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Hypersensitivity reactions(HSRs)are adverse events that are potentially caused by all anticancer agents. HSRs are unpredictable and can occur at any time, and prompt intervention is needed when symptoms occur. The types of symptoms and their degrees vary with the anticancer agent used and the number of chemotherapy cycles. Here, we evaluated the degree of HSRs and their frequencies in the outpatient chemotherapy center of Gunma University Hospital. Among 55,046 patients, 141 (0.26%)cases of HSRs and 70(0.13%)cases of infusion reactions were identified. Oxaliplatin and docetaxel conferred higher incidences of HRSs, whereas infliximab and rituximab conferred higher incidences of infusion reactions. The most common symptoms were skin reactions. HSRs to oxaliplatin were observed after a median of 7 cycles of chemotherapy, and the number of the patients developing HSRs was the highest during the second cycle of chemotherapy. The incidences of HSRs and the profiles of the anticancer drugs exhibiting higher frequencies of HSRs were similar to those in previous reports. The present study provides valuable information about appropriate management for HSRs depending on the anticancer agents used.

The introduction of generic drugs is promoted from the perspective of medical economics. In this context, we need to understand not only the bioequivalence of generic drugs specified in "the Guidelines for Bioequivalence Studies of Generic Products", but also formulation properties to consider their effect on pharmacological therapy. We evaluated the pharmaceutical characteristics of rebamipide formulations, a brand-name drug and two generic drugs, and their clinical functionality by using rat models of gastric mucosal injury induced by non-steroidal anti-inflammatory drugs (NSAIDs). Pharmaceutical evaluation showed significant differences in hardness. The inter-lot variation was small in all rebamipide formulations. In the clinical functionality study, biochemistry test values 7 d after the administration of rebamipide showed no differences among formulations. Higher levels of mucosal fluid secretion and antioxidative enzymes were observed in the groups administered rebamipide than in the control group. The levels of lipid peroxide were lower in the groups administered rebamipide than the control group. Multivariate analysis showed slight divergence between the brand-name and generic drugs. In future, it will be necessary to select generic drugs after careful consideration of bioequivalence, clinical functionality, and therapeutic equivalence by reviewing scientific evidence such as indication and formulation design, not to mention stable provision.

There are various nonpharmacological therapies available for elderly people with dementia, and these can improve quality of life and the behavioral and psychological symptoms of dementia (BPSD) that appear throughout the progression of the disease. Since a substantial number of effects have been reported for music therapy, we focused on this nonpharmacological intervention. Generally, musical therapy is provided collectively in facilities. However, the music used in this context may not consider the preferences and music abilities of each person. Therefore, in this study we created made-to-order music CDs that accounted for each participant's musical preferences and abilities. Utilizing the CDs, we conducted an intervention study of music therapy using a video phone (Skype) that elderly people with dementia can use at home. An advantage of conducting music therapy for individuals with dementia using a video phone is that those who have difficulty going to the hospital or participating in dementia-related therapy groups can participate in therapy in a familiar place. The results of this intervention showed that participants demonstrated signs of improvement as measured by the smile degree(Smile scan)and Behavior Pathology in Alzheimer's Disease (BEHAVE-AD) scale.

Sjögren's syndrome (SS) is an autoimmune disease that affects exocrine glands including salivary and lacrimal glands. It is characterized by lymphocytic infiltration into exocrine glands, leading to dry mouth and eyes. A number of auto-antibodies are detected in patients with SS. However, no SS-specific pathologic auto-antibodies have yet been found in this condition. M3 muscarinic acetylcholine receptor (M3R) plays a crucial role in the secretion of saliva. It is reported that some patients with SS carried inhibitory auto-antibodies against M3R. To clarify the epitopes and function of anti-M3R antibodies in SS, we examined antibodies to the extracellular domains (N terminal region, the first, second, and third extracellular loop) of M3R by ELISA using synthesized peptide antigens encoding these domains in 42 SS and 42 healthy controls (HC). Titers and positivity of anti-M3R antibodies to every extracellular domain of M3R were significantly higher in SS than in HC. Our results indicated the presence of several B cell epitopes on M3R in SS. Moreover, we analyzed the functions of anti-M3R antibodies by Ca(2+)-influx assays using a human salivary gland (HSG) cell line. The functional analysis indicated that the influence of such anti-M3R antibodies on Ca(2+)-influx in HSG cells might differ based on the epitopes to which they bind. Interestingly, both IgG from anti-M3R antibodies to the second extracellular loop positive SS and anti-M3R monoclonal antibodies against the second extracellular loop of M3R, which we generated, suppressed Ca(2+)-influx in the HSG cells induced by cevimeline stimulation. These observations suggested that auto-antibodies against the second extracellular loop of M3R could be involved in salivary dysfunction in patients with SS. These results indicated the presence of several B cell epitopes on M3R in SS and the influence of anti-M3R antibodies on salivary secretion might differ based on these epitopes. Thus, anti-M3R antibodies could be not only potential pathologic auto-antibodies, but also new diagnostic makers and therapeutic targets for SS.

