Tumor-to-tumor metastasis: lung cancer within a thymoma.

Tumor-to-tumor metastasis is a rare phenomenon. We present a rare case of an 83-year-old man with pulmonary squamous cell carcinoma and thymoma. Thymectomy and superior segmentectomy of the left lower lobe were successfully performed on the patient. This thymoma had a region of lung cancer. Metastasis from other tumors to thymoma is rare, and we found a report that described a pancreatic carcinoma metastasizing to thymoma. We report an extremely rare case of metastasis from lung cancer to a thymoma.

Comparison between pancreatoduodenectomy and hepatopancreatoduodenectomy for bile duct cancer.

BACKGROUND/AIMS: Pancreatoduodenectomy has been accepted as a standard operative procedure for distal bile duct cancer with low operative mortality. However, hepatopancreatoduodenectomy has not been accepted as a standard treatment modality for diffuse bile duct cancer. METHODOLOGY: From December 12, 1992 to December 15, 2000, 37 patients with the diagnosis of extrahepatic bile duct adenocarcinoma (cholangiocarcinoma) underwent pancreatoduodenectomy or hepatopancreatoduodenectomy, at the department of surgery, Ibaraki Prefectural Central Hospital and the Cancer Center. The differences in indications and results of both operative procedures were investigated retrospectively. RESULTS: Thirty-day operative mortality was 0% after either pancreatoduodenectomy or hepatopancreatoduodenectomy. One- to 5-year cumulative survival rates for the 24 patients after pancreatoduodenectomy were 76.3%, 41.5%, 41.5%, 41.5%, 41.5%, respectively. One- to 4-year cumulative survival rates for the 13 patients after hepatopancreatoduodenectomy were 48.0%, 32.0%, 32.0%, 16.0%, respectively. There were no statistically significant differences between cumulative survival rates after pancreatoduodenectomy and hepatopancreatoduodenectomy either in all the patients or in patients with UICC stage IV. CONCLUSIONS: Hepatopancreatoduodenectomy should be tried for patients with diffuse bile duct cancer, because only hepatopancreatoduodenectomy has the possibility of a cure at this time.

[Bacterial infection in the conjunctiva of patients with adenoviral conjunctivitis].

PURPOSE: We evaluate the microbiological features of mixed infection in adenovirus-infected conjunctiva. SUBJECTS: Isolation of bacteria was performed in 82 samples of adenoviral conjunctivitis at six eye clinics in Japan. METHODS: For microbiological diagnosis, we performed immunochromatography (IC) and polymerase chain reaction--restriction fragment length polymorphism (PCR-RFLP) analysis for detection and serotyping of adenovirus, and PCR for detection of herpes simplex virus (HSV) and Chlamydia trachomatis antigens out of 82 samples with adenoviral conjunctivitis. RESULTS: Pathogenic bacteria were isolated in 6 samples out of 82. Out of these 6 cases, 5 samples were gram-negative rods and most of them were Flavobacterium meningosepticum (4 samples). Adenovirus type 8 was isolated from all these mixed infection cases. However, HSV-1 and Chlamydia trachomatis were not found. CONCLUSIONS: From these results, it is suggested that gram-negative rods, especially F. meningosepticum, are the most common bacteria causing mixed bacterial infection in adenoviral conjunctivitis.

[AIDS control in industry in Okinawa Prefecture, Japan].

To see how industry is responding to AIDS, an anonymous questionnaire survey was conducted on member companies (n = 407) of the chamber of commerce with 50 or more employees in three large cities in Okinawa, during February to March, 1994. Responses were obtained from 221. The questionnaire looked at type of industry, number of employees, number of business trips to foreign countries, specialists for health management, AIDS control, attitudes and actions taken toward infected persons and AIDS patients, etc. The main results were as follows; In 73 companies foreign business trips had been made. The rate of appointment of specialists in health management was below 50%. In 80% of the companies, AIDS control was not in place. About 1/2 of the companies responded that there was a need to grapple with AIDS control while 40% of the companies were undecided. The majority of the companies felt that there was no chance of their employees having HIV infection within five or six years. Many companies had no regulations for dealing with employees who are infected with HIV. From the survey, three points were made clear: 1. Industry does not have an adequate plan to deal with AIDS. 2. There is no awareness of a crisis. 3. There is insufficient dissemination of information regarding AIDS. HIV/AIDS is predicted to increase in industries in our country and management will be hard-pressed to deal with the intricate problems that arise. HIV/AIDS is not exclusively an individual problem, but should be the concern of industries and society as well.(ABSTRACT TRUNCATED AT 250 WORDS)

[A case of spontaneous hemopneumothorax associated with uncontrolled massive bleeding after inserting thorathic drain].

