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Wistar rats exposed to inescapable foot shocks (IS) for 2 wk exhibited PTSD-like bi-directional changes similar to avoidance/numbing and hyperarousal symptoms when placed in a shuttle box. Paroxetine administration after IS reduced the hyperarousal-like behavior, and its therapeutic effect on avoidance/numbing-like behavior was also significant. Further, F344 rats, which were more vulnerable to various kinds of stressors, showed more significant 'bi-directional changes' than Wistar rats. Thus, the paradigm we have developed could serve as a useful PTSD model because of its face, predictive, and construct validity. Moreover, the intensity of IS dose-dependently induced PTSD-like behaviors and hypo-activity in a shuttle box, similar to the 'avoidance/numbing' that reappeared in a square open field. These findings further support the construct validity of this paradigm. Both electro-convulsive shock treatment before and after IS ameliorated the PTSD-like behaviors in this model, so electro-convulsive therapy may be an effective method for prevention and medical treatment of PTSD in the future. On the other hand, pretreatment with fluvoxamine before IS did not have a significant effect, and its improving effect after IS was only observed for 'hyperarousal' behavior. Lastly, we recently developed a useful criterion, which is represented as a 'bi-directional index', for separating real PTSD rats from those exposed to IS.

We administered inescapable footshocks (IS) to male Wistar rats in a shuttle box, and after 2 weeks, an avoidance/escape task was performed in the same box. The rats exposed to IS 2 weeks beforehand exhibited PTSD-like bi-directional changes similar to symptoms of "avoidance/ numbing" and "hyperarousal". That is, in the relatively calm period just before the avoidance/escape task, spontaneous locomotor activities decreased. On the other hand, in the stressful situation after starting the task, not only responses to external stimuli but also locomotor activities increased. Thus, the paradigm we have used until now could serve as a useful PTSD model because of its "face validity". To demonstrate the greater validity, we administered paroxetine (PRX), which is effective for PTSD, to rats to examine its chronic effect on our model. We also substituted F344 rats, which are vulnerable to various stressors, for the Wistar rats to investigate the difference between the strains. Two weeks of PRX treatment significantly reduced hyperarousal-like behavior, and its ameliorating effect on avoidance/numbing-like behavior was also significant. F344 showed more significant 'bi-directional changes' than Wistar rats. These findings demonstrate that our paradigm is sufficiently valid for an animal model of PTSD, especially in "predictive validity" and "construct validity."

Intraductal papillary-mucinous neoplasms (IPMN) of the pancreas have recently been defined and classified by the World Health Organization. In addition, many cases of IPMN continue to be recognized frequently. We report a case of a 65-year-old female who underwent surgical resection of the pancreas twice within a period of 6 months for primary and recurrent IPMN. We first performed distal pancreatectomy with splenectomy for IPMN in the pacreatic body. A histopathological study revealed invasive adenocarcinoma and the negative margin of the pancreatic duct. A cystic mass in the uncinate process of the gland was identified by CT scan 6 months after the initial surgery. Complete pancreaticoduodenectomy was performed. Recurrent IPMN consisted of adenosquamous cell carcinoma. She currently is alive without evidence of disease at 3 years from the second resection. Recurrent disease in the residual pancreas suggests that a long-term surveillance is critical.

We report a case of a 54-year-old man with unknown primary squamous cell carcinoma in the bilateral neck. The patient was treated with chemotherapy and radiation therapy, because his right common carotid artery was invaded by the right neck tumor, and a complete curative operation was not considered possible. We chose instead combination chemotherapy with nedaplatin, adriamycin and 5-fluorouracil (NAF), because it was reported that NAF was available for advanced squamous cell carcinoma of the esophagus. After 3 cycles of NAF chemotherapy, the patient showed a partial response of approximately an 86% decrease in the right neck tumor for over three months. In addition to NAF, radiation therapy was performed. In the CT findings after chemotherapy and radiation therapy, the patient showed a complete response in the bilateral neck tumors. Unknown primary squamous cell carcinoma in the neck has been treated by combination therapy consisting of chemotherapy, radiation therapy and surgery. The regime of 5-fluorouracil and cisplatin is said to be an effective treatment for unknown primary squamous cell carcinoma in the neck. Based on our experience, NAF would be available as chemotherapy for unknown primary squamous cell carcinomas in the neck.

