Psychological effect of the Nagasaki atomic bombing on survivors after half a century

In 1997 a mental health survey using a 30-item General Health Questionnaire (GHQ-30) and an interview survey of an atomic bombing experience were conducted in survivors of the Nagasaki atomic bombing. Overall psychological distress measured on the basis of the GHQ-30 was greater in the atomic bombing survivors than in the controls. As for the contents of psychological distress, those concerning emotion such as anxiety and depression were milder in survivors than in the controls, but those related to social activities such as apathy, disturbance of human relations, loss of enjoyment of living were more severe. Furthermore, recurring and distressing recollection of the experience of the atomic bombing, suspicion over the relationship between the atomic bombing and an unhealthy physical condition, and the experience of witnessing death or severe injury of close relatives due to the atomic bombing were significantly related to the degree of psychological distress of the survivors.

Reconstruction after total pharyngolaryngoesophagectomy. Comparison of elongated stomach roll with microvascular anastomosis with gastric pull up reconstruction or something like that

BACKGROUND

We have performed total pharyngolaryngoesophagectomy in case of double cancer, head-neck and thoracic esophageal cancer, or cervical esophageal cancer that extended down to the level of aortic arch. The procedure is very challenging.

METHODS

From April 1984 to May 1998, 14 patients underwent the procedures for double cancer of head-neck and thoracic esophagus (n=10), hypopharyngeal or cervical esophageal cancer (n=3), and synchronous esophageal cancer (n=1). The grafts used were whole stomach (n=6), elongated stomach roll (n=5), and stomach roll with free jejunum (n=3). The routes of reconstruction were posterior mediastinum (n=10), antesternal (n=3), and retrosternal (n=1).

RESULTS

Elongated stomach roll with microvascular anastomoses was long enough for reconstruction and the blood supply of the graft was sufficient. There was no fatal complication in this procedure. Oral feeding was achieved in 13 (93%) patients.

CONCLUSIONS

The elongated stomach roll with microvascular anastomosis is efficient and the placement of the conduit in the posterior mediastinum is recommended to allow a better alimentary comfort in total pharyngolaryngoesophagectomy.

Long-term benefits for the quality of life after video-assisted thoracoscopic lobectomy in patients with lung cancer

Quality of life (QOL) after video-assisted thoracic surgical (VATS) lobectomy remains to be defined. Forty-four consecutive patients with clinical stage I lung cancer underwent lobectomy by the VATS approach (n = 22 patients) or thoracotomy approach (n = 22 patients). Acute pain was quantitated by postoperative narcotic requirements and the need for epidural anesthesia. Long-term QOL was assessed by questioning patients about the presence of chronic chest pain, ongoing limitations in arm or shoulder function, time until return to preoperative activity, and satisfaction with the operation. Patients who underwent VATS lobectomy had significant decreases in both acute and chronic chest pain and time until return to preoperative activity. Patients also had more confidence regarding wound size and their overall impression of the operation. In this series, VATS lobectomy was associated with long-term benefits for the QOL in patients with lung cancer. However, the exact role of this approach should be defined by carefully-designed controlled trials studying long-term survival.

[Surgical analysis for small cell lung cancer of the lung]

Clinical features of small cell lung cancer were studied in 15 cases. The overall 5-year survival rate of the patients with limited small cell lung cancer was 11.4%. Surgery played substantial role for long-term survival in limited SCLC. The 4-year-survival rate of the patients in stage I was 50%, and that of those in stage II and IIIA was 50% and 37.5%, respectively. In the two survivors over four years in stage IIIA, all tumor was categorized as pT3 disease. The 4-year-survival rate of the patients treated with PE was 100%, and that of those treated with another chemotherapy was 10%, and that difference is statistically significant (p < 0.05). There was no significant difference in prognosis of patients in any other factors such as location (central or peripheral), histological subtype, curability or R number, pT factor, pN factor, p stage or with or without thoracic irradiation. Surgical resection for limited SCLC should be recommended in patients with stage I, II and T3N0M0 or T3N1M0 disease. For the patients in stage IIIA, particularly in N2M0 disease, who showed partial response or no change after chemotherapy, surgery should be considered because those patients might have nonsmall cell carcinoma components.