The provision of home care service, 20 years since it was established, is becoming more important. The aging population is now at its highest ever level, and the number of patients in need of nutrition therapy is increasing. We have provided a home care service since 1996, mainly for the provision of home palliative care. Home care service has been provided to 168 patients, about 90% of which suffered from malignant disease, and about 80% of the malignant disease patients were in the terminal stage. The patients included 151 on home parenteral nutrition(HPN)and 7 on home enteral nutrition(HEN)using percutaneous endoscopic gastrostomy(PEG). Six patients with gastrostomy underwent drainage of malignant digestive obstruction. For HPN of malignant terminal stage patients, we considered whether the HPN menu was available for malignant cachexia. We primarily considered the intent of the patients with malignant cachexia and their families.

We report a case of combined noninvasive ductal and lobular carcinoma. The patient was a 54-year-old woman with a breast tumor. The tumor was a palpable movable mass measuring 1 cm in diameter in the AC region of her breast. Mammography, ultrasonography, magnetic resonance imaging, and vacuum-assisted core-needle biopsy were performed. The histopathological diagnosis was intraductal papillary cystic lesion. However, there was also a ductal lesion. We performed lumpectomy, and the diagnosis was combined noninvasive ductal and lobular carcinoma. It was difficult to determine the range of carcinoma, and thus, we performed Bt+Ax. Combined noninvasive ductal and lobular carcinoma is rare. We should study additional cases and develop more adequate treatments.

Here, we report the case of a 40-year-old woman who was discovered upon examination to have a lump in her left breast. Breast ultrasonography revealed a hypoechoic mass of size 2.5×2.5 cm, shaped irregularly with fine calcification in the left DE area. A needle biopsy was performed and the resulting pathological diagnosis was invasive cancer(apocrine carcinoma, T2N0M0, Stage IIA),negative for estrogen receptor (ER), progesterone receptor (PgR), and human epidermal growth factor receptor type 2(HER2). Neoadjuvant chemotherapy was then performed with docetaxel/cyclophosphamide (TC)(4 courses) and epirubicin/cyclophosphamide (EC)(4 courses), after which ultrasonography revealed a significant reduction in mass, with a hypoechoic area of 1.0 cm×1.0 cm. Using magnetic resonance imaging (MRI), the tumor- contrast enhancement effect disappeared after the TC therapy, but the strong tumor-contrast enhancement enhancement effect diffused after EC therapy. Left breast segmentectomy and axillary lymphadenectomy were performed, and the tumor disappeared. The effectiveness of the chemotherapy was judged to be grade 3, and there was no subsequent metastasis or recurrence.

In order to push forward with home palliative care under the regional alliance in Iwaki city, we worked toward building a medical network. The current main four actions are: 1 ) Educational medical training course for palliative skill-improvement in the regional party of Iwaki city medical associate, 2 ) Combined educational and medical training for home palliative care and an assembly of regional alliance, 3 ) Critical path for the regional alliance of palliative care, and 4 ) Iwaki palliative therapy research. However, the present status of these actions has not been working well in supporting of home palliative care under the hospital-clinic cooperation. On the other hand, we actually felt that the regional alliance called face to face cooperation between doctors and many paramedics was proceeding well. In our department as a whole, the palliative cases with the help of regional alliance have been increasing. We also experienced with home palliative care under the hospital clinic cooperation. The most important action is to notify the medical offices of clinics and hospitals to let them acknowledge that we have been actively providing home palliative care and services. Moreover, it is also necessary to introduce our palliative care and services to medical offices when a patient is in the early stage of the disease.

