverse events. The response rate in all cases was 21% and the median survival time (MST) was 343 days, or 25.3% and 265 days if limited to unresectable and recurrent cases. The response rates were 38.2% for unresectable cases, 16.3% for recurrent cases and 14.6% for curability C cases, and the MSTs were 250 days, 276 days and 419 days, respectively. The response rates in terms of whether or not patients had received chemotherapy were 11.6% for those who had received chemotherapy and 40.0% for those who had not, and the MSTs were 239 days and 325 days, respectively. Thus, both were significantly better in patients who had not received chemotherapy. The response rates for patients who had not received chemical therapy by target organs were favorable on the order of 50% for stomach and 33% for liver metastasis, and the MSTs were on the order of 474 days for peritoneum, 39 1 days for liver metastasis and 326 days for lymph nodes. There were 10 cases of long-term survival of 600 days or longer, but not in unresectable cases, and the target organs in many of the cases were the peritoneum and lymph nodes. Adverse reactions were observed in 34.4% of all cases and those of grade 3 or more in 9.4%, all of which were improved only by discontinuation of the drug. It was again confirmed that single therapy with TS-1 for advanced/recurrent gastric cancer is an excellent therapy providing both high antitumor effects and safety.

Reduction therapy of alanine aminotransferase levels prevent HCC development in patients with HCV-associated cirrhosis.

BACKGROUND: To find a way to prevent the development of hepatocellular carcinoma (HCC) from hepatitis C virus-associated liver cirrhosis (HCV-LC), an analysis of the HCV-LC patients who had received reduction therapy of the alanine aminotransferase (ALT) levels was performed. PATIENTS AND METHODS: Seventy-four consecutive HCV-LC patients of Child Stage A were followed for >10 years for the development of HCC. They were divided into two groups: in group A, the reduction therapy for the ALT levels was aggressively performed, while in group B, the reduction therapy was not performed aggressively. The patients were subdivided into three sub-groups according to their serum ALT levels. In groups A and B, the high ALT group was comprised, respectively, of nine and five patients whose annual average serum ALT levels were persistently high (> or =80 IU), while the low ALT group was comprised of 19 and 20 patients whose annual average serum ALT levels were persistently low (<80 IU). The remaining eleven and ten patients had annual average serum ALT levels which fluctuated and were unclassified (unclassified group). RESULTS: In group B, 65.7% of the patients had developed HCC in 13 years, in contrast to only 41.0% of group A (p=0.039). In group A, the median HCC development time was 12.8 years, in contrast to only 3.8 years in group B (p=0.0013). Multivariate analysis demonstrated that the mode of reduction therapy and ALT levels were the significant factors affecting HCC development. CONCLUSION: The chances of surviving for more than ten years without developing HCC for HCV-LC patients

A phase I study of bi-weekly combination therapy with S-1 and docetaxel for advanced or recurrent gastric cancer.

BACKGROUND: S-1 is a novel oral fluorouracil antitumor drug that contains a combination of 3 pharmacological agents: tegafur (FT), a 5-fluorouracil (5-FU) prodrug, 5-chloro-2,4-dihydroxypyridine (CDHP), which inhibits the activity of dihydropyrimidine dehydrogenase (DPD), and potassium oxonate (Oxo), which reduces the gastrointestinal toxicity of 5-FU. S-1 and docetaxel have both been identified as effective agents for the treatment of gastric cancer. However, little is known about the effects and/or adverse effects of a combination of these drugs in the treatment of gastric cancer. The aim of this phase I study was to determine the maximum-tolerated dose (MTD) and the recommended dose of docetaxel with a fixed dose of S-1 in patients with advanced or recurrent gastric cancer. PATIENTS AND METHODS: Patients with metastatic, recurrent, or unresectable gastric cancer received docetaxel at a starting dose of 25 mg/m2 by i.v. infusion over 1 h on days 1, 15 and 29, and S-1 at the full dose of 80 mg/m2 daily for 4 weeks of every 6 weeks. Nine patients were treated with increasing dosages of docetaxel as follows: (docetaxel/S-1, mg/m2): 25/80 (level 1), 30/80 (level 2) and 35/80 (level 3). All cases were assessable for drug safety and 7 were assessable for response. Colony-stimulating factor (CSF) was not used in this study. The adverse effects of treatment were analyzed according to NCI-CTC, version 2 and the response was assessed according to the Japanese Classification of Gastric Cancer, 13th Ed. RESULTS: The MTD was reached at the 35/80 mg/m2 dose-level in 3 out of 3 patients. These patients experienced some dose-limiting toxicity (DLT) or grade 3 anemia. The reported DLTs included diarrhea, stomatitis and general fatigue. Due to these results, 3 additional patients were not enrolled at this dose-level. No hematological or non-hematological adverse effects (more severe than grade 2) were observed in any of the level 1 or 2 patients. However, among the level 1 patients, 66.7% developed grade 2 leukocytopenia and 33.3% developed grade 2 neutropenia. Among the level 2 patients, 33.3% developed grade 2 appetite loss, diarrhea and general fatigue. Partial responses were achieved in 3 (42.9%) out of the 7 patients with evaluable lesions. These results indicated that the appropriate doses of the 2 drugs in combination therapy are 30 mg/m2 for docetaxel and 80 mg/m2 for S-1. CONCLUSION: The S-1/docetaxel drug combination showed a good safety profile, with diarrhea and general fatigue being common, but manageable, adverse reactions. Moreover, the responses observed in this study suggest that the drug combination shows a high degree of efficacy in patients with advanced and/or recurrent gastric cancer.