Long-term effects of distal splenorenal shunt with splenopancreatic and gastric disconnection on hypersplenism due to liver cirrhosis

BACKGROUND/AIMS

Though the distal splenorenal shunt has been applied for gastroesophageal varices caused by liver cirrhosis, many patients develop secondary hypersplenism due to the portal hypertension following liver cirrhosis. We examined whether this operation could be effective for alleviating secondary hypersplenism for a long post-operative period. The subjects were 42 cases with gastroesophageal varices following liver cirrhosis in which we had performed distal splenorenal shunts with splenopancreatic and gastric disconnection at our institution in the period from 1983 1994 and the post-operative survival periods had been over 3 years.

METHODOLOGY

White blood cell counts, platelet counts and spleen volume were measured prior to operation, 1 month after operation and during the post-operative period of 3-5 years. Quality of life and clinical symptoms were evaluated during the post-operative period of 3-5 years.

RESULTS

White blood cell counts, platelet counts and spleen volume were improved respectively at 1 month and during the 3-5-year period after surgery, compared to those prior to operation. None of the clinical symptoms of hypersplenism were observed and the long-term performance status was satisfactory.

CONCLUSIONS

We can conclude that the distal splenorenal shunt with splenopancreatic and gastric disconnection alleviated hypersplenism for post-operatively long periods.

Selective distal splenorenal shunt without requiring splenopancreatic disconnection with the use of the external iliac vein graft: a preliminary report

BACKGROUND

Distal splenorenal shunt (DSRS) with splenopancreatic disconnection (SPD) is an ideal operation for permanent control of variceal bleeding. However, it is a very complicated procedure, and DSRS without SPD has a functional disadvantage: It gradually loses its selectivity and portal blood flow. To overcome these conditions, we designed a new technique--modified DSRS, which is easy to perform and maintains long-term selectivity of the shunt.

METHODS

Modified DSRS was performed by using an external iliac vein graft without treating small pancreatic tributaries of the splenic vein. It was applied in 4 cases, and shunt patency and selectivity were examined by angiography during follow-up periods (6-76 months).

RESULTS

Modified DSRS was technically more feasible and less complicated than DSRS with SPD. Every attempt was successful. There was no operative mortality, and all the patients were discharged from the hospital in good condition. The shunts were patent in all of them, and the selectivity of the shunt was maintained better in comparison to standard DSRS.

CONCLUSIONS

Modified DSRS is a much easier and safer technique than standard DSRS. We consider this procedure to be the best method for surgical management of portal hypertension causing esophageal and gastric varices.

Prevalence and characterization of hepatitis C virus in hemodialysis patients

OBJECT

Chronic hepatitis C virus (HCV) infection is common in hemodialysis (HD) patients. In the present study, the prevalence and properties of HCV in HD patients were analyzed.

METHODS AND RESULTS

Of 125 HD patients, 34 (27%) were positive for antibody to HCV, and HCV-RNA was detected in 23 (68%) of the 34 patients using reverse transcription polymerase chain reaction. The HCV-RNA sequence analysis did not identify the alterations specific to HD patients with HCV, although one patient had a variant virus containing the deletion of the core gene sequence. When serial changes in the levels of HCV-RNA were evaluated in 15 patients by a branched DNA assay, the values decreased immediately after HD procedure, but returned to the baseline values 2 days after the procedure.

CONCLUSION

These results indicate that HCV in HD patients is replication-competent, although a transient reduction in the levels of HCV-RNA occurs during HD.

Synthesis and biological evaluation of alpha-mannosidase inhibitory activity of three deoxy derivatives of mannostatin A

Three deoxy derivatives of alpha-mannosidase inhibitor mannostatin A have been synthesized and their inhibitors activity for Jack beans alpha-mannosidase evaluated in order to elucidate roles of each hydroxyl groups of the inhibitor The 1- and 2-deoxy derivatives have preserved inhibitory potentials although they lowered the activity one-hundred fold compared to the parent, but the 3-deoxy derivative lost activity.

Synthesis and evaluation of glucocerebrosidase inhibitory activity of anhydro deoxyinositols from (+)-epi- and (-)-vibo-quercitols

Twelve 1,2- and 2,3-anhydro-1,2,3,4,5-cyclohexanepentols were synthesized from (+)-epi- and (-)-vibo-quercitols, readily available by bioconversion of myo-inositol, and assayed for inhibitory activity against glucocerebrosidase (mouse liver). Among them 1L-1,2-anhydro-1,2,4/3,5-cyclohexanepentol, the 3-deoxy derivative of the irreversible inhibitor conduritol B epoxide (CBE), has been demonstrated to be a highly potent and specific inhibitor, almost comparable to the parent compound.