In May 2009, a 57-year-old woman who had rheumatoid arthritis since 9 years was admitted to our hospital for dyspnea due to interstitial pneumonia (IP). On admission, she exhibited proximal scleroderma, finger edema, Raynaud's phenomenon, digital pitting scars, ankyloglossia, and esophageal dysmotility. The patient was diagnosed as having systemic sclerosis (SSc), according to the American College of Rheumatology criteria. After initiation of high-dose corticosteroid therapy, gradual amelioration of IP was observed. However, the patient complained of abdominal fullness. Computed tomography and intestine series findings revealed significant dilatation of the small intestine due to intra-abdominal free air and pneumatosis cystoides intestinalis but no mechanical obstruction, leading to a diagnosis of SSc with pseudo-obstruction. The patient underwent decompression with a long intestinal tube, which led to improvement in her symptoms. Although erythromycin (EM) and some prokinetic agents were administered, abdominal involvement recurred several days after resumption of oral ingestion. Therefore, we changed the antibiotic from EM to metronidazole (750 mg/day). Her manifestations were promptly ameliorated by metronidazole therapy in 4 days and did not recur. Metronidazole is an antibiotic used to treat intra-abdominal anaerobic bacterial infections and is also commonly used in preoperative treatment for colorectal surgery. In conclusion, we report a case where SSc-associated pseudo-obstruction was successfully managed by metronidazole therapy.

Sjögren's syndrome (SS) is an autoimmune disease that affects exocrine glands including salivary and lacrimal glands. It is characterized by lymphocytic infiltration into exocrine glands, leading to dry mouth and eyes. A number of auto-antibodies, such as anti-SS-A and SS-B antibodies, are detected in patients with SS. However, no SS-specific pathologic auto-antibodies have yet been found in this condition. M3 muscarinic acetylcholine receptor (M3R) plays a crucial role in the secretion of saliva from salivary glands. It is reported that some patients with SS carried inhibitory auto-antibodies against M3R. To clarify the epitopes and function of anti-M3R antibodies in SS, we examined antibodies to the extracellular domains (N terminal region, the first, second, and third extracellular loop) of M3R by ELISA using synthesized peptide antigens encoding these domains in 42 SS and 42 healthy controls (HC). Titers and positivity of anti-M3R antibodies to every extracellular domain of M3R were significantly higher in SS than in HC. For functional analysis, human salivary gland (HSG) cells were pre-cultured with IgG from anti-M3R antibodies positive SS, negative SS, and HC. HSG cells were stimulated with cevimeline hydrochloride and intracellular calcium concentration ([Ca(2+)](i)) was measured. IgG from anti-M3R antibodies to the second loop positive SS inhibited the increase of [Ca(2+)](i), but IgG from antibodies to the N terminal or the first loop positive SS enhanced it, while IgG from antibodies to the third loop positive SS showed no effect on [Ca(2+)](i) as well as IgG from anti-M3R antibodies negative SS and HC. These findings indicated the presence of several B cell epitopes on M3R in SS and effect of anti-M3R antibodies on the salivary secretion might differ with these epitopes.

Two years of palliative home care for advanced and recurrent breast cancer of six patients was performed since January 2007. The reasons to provide palliative home care include an administration of skin infiltrative tumor, pain, home oxygen therapy (HOT), and chemotherapy. Most important part of home palliative care is to prepare any physical and psychosocial problems among any types of occupation.

A 46-year-old woman was diagnosed with complaints of bilateral breast tumor with massive ascites retention. The patient was examined as scirrhous carcinoma by lacteal gland inspection and dysplastic cell by ascites cytotechnology. We diagnosed her case to be bilateral breast cancer with peritonitis carcinomatosa, lymph node metastases and bony metastases. In addition to that, gastric metastasis was diagnosed by the result of widespread irregular gastric mucosa, which was inspected through upper gastrointestinal endoscope. The patient was treated with S-1 and paclitaxel and has achieved a remarkable response. The patient's tumor, gastric metastasis, and ascites were disappeared almost completely.