We report a case of disease-free survival of liver and lung metastases of rectal cancer resected for a total of five times. A 54-year-old female with metastatic liver and lung tumors of rectal cancer was admitted to our hospital. After a radical resection of the original tumor was performed at a previous hospital, liver and lung metastases had been confirmed in 1 year and 9 months and in 2 years and 2 months, respectively, and that both metastases had been resected as well. On admission to our hospital, computed tomography (CT) showed a liver metastasis of 3-cm in diameter in segment 3 and a lung metastasis of 2-cm in diameter in lingular segment. Two surgeries were performed to resect both of them. Because of a recurrent liver metastasis observed in segment 4, we performed a right hepatic lobectomy and partial duodenectomy 2 years later from the surgeries. After the fifth surgery for metastatic lesions, no sign of recurrence has been observed in 2 years and 11 months.

We report three patients with squamous cell anal carcinoma who were treated by chemoradiotherapy. Case 1: A 62-year-old female with squamous cell anal carcinoma invading the vagina underwent a posterior pelvic exenteration. She had paraaortic lymph node metastases. She was treated by chemoradiotherapy with 5-FU/CDDP and external irradiation (50 Gy) as an adjuvant therapy, and survived for 5 years. Case 2: A 74-year-old female with anal squamous cell carcinoma Stage II was treated by chemoradiotherapy with tegafur/uracil, external irradiation (30 Gy) and interstitial irradiation (24 Gy). She is currently living without any signs of recurrence for 3 years and 8 months. Case 3: A 53-year-old female with anal squamous cell carcinoma Stage IIIa was treated by chemoradiotherapy using 5'-DFUR and external irradiation (66 Gy). She is currently living without any signs of recurrence for 1 year and 9 months. The prognosis of anal squamous cell carcinoma that received Cur B or C resection was extremely poor with a median survival time (MST) of 7 or 6 months. Chemoradiotherapy seems to be effective as the first line treatment.

A 47-year-old man was admitted to our hospital for anal pain and diagnosed with submucosal tumor by digital examination. Transsacral resection was performed because the patient refused a stoma. Leiomyoma with highly malignant potential was histologically diagnosed. Surveillance was performed by computed tomography, magnetic resonance imaging and digital examination, but a correct diagnosis was difficult. Due to local tumor increases in the resected region, trans-anal resection was performed 2 years later at the time of local recurrence diagnosis. Over the last 10 years, a total of 8 local resections have been performed since the first surgery. No distant metastases have been confirmed to the patient without a stoma. It appears that a local resection of leimyosarcoma of the rectum with a close surveillance was effective.

We evaluated the effect of hepatic arterial infusion (HAI) chemotherapy after curative resection of liver metastases of colorectal cancer. A total of 161 patients underwent curative resection of liver metastases. Among them, 50 patients underwent HAI of 5-FU, and 111 patients had no HAI therapy. The 50% disease-free survival time (50% DFS) was 758 days and 342 days in the HAI group and the non-HAI group (logrank test, p<0.01), and the 50% overall survival time (50% OS) was 978 days versus 730 days (p<0.05), respectively. Among the 71 patients with multiple resectable metastases (H2 or H3), the HAI group had a significantly superior 50% DFS. HAI therapy seems to be an effective form of adjuvant chemotherapy after hepatic resection of metastatic colorectal cancer.

To better understand neuroscientific aspects of posttraumatic stress disorder (PTSD), it is necessary to establish an animal model of PTSD in which behavioral changes persist after initial traumatization. We administered inescapable footshock (IS) to male Wistar rats in a shuttle-box (inescapable stress session), and after 2 weeks we performed an avoidance/escape task session in the shuttle-box using signal lights as anxiogenic external stimuli. Rats exposed to IS beforehand exhibited PTSD-like bi-directional behavioral changes, that is, "avoidance/numbing" (e.g. decreased activity, reactivity, and interest in surroundings) and "hyperarousal" (e.g. irritability and exaggerated responsiveness to external stimuli). Concretely speaking, in a relatively calm situation, spontaneous locomotion decreased during a 5-min adaptation period just before the avoidance/escape task session. On the other hand, in a stressful situation after starting the task session, not only avoidance responses to external stimuli (signal lights) but also gate-crossings during inter-trial interval increased. Accordingly, the paradigm used here could serve as a useful model of PTSD. We administered paroxetine (PRX) to rats just after IS for 2 weeks to examine its chronic effect on our animal model. Two weeks of PRX treatment significantly reduced hyperarousal-like behaviors, but no effect on avoidance/numbing-like ones was manifested.