Cyclin D1 expression in non-small-cell lung cancers: its association with altered p53 expression, cell proliferation and clinical outcome

Cyclin D1, like p16INK4 (p16) and retinoblastoma (RB) proteins, participates in the cell cycle control at the G1-S transition. We have previously demonstrated altered p16 and RB protein status in non-small-cell lung cancers (NSCLCs) and their potential synergistic effect with altered p53 protein on proliferative activity (Kinoshita et al (1996) Cancer Res 56: 5557-5562). In the present study, cyclin D1 expression was studied by immunohistochemistry in the same cohort of 111 resected NSCLCs as in our previous study, and the amount of the cyclin D1 gene was analysed by Southern blot analysis in 29 NSCLCs. Cyclin D1 expression was analysed in relation to the status of p53, p16 and RB proteins, and proliferative activity determined by the Ki-67 index. It was also analysed in relation to survival of 77 patients with NSCLCs which were potentially curatively resected between 1990 and 1995. We found that: (1) cyclin D1 was expressed in 13 (11.7%) of 111 NSCLCs; (2) the cyclin D1 gene was neither significantly amplified nor rearranged; (3) cyclin D1 expression significantly correlated with altered p53 protein expression (P = 0.04), whereas it did not correlate with p16 and RB protein status; (4) proliferative activity tended to be higher in cyclin D1-positive (+) tumours than in cyclin D1-negative (-) tumours, although this difference was not statistically significant (P = 0.08); and (5) patients with cyclin D1+ tumours survived longer than patients with cyclin D1- tumours (5-year survival rates, 89% and 64% respectively, by the Kaplan-Meier method; P = 0.045 by the log-rank test), and cyclin D1 expression tended to be a favourable prognostic factor (P = 0.08 in univariate analysis). These findings suggest the involvement of cyclin D1 in the development and progression of NSCLCs, their proliferative activity and clinical outcome of NSCLC patients.

[Assay of specific anti-Chlamydia pneumoniae antibodies by ELISA method. 3. Setting of serological criteria]

"HITAZYME C. pneumoniae" (or "HITAZYME CPN", for short) is a diagnostic reagent that has been recently developed by adopting an ELISA method for detection of anti-Chlamydia pneumoniae (C. pneumoniae) antibodies. When this reagent is used under a current diagnostic standard that has been set as a provisional standard, however, high antibody positive rates are often produced for both IgG and IgA even using the specimens of healthy persons. So, it is difficult to distinguish C. pneumoniae-infected patients from healthy persons. Therefore, this time, we tried to establish a new diagnostic standard by setting up of special cut-off values for a single serum and rise rates of antibody titers for paired sera to improve the accuracy for diagnosis of C. pneumoniae infection. For a single serum testing, we set a special cut-off value at ID 3.00 for both IgG and IgA, so that most healthy persons fall within the range of the "negative" zone. This value was based on the calculation of "Mean+2SD" using measurement results (or IDs) of healthy persons. When this cut-off value was applied, the rate of > or = ID 3.00 for either IgG or IgA was 7.6% for healthy persons, and 64.9% for infected patients. (The rate reached 76.4% when the highest IDs of multiple specimens taken from each patient for this test were used in calculation) As a diagnostic standard for a single serum, therefore, it was defined that: "If ID is 3.00 or greater for IgG and/or IgA, it is highly likely that the case has an acute or a present infection." Using paired sera, we could confirm almost a linear relationship between the results by HITAZYME CPN and those by micro-IF method. Under micro-If method, if the antibody titer increases four times or greater using paired sera, acute infection is diagnosed. As it was found that the four-fold increase in antibody titer corresponds to the increase of 1.35 in ID for IgG and 1.00 for IgA, we defined a diagnostic standard for paired sera as follows: "If ID increases by 1.35 or greater for IgG, and/or if ID increases by 1.00 or greater for IgA, the case may be diagnosed as acute infection."