We here describe a case of advanced breast cancer (Stage IV) in which an oral S-1+TAM therapy following a primary systemic chemo-radiotherapy has been effective in maintaining the patient's QOL. A 40-year-old woman visited our hospital because of her left breast tumor. On physical examination, the tumor had invaded to the skin adjacent to the nipple forming a skin ulcer and marked deformity of the entire breast. Also noted were swollen lymph nodes in the left armpit. Subsequently, radiographic imaging tests revealed that the tumor had metastasized to the liver and lungs, as well as the skull. Accordingly, a primary systemic chemotherapy (4 series of AC/T) was started and followed by local radiation therapy (60 Gys) immediately after completing the chemotherapy. The metastasizing lesions in the liver, lungs, and skull had markedly reduced in the size and number, and the skin ulceration had healed up by these treatments. Afterwards, she has been given TAM daily and S-1 for 4 weeks with a 2-week interval. She has been quite well without any adverse effects by S-1 and TAM, and the primary as well as metastasizing lesions remain stable with normalized tumor marker levels (NC) for nearly 3 years.

The aim of this study was to investigate the usefulness of whole-body MRI(WB-MRI) in the evaluation of cellularity in bone marrow and the distribution of fatty marrow in aplastic anemia. WB-MRI was performed on five patients with aplastic anemia who ranged in age from 62 to 70 years of age, and on four controls with malignant lymphoma who ranged in age from 59 to 67 years. Coronal images were obtained using a body coil with an FOV of 48 cm x 48 cm, and with both fast short T1 inversion recovery(STIR) and spin-echo T1-weighted(T1-WI) in three regions: (1) head to thorax, (2) abdomen to pelvis, and (3) lower extremities. The findings on WB-MRI were compared with those of histological studies of bone marrow at the sternum and the posterior iliac crest. The results were as follows: (1) there was a correlation between the cellularity of histological studies of bone marrow and signal intensity on WB-MRI; (2) WB-MRI could detect the activity of bone marrow; and (3) in a comparison of signal intensity in aplastic anemia and control subjects, there were differences of signal intensity in the central marrow.

The aim of this study was to investigate the usefulness of whole body MR imaging (WB-MRI) in the detection of bone metastases from breast cancer and to compare the results with those from bone scintigraphy. In 21 patients with suspected bone metastasis from breast cancer, both bone scintigraphy and WB-MRI were performed. With WB-MRI, coronal images were obtained using a body coil in an FOV of 48 cm, and sequences of fast short TI inversion recovery (STIR) and gadolinium-enhanced fast spoiled GRASS (SPGR) were used in three parts: from the head to the thorax, the abdomen to the pelvis, and the lower extremities. Of the total 105 metastatic bone lesions, 65 (61.9%) were detected by bone scintigraphy, 98 (93.3%) by fast STIR, and 74 (70.5%) by fast SPGR. Thus, the detection of bone metastases by WB-MRI was excellent. However, detectability in the ribs was lower for WB-MRI than for bone scintigraphy. Contrast-enhanced MRI was useful in the differentiation of osteosclerotic lesions, in which high signal intensity is rare, pleural effusion, which has high signal intensity on STIR, and bone metastatic lesions. In conclusion, WB-MRI showed high reliability in the detection of bone metastatic lesions from breast cancer.

Preliminary studies were performed to evaluate the usefulness of whole-body magnetic resonance imaging (WB-MRI) in the screening of bone metastases. The fast short TI inversion recovery sequence was the most suitable method because of its minimal image distortion and uniformity of fat suppression in a large field of view. In 4 cases of malignant tumor, the localization of all 8 bone metastases detected with bone scintigraphy (BS) could be clarified with WB-MRI. Furthermore, WB-MRI with fast STIR alone could depict 4 lesions undetected by BS, and WB-MRI combined with contrast enhancement could depict 5 such lesions.

An operated case of inflammatory pseudotumor of the lung is reported. A 27-year-old female was pointed out a coin lesion in the left lower lung field on chest X-ray and the size of mass increased. She had a history of thymomectomy for thymoma, and resection of right intrathoracic dissemination. Therefore operation was performed on suspicion of metastasizing thymoma. A partial resection including the mass with VATS was performed and histopathologic examination revealed inflammatory pseudotumor. The postoperative course was uneventful, and there has been no evidence of recurrence thereafter. In Japan, sixty-eight cases of inflammatory pseudotumor of the lung including our case have been reported in the literature.