Midterm results of transluminal endovascular grafting in patients with DeBakey type III dissecting aortic aneurysms.

OBJECTIVE: Transluminal endovascular grafting (TEG) is less invasive than conventional operative procedures for the treatment of DeBakey type III dissecting aortic aneurysms (DAA). We have used two different kinds of stent grafts covered with woven Dacron grafts, a Gianturco Z-stent graft (G-SG) and a Spiral Z-stent graft (S-SG). Because the G-SG lacks adequate flexibility, the end of the graft may injure the intima after long-term deployment in the proximal descending aorta. We have used S-SGs, which are more flexible than G-SG, to improve outcome. We report our late midterm results and discuss treatment policy. SUBJECTS AND METHODS: We studied 45 patients with DeBakey type III DAA. Thirty-two G-SGs and 13 S-SGs were used. Follow-up ranged from 1 year 6 months to 8 years 5 months (mean, 5 years 2 months). RESULTS: 1) Surgical outcome: (a) TEG was technically successful in all patients. There was no operative mortality. (b) One week after surgery, 36 patients had no endoleaks, 5 had minor endoleaks, and 4 had major endoleaks. 2) Late midterm results: (a) Four patients with residual major endoleaks, underwent replacement of the descending thoracic aorta. (b) Intimal injury occurred at the distal end of the stent graft 4 to 18 months (mean, 10.5 months) after surgery in 12 patients with G-SG and 1 with S-SG. One of these patients had recurrent dissection, and 12 had ulcer like projections (ULP). Two patients underwent additional stent implantation to block blood flow. (c) Four patients with S-SG had major endoleaks 3 to 6 months after surgery. In 3 of these patients, the Spiral Z-stents were compressed and occluded, and thrombus had formed in the lumen. Three patients underwent replacement of the descending thoracic aorta. (d) Additional replacement of the descending thoracic aorta was done in 9 of the 45 patients (20%) 4 to 24 months after TEG. All patients responded to treatment and were discharged from the hospital. CONCLUSION: Intimal injury was caused by Gianturco Z-stents because of inadequate flexibility, and endoleaks and stent-graft occlusion were caused by Spiral Z-stents because of insufficient radial force against the aortic wall. The development of stents with these improved properties is expected to further improve outcome.

[A case of thymic cancer with pericardial tamponade as initial manifestation].

We report a case of thymic cancer with pericardial tamponade in a 70-year-old woman. The patient complained of chest pain and was carried to our hospital. CT scan showed a mediastinal mass and massive pericardial effusion. The effusion was serous fluid, not bloody, and no malignant cells were found. The patient underwent a tumor resection, and the final pathological diagnosis was squamous cell carcinoma of the thymus. In a review of 14 cases of thymic tumor with pericardial tamponade as initial manifestations in the Japanese literature,there were only three cases of thymic cancer. The prognosis was reported to be extremely poor.Some reports showed the effectiveness of chemotherapy and irradiation therapy. We should keep looking for the best treatment for this disease.

Water-generated negative air ions activate NK cell and inhibit carcinogenesis in mice.

Negative ions are considered to have potential health benefits, but few studies have examined their effects in vivo. We studied water-generated negative ions (WNI) with respect to physical properties as well as immunologic activation and anti-tumor activity (inhibition of carcinogenesis and tumor growth) in mice. Electrically, generated negative ions (ENI) served as control. Water-generated negative ions had a long life, significantly enhanced the cytotoxic activity of natural killer cells, and significantly decreased the incidence of cancer and inhibited tumor growth. Anti-tumor effects were attributed to enhancement of natural killer cell activity. The mechanisms and applications of negative ions warrant further investigation.