A novel mutation of the doublecortin gene in Japanese patients with X-linked lissencephaly and subcortical band heterotopia

The doublecortin (DCX) gene was recently found to be involved in patients with X-linked lissencephaly and subcortical band heterotopia or double cortex syndrome. We have studied the coding regions of the DCX gene in 11 Japanese patients with cortical dysplasia and have identified three different mutations (R186C in exon 3, R272X and R303X in exon 5) in four sporadic female cases. R272X, which has been detected in two unrelated cases, is a novel mutation. Although the number of cases studied remains limited, exon 5 may be a common mutational site in Japanese patients in contrast to many previous reports concerning exons 2 and 3.

[CT diagnosis of hyperdense intracranial neoplasms: review of the literature]

In contrast to typical astrocytic tumors that show hypodense areas on computed tomographic images, some intracranial tumors show hyperdense areas on CT images. The major reasons for hyperdensity on CT images are hypercellular lesions, intratumoral calcification, and intratumoral hemorrhage. Malignant lymphomas, germinomas, and medulloblastomas show homogeneous hyperdensity on CT images because of their hypercellularity. Tumorous lesions such as subependymal giant cell astrocytomas, oligodendrogliomas, ependymomas, central neurocytomas, craniopharyngiomas, and meningiomas often present with hyperdense calcified lesions on CT images. Intratumoral hemorrhage also causes hyperdensity on CT images, and is often associated with metastatic brain tumors, glioblastomas, pituitary adenomas, and rarely with any of the other intracranial tumors. Although magnetic resonance imaging is now the major diagnostic tool for diseases of the central nervous system, the first imaging studies for patients with neurologic symptoms are still CT scans. Hyperdense areas on CT images are a clue to making an accurate diagnosis of intracranial neoplasms.

Long-term results of surgical treatment for invasive thymoma

BACKGROUND

The aim of this study was to analyse the operative outcome of extensive surgery for invasive thymoma and to assess the prognostic factors for long-term survival.

MATERIALS AND METHODS

Forty patients with invasive thymoma have been operated on at our institution during past the 33 years. We performed total removal of the tumour, including invaded neighboring organs. Complete resection was performed in 27 patients, incomplete resection in 4. Nine patients had unresectable thymoma. Postoperative radiotherapy was performed in 30 patients with a median dose of 48 Gy.

RESULTS

The 10-year survival rate was 72% for Masaoka stage II, 47% for stage III, and 0% for stage IV. There was no postoperative mortality. Concerning the prognostic factors for long-term survival, there were no significant differences in the analysis of Masaoka staging, histological classification, association of autoimmune disease, and postradiotherapy. However, the survival rate was significantly higher for patients with complete resection than for patients with incomplete resection or biopsy only (p = 0.019).

CONCLUSIONS

Whether the tumour is resected completely or not is the most important factor for long-term survival; therefore it is preferable to perform extensive surgery for invasive thymoma.

Medicinal flowers. I. Aldose reductase inhibitors and three new eudesmane-type sesquiterpenes, kikkanols A, B, and C, from the flowers of Chrysanthemum indicum L

The methanolic extract from the flowers of Chrysanthemum indicum L., Chrysanthemi Indici Flos, was found to show inhibitory activity against rat lens aldose reductase. By bioassay-guided separation, the active components, such as flavone and flavone glycosides, were isolated from the extract together with three new eudesmane-type sesquiterpenes, kikkanols A, B, and C. The structures of kikkanols A, B, and C were elucidated on the basis of chemical and physicochemical evidence, which included application of the modified Mosher's method.

Technical feasibility of video-assisted lobectomy with radical lymphadenectomy for primary lung cancer

The morbidity and mortality for video-assisted curative resection of lung cancer was evaluated retrospectively. Forty-one consecutive patients with stage I and II lung cancer underwent video-assisted curative lobectomy with complete hilar and mediastinal lymphadenectomy. Conversion to an open procedure was necessary in two patients. The operating times for the second half of the series were shorter than for the first half. Compared with patients receiving a standard open procedure, the video-assisted patients experienced satisfactory results. We conclude that video-assisted curative lobectomy with complete lymphadenectomy for stage I and II lung cancer is technically feasible in the majority of patients, although follow-up is required to determine the long-term prognosis. Comparative series between video-assisted and open procedures should not be conducted until the surgeon has acquired the necessary video-assisted skills. A prospective randomized trial will determine the actual value of video-assisted procedure for lung cancer treatment.