It was possible to obtain images for individual heart beats using single-shot Echo Planar Imaging(EPI), and changes of myocardial signal intensity could be assessed visually after GD-DTPA administration. Measurement of the same site in the myocardium on myocardial perfusion images for individual heart beats was facilitated by imaging during breath-holding, and accurate evaluation was possible. In patients with coronary artery disease, the site of myocardial infarction tended to show less increase in signal intensity than the normal myocardium, and could easily be distinguished from normal myocardium according to the change in signal intensity. In patients with atrial fibrillation, the signal intensity of the myocardium varied with each heart beat, and it was difficult to assess perfusion hemodynamics. Myocardial perfusion studies using EPI still present problems with respect to spatial resolution, but the myocardial perfusion hemodynamics for individual heart beats can be determined by preparing time/intensity curves. It is also possible to obtain information on cardiac morphology, wall motion, and myocardial metabolism in addition to perfusion data by combining myocardial perfusion studies with methods such as high speed cine MRI, tagging, or myocardial MRS. It is possible that this method will also be useful in studying myocardial viability.

We evaluated the therapeutic effect of percutaneous transluminal mitral commissurotomy (PTMC) on pulmonary function, and the damage caused to pulmonary vasculature by transient occlusion of the mitral valve during PTMC in patients with mild mitral stenosis. Pulmonary function tests were done and serum thrombomodulin was measured in 6 patients before and after PTMC. The mean pulmonary arterial pressure and mean pulmonary arterial wedge pressure decreased significantly from the control values, and the decreases were proportional to the increase in the area of the mitral valve. VC, %VC, and DLco were in the normal range before and after PTMC but PEFR, FEV1%, FEV1, V50, V25, and V50/V25 were significantly higher after PTMC. Change in the area of the mitral valve correlated with the changes in FEV1% (r = 0.841), in V50 (r = 0.624), and in V25 (r = 0.697). The serum thrombomodulin levels before and after PTMC did not differ. We conclude that pulmonary dysfunction in patients with mild mitral stenosis MS is mainly due to an obstructive ventilatory defect, and that PTMC can correct this dysfunction without damaging the pulmonary vasculature.

We developed a system for 24-hour ambulatory recording of blood oxygenation (SpO2) and electrocardiography (ECG). Using this system, we studied 10 healthy volunteers and 7 patients with chronic pulmonary diseases. The system incorporated a portable pulse oximeter (SM50) manufactured by Fukuda Denshi KK; the first and second channels were used to record ECG data and the third was used to record SpO2 data. An SpO2 sensor (Dispo-sensor D-25; Nellcor Inc.) was applied to the fourth of fifth finger. The SpO2 data (MicrO2; Siemens AG) were digitized and stored in the ambulatory recording device; the ECG was recorded simultaneously. The data were analyzed with a model DMW-9000H analyzer (Fukuda Denshi KK). A custom-designed program was also used, to remove noise errors. In the healty volunteers, SpO2 was at least 90% for the entire 24 hours. In all the patients, SpO2 fell below 90% at rest during the night or after a 15-minute walk. Transient atrial tachycardia was observed in 3 patients, and during the tachycardia the SpO2 was low. The number of extra ventricular beats divided by the total number of beats increased more in the patients than in the healthy volunteers (1.21 +/- 0.89 vs 0.6 +/- 0.3%, p < 0.05). SpO2 did not change significantly in the patients. In outpatients and in patients receiving home health care, the present system facilitates simultaneous diagnosis of respiratory failure an arrhythmias. In patients with chronic pulmonary diseases desaturation may cause transient atrial tachycardia.

We examined the effect of one year of treatment with the selective alpha 1-adrenergic inhibitor doxazosin on right ventricular mass (RV mass), left ventricular mass (LV mass), and arterial blood gases. The subjects were 24 outpatients (18 men and 6 women, mean age 68.3 +/- 9.4 years) with chronic pulmonary disease complicated by hypertension who were clinically stable. One year of drug therapy was associated with significant decreases both in systolic pressure (159 +/- 15.2 vs 125.8 +/- 14.1 mmHg, p < 0.05, n = 24), and in LV mass index (101.0 +/- 13.4 vs 97.6 +/- 11.8 gm-2, p < 0.05), n = 24). We obtained the RV mass index by multiplying the thallium score RV/LV count and the LV mass index obtained by echocardiography. One year of drug therapy was associated with a significant increase in RV mass index (42.9 +/- 31.2 vs 53.6 +/- 30.5 gm-2, p < 0.05, n = 8). Vital capacity decreased (2.18 +/- 1.95 vs 1.95 +/- 0.57 l, p < 0.05, n = 24), but PaO2 improved (77.3 +/- 17.2 vs 82.2 +/- 2.4 mmHg, p < 0.05, n = 24). These data indicate that doxazosin can decrease blood pressure and can depress the left ventricle with no adverse effect on oxygenation in patients with chronic pulmonary disease complicated by hypertension. The worsening of RV hypertrophy may have been caused by a mechanism different from the one that caused LV hypertrophy, and by an increase in the work load on the right ventricles secondary to lung deterioration.