A 31-year-old man admitted to our hospital complaining of right chest pain. Chest X-ray on admission revealed a collapsed lung and an air fluid line in the right thorax. A chest tube drainage was carried out, but hemorrhagic pleural fluid was drainaged. Forty minutes later, an anemia developed and chest X-ray showed increased massive right pleural collection. Therefore, emergent surgery was performed. An operation under thoracoscopic guidance was converted into thoracotomy because of massive blood clots and fresh bleeding. A bleeding originating from the branch of 1st intercostal artery and a bulla on upper lobes were noted. The artery was coagulated with electrocoutary and ligated using Endo-loop. This artery is not congenital abnormal one but collateral expanded one of which the elastic lamina is thickened. Spontaneous hemopneumothorax is life-threatening, emergent operation should be undergone.

[Ineffective and recurrent cases of thoracoscopic sympathectomy for hyperhidrosis and intractable pain].

We reported the cases of thoracoscopic sympathectomy, that is, six cases of hyperhidrosis, three of post herpetic neuralgia, and four of reflex sympathetic dystrophy, including recurrent or incompletely resected or ineffective ones. Recently this procedure for hyperhidrosis had been performed frequently because of its effectiveness, less pain, early discharge and cosmetic aspect. For an ineffective case of hyperhidrosis abdominal respiration which emphasized the exhalation and using an upper abdomen decreased the sweating. The balance of autonomic nerve system, toward parasympathetic dominant, was thought to be improved by conscious respiration. The decrease of sweating right after the operation in a case of incomplete resection indicated that intraoperative maneuver could restrict the sympathetic nerve. This procedure for a pain control could be less effective than that for hyperhidrosis, so an adequate preoperative informed consent was thought to be necessary.

[Treatment for advanced colorectal carcinoma with 5-fluorouracil plus low-dose leucovorin].

From July 1992 to May 1996, 16 patients with non-curative postoperative or recurrent colorectal carcinomas were treated with 5-fluorouracil (5-FU) plus leucovorin (LV) systemic chemotherapy. LV was given at a dose of 20 mg/m2/d immediately followed by 5-FU at 370 mg/m2/d. LV was given by rapid intravenous (i.v.) injection and 5-FU by rapid or drip i.v. for 5 consecutive days. Courses were repeated once every 4 weeks for two months and then once every 5 weeks. All patients took 3 or more courses. The toxicity was tolerable, but one patient needed hospitalization because of severe gastro-intestinal toxicity. We observed 3 PR cases, no CR and an overall response rate of 19%. The response duration was 6 to 8 months, averaging 7.3 months, and median survival was 12 months. It was possible to perform this chemotherapy on an outpatient basis, so we think this chemotherapy is superior to in-hospital chemotherapy considering the issue of quality of life. However, the response rate was low and its duration was short. We must investigate chemotherapy further with new and more powerful chemical modulations to increase the response rate and to prolong the response duration.

[Studies on the effect of lentinan on human immune system. II. In vivo effect on NK activity, MLR induced killer activity and PHA induced blastic response of lymphocytes in cancer patients].

Immunological activities of lymphocytes were studied in patients with cancer of digestive organs and mamma after administration of lentinan. When 11 cancer patients received lentinan i.v. 2 mg, NK activity of lymphocytes was increased in 4 patients on the following day. With the same condition, MLR induced killer activity against Raji cell of lymphocytes was increased in 3/7 patients and PHA response was also increased in 3/7 patients. These activities were returned to values before the administration of lentinan. Then each activity was examined after administration of lentinan twice a week. NK activity, MLR induced killer activity and PHA response were increased in 4/15, 8/12 and 5/11 patients, respectively.