Experimental study of tracheal patch reconstruction with a covered expandable metallic stent

BACKGROUND

We evaluated the efficacy of tracheal patch reconstruction with a covered expandable metallic stent (EMS) with omentoplasty.

METHODS

After resecting the right half of the circumferential wall of two tracheal rings in adult beagle dogs, we inserted a covered EMS to reconstruct the defect interiorly. Then, through laparotomy, we made an omental pedicle flap and wrapped it around the EMS-interposed area. For comparison with the group without omentoplasty, we periodically examined the healing process macroscopically and histologically.

RESULTS

Bronchofiberscopic observations revealed that incorporation of the covered EMS progressed with the passage of time and tracheal luminal patency was maintained well in both groups. However, polyplike granulation developed gradually at both ends of the EMS. Histologically, epithelium was regenerated in the patched area 4 weeks postoperatively and the area was covered with pseudostratified ciliated epithelium at 12 weeks postoperatively. Quantitative analysis of the macroscopic and histologic findings showed that the inflammatory polyps were reduced and epithelialization was promoted in the group with omentoplasty.

CONCLUSIONS

Tracheal patch reconstruction with a covered EMS, when combined with omentoplasty, promoted early epithelial regeneration and suppressed the development of inflammatory polyps.

Fluid-fluid levels in giant cavernous hemangioma of the liver: CT and MRI demonstration

Fluid-fluid levels were observed in a case of giant cavernous hemangioma on computed tomography (CT) and magnetic resonance (MR) imaging. The fluid-fluid level may be attributed to the separation of blood cells and serous fluid due to the extremely slow flow in cavernous hemangioma of the liver.

[Pulmonary actinomycosis with "balls-in-a hole" appearance diagnosed by examination of bronchial lavage fluid]

A 49-year-old man was referred to our hospital because of abnormal chest X-ray findings. Chest X-ray films showed infiltrative opacities in the right lung, and histological findings of a transbronchial biopsy specimen showed non-specific inflammation. The patient was treated with Ofloxacin for one month. After the treatment, chest X-ray films showed that the infiltrative opacities in the right upper lobe had decreased, but that opacities in the right lower lobe had increased, with an air meniscus sign. A chest computed tomography scan at the same time revealed that the remaining opacities contained multiple mass-like lesions within a cavity in the right S6, appearing as "balls in a hole". One year after the first visit, the patient visited the hospital again because of cough and sputum. A chest X-ray film showed that the size of the cavity in the right lower lobe had increased. The histological findings from a fresh transbronchial biopsy specimen revealed a non-specific inflammation again; however, black clots obtained from bronchial lavage fluid after biopsy were histologically identified as sulfur granules, a classic pathological indication of actinomycosis. This confirmed the diagnosis of pulmonary actinomycosis. The patient was treated with penicillin, and the opacities in the right lower lobe subsided.

[Pneumonia caused by granulomatous Pneumocystis carinii in a patient with the acquired immunodeficiency syndrome]

A 54-year-old man was admitted to the hospital because of fever and general fatigue. A chest roentgenogram on admission showed lobular opacities and ill-defined opacities in both lower lobes. The pneumonia was successfully treated with antibiotics. The acquired immunodeficiency syndrome was diagnosed because ELISA and PCR tests for antibodies to the human immunodeficiency virus were positive and the CD 4+ lymphocyte count was 39 per cubic millimeter. Examination of bronchoalveolar lavage fluid revealed no Pneumocystis carinii. Trimethoprim and sulfamethoxazole were given prophylactically, but were withdrawn because of a rash. The patient began to receive aerosolized pentamindine and was discharged. On the next day, he was readmitted to the hospital because of a high fever. A chest roentgenogram showed diffuse miliary opacities. Chest CT scan also showed diffuse small nodular opacities in both lungs. Examination of a transbronchial biopsy specimen revealed well-defined, noncaseating granulomas with pneumocystis organisms in their centers. Cultures for tuberculosis and fungi were all negative. We diagnosed granulomatous pneumonia caused by Pneumocystis carinii, which is an atypical manifestation of Pneumocystis carinii pneumonia. The patient died of sepsis and cardiac tamponade. Microscopically, the lung tissue was found to have foamy intra-alveolar exdates, which is a typical histological feature of Pneumocystis carinii pneumonia.