A 75-year-old woman had an irregularly shaped cavitary lesion in the right upper lung field on a chest X-ray film and a CT scan. Primary lung cancer was suspected, but no evidence of malignancy or of infection was found on examination of specimens obtained by transbronchial biopsy and by lavage. Seven months after the first examination the cavity was found to have enlarged and an intra-cavitary fungus ball like shadow was seen. On the basis of these findings, pulmonary aspergilloma with or without primary lung cancer was suspected. Examination of a specimen obtained by transbronchial biopsy revealed squamous cell carcinoma. Right upper lobectomy was done, and the resected tissue included a polypoid nodule and a cavity wall composed of a milky-white solid tumor. Microscopic examination revealed a moderately differentiated squamous cell carcinoma in both the cavity wall and the polypoid nodule, and no evidence of fungal involvement.

A 70-year-old male, underwent left lower lobectomy due to lung cancer, had an extremely rare form of left pulmonary artery branching. His pulmonary artery supplying to lateral and posterior basal segments (A9 + 10) was arisen anteriorly from the root of the left pulmonary artery in the mediastinum and ran below in the anterior portion of the upper lobe stem bronchus. Embriologically, this abnormality might be due to a derangement of anastomosis between the pulmonary arch system and splanic plexus in primitive lung, and was interpreted as one of the pulmonary sequestration. Clinically, particularly at thoracotomy, the presence of a large vessel in an unexpected location is very hazardous, so that preoperative pulmonary angiography is useful to detect the abnormal branching.

A 50-year-old woman was admitted to our hospital complaining of recurrent bloody sputum and hemoptysis. Chest X-ray films showed an infiltrative shadow in the left lower lung field. Chest computed tomograms showed a nodular tumor shadow near the left B8 and this tumor shadow was found between A8 and A9 by pulmonary arteriography. Bronchoscopic examination revealed a red coagulum in the left B8 and cytologic examination of broncho alveolar lavage fluid revealed atypical squamous cells. With a clinical diagnosis of squamous cell carcinoma of the lung, a left lower lobectomy with hilar and mediastinal lymph node dissection was done. A milk-white tumor was found in the lower lobe of the resected lung. The pathological diagnosis of the resected tissue specimen was carcinoid, accompanied by pulmonary, hilar, and mediastinal lymph node metastases. Reduced immunofluorescence by Chromogranin A and serotonin staining were further evidence that the tumor was atypical. This case is very interesting in that the tumor metastasized to the lung and lymph nodes, even-though it was pathologically typical.

The relatively frequent loss of heterozygosity at loci on the short arm of chromosome 11 in lung cancers has suggested the presence of a putative tumor suppressor gene. For location of the gene, a fine deletion map of human chromosome 11 was constructed by analysis of 79 lung cancers with 31 sequence-tagged-site markers that dotted chromosome 11 and detected polymorphic changes in nucleotide sequences. The results showed that three regions, 11p12-p15, 11q12, and 11q14-q24, were commonly deleted in a considerable number of cancers, indicating the possible presence of more than one tumor suppressor gene.

From April 1987 to June 1995, we performed the chest wall reconstruction in 13 cases of 25 ones who had chest wall resection. The clinical records of these 13 patients were reviewed as follows. The histological diagnosis of these cases were direct invasion by primary lung cancer in 13 cases, malignant tumor of the chest wall in 5 cases, benign tumor or inflammation of the chest wall in 4 cases, local recurrence of the breast cancer and post operative radiation ulcer in each 1 case respectively, and mediastinal peripheral nerve sheath tumor in 1 case. Full diagnosis of the mediastinal malignant tumors were Ewing' sarcoma, chondrosarcoma, malignant lymphoma, malignant fibrous histiocytoma and eosinophilic granuloma in each 1 case respectively. The total number of resected ribs was 10 (bilateral 5 ribs with sternal body) in 1 case, 4 in 1 case, 3 in 6 cases, 2 in 2 cases and 1 in 4 cases. The following statement shows our methods of chest wall reconstructions. We treated one case with wide anterior chest wall resection, we treated by the Marlex-resin sandwich, 4 cases with 4 or 3 ribs of anterior or lateral chest wall, by sheets of Marlex mesh in layers, 3 cases with 3 ribs of posterior site, 1 case with 2 ribs and 4 cases with one rib, these 7 cases treated by cross sutures. And, we treated another 2 cases by pedicle omental flap and major pectoral muscle in each case respectively. The Marlex-resin sandwich has easy fixation and excellent stability, but it has also foreign body reaction. Therefore our case needed to remove of sandwich 10 months later for cellulitis and infection after the operation. Recently we use mostly sheets of Marlex mesh in layers, for the reconstruction of the chest wall with 3 or more rib's defect, but if it is more small defect, we use the cross suture method. The cross suture is very easy and effective method to maintain the stability of small chest wall defect.