[Diagnostic imaging of cholelithiasis--CT & MRI].

CT and MRI are inferior to ultrasound for detection of gallstones. CT and MRI however, might have distinctive features for diagnostic imaging of the cholelithiasis. The CT is sensitive, as regard with calcification of the gallstones, and able us to diagnose the composition of the gallstones manipulate the CT number. Then spiral CT, which is a new technique, is expected to improve the accuracy of detection of gallstones. Three-dimensional CT reconstruction images are useful in the sense of the anatomy of the biliary system. MRI is superior to evaluate bile juice concentration, so that it appears to make it possible to evaluate gallbladder function. Furthermore, the MRI has the potential advantage for acquisition the new knowledge relating to stone lysis.

Treatment and prognosis of angiosarcoma of the scalp and face: a retrospective analysis of 48 patients.

OBJECTIVE: The objective of this study was to retrospectively analyse the treatment results of clinically localised angiosarcoma of the scalp and face. METHODS: The records of 48 patients who were treated between 1987 and 2009 were reviewed. single modality or a combination of surgery, radiotherapy, chemotherapy and immunotherapy were administered. The median follow-up of all 48 patients was 13.7 months (range 2.5-105.9 months). RESULTS: At the time of analysis, 45 of 48 patients (93.8%) had disease recurrences, and the lung was the most frequent site for recurrence (37 patients). In multivariate analysis, performance status (PS) and number of tumours were significant predictors of lung-metastasis-free (LMF) rate. For patients with multifocal tumours, chemotherapy use significantly decreased the LMF rate (p=0.0072). The 2-year actuarial overall survival (OS), progression-free survival and local control rates in all 48 patients were 22.1%, 10.7% and 46.3%, respectively. In multivariate analysis, PS, number of tumours, surgery and radiotherapy were significant prognostic factors for OS. Patients treated with both surgery and radiotherapy (2-year OS: 45.8%) had a significantly more favourable OS (p<0.0001) than patients treated with either surgery or radiotherapy (2-year OS: 11.1%) and patients treated with neither surgery nor radiotherapy (2-year OS: 0%). CONCLUSIONS: Our results indicated that PS and number of tumours were significant predictors for developing lung metastases. Our results also indicated that PS, number of tumours, surgery use and radiotherapy use were independent prognostic factors for OS. Multimodal treatments including surgery and radiotherapy were effective in improving OS for patients with these tumours. Advances in knowledge Multimodal treatments including surgery and radiotherapy are effective in improving overall survival for patients with angiosarcoma of the scalp and face.

Differential effects of vitamin A on fetal lung growth and diaphragmatic formation in nitrofen-induced rat model.

Congenital diaphragmatic hernia (CDH) is associated with high neonatal mortality and morbidity due to pulmonary hypoplasia and pulmonary hypertension. Antenatal interventions have been developed in an attempt to reduce the unacceptable mortality rate of CDH. The pathogenesis of pulmonary hypoplasia is not fully understood. It is not clear whether the increase of lung growth would be necessary for diaphragmatic closure. Vitamin A is important for various aspects of lung development. Therefore, the aim of this study was to examine whether antenatal treatment with vitamin A can increase lung growth and reduce the incidence of CDH in a nitrofen-treated rat model. The animals were randomly assigned to four groups: control, vitamin A, nitrofen, and nitrofen/vitamin A (NIP/Vit A). The incidence of CDH in the NIP/Vit A group (54%) was markedly lower than that in the nitrofen-treated group (85%). Although lung weight was decreased in the nitrofen-treated and NIP/vitamin A groups, the fetal lung weight-to-body weight ratio was slightly increased in the NIP/vitamin A group, compared to the nitrofen-treated group. The mRNA levels of lung surfactant proteins were decreased in the NIP/vitamin A group. We conclude that antenatal treatment with vitamin A reduced the incidence of CDH without lung maturation in the nitrofen-induced rat model.

A light-activated DNA-binding factor stimulates transcription of the rrnA operon in the cyanobacterium Synechococcus sp. PCC 6301.