The immediate goal of management of heart failure is to improve cardiac function and eliminate symptoms. On the other hand, the final goal is to improve the quality of life and survival. In this chapter, general approaches to fulfill these goals are discussed. First, precise evaluation of the patient is necessary and the underlying cause of heart failure must be diagnosed. If possible, the underlying cause should be rectified. Precipitating factors, such as infection, should also be removed. Appropriate therapeutic measures are then selected according to the type and severity of heart failure. In pharmacotherapy, digoxin, diuretics and vasodilators are usually used in combination. In refractory heart failure, inotropic drugs, including sympatomimetic amines, are usually effective. Special measures including dialysis and assisted circulation, may also be considered in acute or refractory heart failure. Finally, management of ventricular arrhythmias in patients with heart failure is still controversial.

We produced an experimental adult respiratory distress syndrome model by intravenous administration of oleic acid (OA) in 30 dogs (Group I: 10 normal dogs; Group II: 10 dogs with 0.02 ml/kg of OA; Group III: 10 dogs with 0.04 ml/kg of OA; Group IV: 10 dogs with 0.08 ml/kg of OA). Changes in albumin (AL) and fibronectin (FN) in serum and BALF of these dogs were examined. The following results were obtained: 1) Serum values of AL and FN were significantly decreased after OA injection as compared with the baseline values. These changes were not correlated with the severity of pulmonary edema. 2) BALF values of AL and FN were significantly increased after OA injection as compared with the baseline values. Significant linear correlations were found between the BALF value of AL and ELWV, and between BALF value of AL and delta ELWV, [r = -0.682, 0.573 (p < 0.01)]. Significant linear correlations were also found between the BALF value of FN and ELWV, and the BALF value of FN and delta ELWV, [r = 0.722, 0.650 (p < 0.01)]. BALF value of AL increased significantly even with the low OA dose (0.02 ml/kg). Thus in comparison with BALF value of AL after OA injection, BALF value of FN was significantly higher than that in the normal group even when pulmonary edema were severe (Groups III and IV). We concluded that we could estimate the severity of pulmonary edema by measuring BALF value of AL and FN simultaneously.

We applied the tentative TNM classification of thymoma to 24 cases of IV b thymoma, 59 cases of thymic carcinoma, and 26 cases of thymic carcinoma (109 cases in total). This classification was useful in these cases because cases could be divided into different grades (e.g. N 0, N 1, N 2, N 3) of the factor N (lymph node metastasis) without any shift to particular grades. Based on this finding, we hereby propose a TNM classification of thymic epitherial tumors which was prepared by slightly modifying the tentative TNM classification of thymoma.

In this study we attempted to estimate pulmonary vascular permeability by indocyanine green (ICG). Permeability pulmonary edema was produced in 9 adult dogs by injecting 0.08 ml/kg oleic acid. We injected 50 mg ICG intravenously in 18 dogs (9 dogs with pulmonary edema and 9 control dogs). We measured the time course of ICG concentrations in pulmonary arterial blood, ICG concentration of peripheral lung tissue, tissue/serum ICG concentration ratios, and wet/dry lung weight ratios. The following results were obtained. The time course of ICG concentration in pulmonary arterial blood showed peak values at 2 minutes and became constant at 5 or 10 minutes after injection. The ICG concentration in peripheral lung tissue, tissue/serum ICG concentration ratios, and wet/dry lung weight ratios in the pulmonary edema group were significantly higher than those in the normal group. There was a strong linear correlation between wet/dry lung weight ratio and ICG concentration in peripheral lung tissue, with correlation coefficients of r = 0.936 (p < 0.01) in the right lung and r = 0.901 (p < 0.01) in the left lung. From these results, we conclude that estimation of pulmonary vascular permeability by ICG is a useful method.