In Synechococcus sp. strain PCC 6301, ribosomal RNA (rRNA) synthesis occurs at specific times during the growth cycle in the light. When light-grown cultures are placed in the dark, rRNA synthesis and cell division stop abruptly. It is shown here that a partially purified DNA-binding protein binds downstream of the rRNA operon (rrnA) P1 promoter in the light but not in the dark. When the DNA binding protein is added to in vitro transcription assays, run-off transcripts are produced in the light but not, under dark conditions. The results indicate that a light-activated regulatory molecule is involved in stimulating rRNA synthesis during the normal cell growth cycle of Synechococcus in the light.

Toward an understanding of cell growth and the cell division cycle of unicellular photoautotrophic cyanobacteria.

The cell division cycle of Synechococcus sp. strain PCC 6301 in light is characterized by the sequential and orderly appearance of macromolecular synthesis periods. In the dark, macromolecular synthesis and cell division are severely curtailed. When dark-incubated cultures are reexposed to light, a new cell cycle is initiated. The pattern of the cell events displayed by Synechococcus in light and the absence of sustained growth in dark incubation conditions suggests that light-activated regulatory molecules control macromolecular synthesis and the cell division cycle. For example, ribosomal RNA synthesis is stimulated by a light-activated DNA binding factor in light but not in the dark. Light/dark conditions induce cell synchrony in Prochlorococcus. Distinct G1, S and G2 phases characterize cell cycles of marine Synechococcus and Prochlorococcus. Cell division in Synechococcus elongatus PCC 7942 and marine Synechococcus is controlled by circadian oscillators.

Isolation and characterization of ultraviolet light-sensitive mutants of the blue-green alga Anacystis nidulans.

Three independently isolated ultraviolet light-sensitive (uvs) mutants of Anacystis nidulans were characterized. Strain uvs-1 was most sensitive to UV in the absence of photoreactivation. Pretreatment with caffeine suppressed the dark-survival curve of strain uvs-1, indicating the presence of excision enzymes involved in dark repair. Under "black" and "white" illumination, strain uvs-1 displays photoreactivation properties nearly comparable to wild-type culture. Mutants uvs-35 and uvs-88 appeared to have partial photorecovery capacities. Upon pretreatment with chloramphenicol, photoreactivation properties of strains uvs-1 and uvs-88 were not evident although the partial photoreactivation characteristics of strain uvs-35 remained the same. Data indicate that strains uvs-1, uvs-35, and uvs-88 are probably genetically distinct UV-sensitive mutants.

Dark incubation causes reinitiation of cell cycle events in Anacystis nidulans.

Synchronized cultures of Anacystis nidulans (Synechococcus PCC 6301), an obligate phototroph, are obtained by incubating exponential cultures in the dark for 12 to 16 h. A temporal and sequential order of macromolecular synthesis is observed within the cell division cycle of a synchronously dividing culture in the light. Apparently, dark incubation causes the cells to realign their cellular activities in such a way that all cells emerge from the dark and grow synchronously in the light. A study was conducted to explore the possible mechanisms responsible for the putative dark-induction process. Samples were taken at various times from a synchronized culture and were subjected to another round of dark incubation for 16 h. When these cultures were returned to the light, the cell number increased from 3 h and doubled at about 7 h. The protein, RNA, and DNA contents started to increase in order well before 3 h. This general pattern of cellular activities, observed for nearly all samples (i.e., for cells of different physiological ages), indicated that the dark incubation period caused the ongoing cell cycle to abort and a new cell cycle to be reinitiated under light growth conditions.

Macromolecular synthesis in synchronized cultures of Anacystis nidulans.

Synchronous culture of Anacystis nidulans has been induced by the light-dark-light regimen. At various time intervals during synchronous growth, samples were pulsed with radioactive labels to determine phospholipid, protein, ribonucleic acid (RNA), and deoxyribonucleic acid (DNA) syntheses within the cell division cycle. A temporal order of protein, RNA, and DNA syntheses occurred within the cell division cycle, whereas phospholipid was characteristically synthesized during midcycle (during cell enlargement) and during the time of cell division. Chemically determined protein, RNA, and DNA syntheses were found to support the schedule of these macromolecules in cultures growing at an 8-h doubling time.