In this clinical study, one normal subject, one patient with primary interstitial pneumonia, one patient with segmental pneumonia due to Staphylococcus aureus, one patient with post-operative esophageal carcinoma, and two patients with mitral stenosis were studied. Dynamic CT scan images under continuous injection of low osmotic contrast medium were analyzed in series, in an attempt to evaluate vascular permeability quantitatively. The following results were obtained: 1) Subtraction CT scan image 10 minutes after the start of contrast medium injection in two patients with pneumonia, showed a reduction of pulmonary vascular permeability following therapy. 2) Subtraction CT scan image of the patient with post-operative esophageal carcinoma treated with 25 Gy radiation showed a discrepancy between pulmonary vascular permeability and other findings. 3) In hemodynamically stable patients with mitral stenosis, subtraction CT images demonstrated that pulmonary vascular permeability was not affected by pulmonary congestion, irrespective of its severity.

A hand-made apparatus which is easily manipulative, cheap, durable and clean was used to measure ambulatory activity of a mouse. The apparatus was assembled with the same type of two plastic round basins commercially available (25 cm in diameter) put one upon another. A pivot was fixed at the center of the outsurface of the inner basin (A), and its open end was inserted into the open socket fixed at the center on the bottom of the outer basin (B). Three microswitches equipped on the brim of (B) at equal intervals were activated and the counts were recorded according to the tiltings of (A) through the movements of the mouse. In order to examine accuracy of the measurement, effects of d-amphetamine (1.25 approximately 5.0 mg/kg), methamphetamine (1.0 approximately 4.0 mg/kg), cocaine (10 approximately 40 mg/kg) and morphine (5.0 approximately 20.0 mg/kg) on the ambulatory activity were investigated. Marked accelerating effects were observed dose dependently after the administrations of all the drugs. Furthermore, the patterns of the activity showed characteristic properties of each drug. This method is especially useful to measure the acute effect of drugs on the ambulatory activity in mice, and many units can be set up at the same time.

A 69 year-old man, who had undergone left pneumonectomy for squamous cell carcinoma of the lung 21 months ago, was admitted with a high temperature and chest pain. A diagnosis of empyema was made, and a chest tube was inserted for drainage. Bronchopleural fistula was not noted. Noticing that food was leaking through the drainage tube, a diagnosis of esophagopleural fistula was made radiologically. Surgery was done in October, 1987, after irrigating an empyema space for two months. The fistula was approximately 4 cm below the carina, and it was closed directly. The omentum was sutured around the closed site to reinforce and obliterate the empyema space. Furthermore, additional thoracoplasty was done because the cavity was too large to close only with the omentum. The postoperative course was uneventful. He was able to eat specially prepared foods within 4 weeks, and was discharged on the 60th day after the operation. This patient could possibly be the first case who had undergone an omental flap for the closure of a postpneumonectomy esophagopleural fistula.

Characteristics of changes in ambulatory activity after repeated administration of morphine, 5, 10 or 20 mg/kg s.c., were investigated in male mice of dd strain. The drug was administered 10 times at intervals of 1, 3-4 or 7 days, and the ambulatory activity of each mouse was measured by a tilting-type round activity cage with a 25 cm diameter for 180 min after each administration. Morphine, 5-20 mg/kg induced a dose-dependent increase in the ambulatory activity, and this effect attained to a peak at 60-90 min and persisted for 120-180 min after the administration. An augmentation of sensitivity (a reverse tolerance) to the ambulation-increasing effect of morphine was induced by the repeated administration of 10 and 20 mg/kg morphine, regardless of the intervals. The reverse tolerance achieved the maximum on the 5-6th administration day, and almost the same level of sensitivity was maintained until the 10th administration day. There was no significant difference in the activity counts at the peak time among the groups of mice varying the administration intervals. However, the persistence of increased ambulatory activity tended to be longer in the group of mice given morphine at intervals of 7 days than in the group given it at intervals of 1 day. The reverse tolerance, once produced, attenuated 2 months after the cessation of the repeated administration. However, the ambulatory activity counts did not return to those on the 1st administration day.(ABSTRACT TRUNCATED AT 250 WORDS)