We evaluated the effectiveness of arterial infusion chemotherapy for liver metastasis from gastric cancer. Nineteen patients (9 synchronous cases, 10 metachronous cases) were treated with hepatic arterial infusion chemotherapy (HAIC). The response rate was 26% (CR 3, PR 2, PD 14), and the median survival time was 357 days after the diagnosis of liver metastasis. The treatment was discontinued in 8 patients because of treatment associated complications and disease progression. Absence of extrahepatic lesion, response of HAIC, and hepatectomy did not improve the prognosis. The combination of systemic chemotherapy with HAIC tended to improve the prognosis. It may be necessary to reevaluate HAIC as a treatment modality for liver metastasis from gastric cancer.

Recent progress in the study of atherosclerosis revealed that the proatherogenic property of LDL is attributable to oxidized LDL. Macrophages recruited to vascular wall phagocytose oxidized LDL and transformed into foam cells, which is a hallmark of atheroma. Endothelial cells also binds oxidized LDL and changes its phenotype to the status of "endothelial dysfunction." We successfully cloned the endothelial receptor for oxidized LDL, designated LOX-1. LOX-1-mediated action of oxidized LDL induces the decrease in NO release and the increased expression of adhesion molecules, which are typical changes in endothelial dysfunction. The expression of LOX-1 is quite inducible. Proinflammatory cytokines, etc. induce the expression of LOX-1 in vitro; and proatherogenic conditions, e.g., hypertension, hyperlipidemia, and diabetes, induce the expression of LOX-1 in vivo. This manner of expression suggests the importance of LOX-1 in pathological settings. LOX-1 binds not only oxidized LDL, but also binds apoptotic cells and activated platelets through the interaction with anionic phospholipids. This property might bridge atherosclerosis and thrombosis. A novel system to detect LOX-1 ligand in plasma detected the increased level of LOX-1 ligand in hypercholesterolemic rabbits compared with normal ones. This system might be useful to predict the status of endothelial function and the risk of ischemic heart disease.

In our hospital, combination therapy, mainly intra-arterial infusion, is performed for multiple liver metastases of colorectal cancer. The median survival time of the combination group (n = 18), the hepatectomy only group (n = 3) and the best supportive care group (n = 7) were 21.7, 12.5 and 6.1 months, respectively. The prognosis of the combination group was significantly better than that in the other groups (p < 0.0001). Univariate analysis against the combination group revealed that serum CEA was a significant prognostic factor (p = 0.0196). Moreover, we divided the combination group into two groups on the basis of serum CEA either below or above 50 ng/ml. The prognosis of the low CEA group (n = 11), whose median survival time was 25.9 months, was significantly better than the high CEA group (n = 7), whose median survival time was 17.8 months (p = 0.0031). It therefore appears that combination therapy may be of no benefit when serum CEA is above 50 ng/ml.

A patient with advanced intrahepatic cholangiocarcinoma had a tumor embolus in the right main branch of the portal vein and lymph node metastases. Hepatic arterial infusion (HAI) therapy with 5-FU (1 g/day) was given as a continuous infusion for 6 days. The treatment was repeated after a one-week interval. As a result the tumor diameter decreased by half, and the tumor embolus contracted. Cytoreductive surgery was then performed. The patient has been disease-free for over 9 months postoperatively with adjuvant HAI with 5-FU. We consider preoperative HAI with 5-FU (two courses of 1 g/day x 6 days) is both safe and effective.

Fifteen patients with liver metastases of colorectal cancer were entered in our study, and 5-FU was given continuously by hepatic intra-arterial route at 1 g/day over 6 days. No leukopenia (< 3,000/mm3), anemia (< 10 g/dl), or thrombocytopenia (< 75,000/mm3) occurred, and no elevation of serum AST (> 150 IU/l) or serum T-Bil (> 2 mg/ml) appeared. One patient (4.2%) had nausea with vomiting 1-5 per day, and another (4.2%) had mucositis requiring treatment. In patients with multiple liver metastases, survival of the continuous infusion group [total dose of 5-FU > or = 12 g] (n = 5) seems to be longer than those of the hepatectomy only group (n = 3) or the control group (n = 7). We suggest that this continuous intra-arterial infusion of high-dose 5-FU is a useful chemotherapy with few side effects or complications.

We retrospectively analysed the perioperative course of 22 patients who underwent emergency CABG for severe left main trunk lesion. The causes of LMT lesion were spontaneous acute myocardial infarction in 14 patients and failed coronary intervention and coronary angiography in 8 patients. IABP was used preoperatively in all patients and additional coronary perfusion catheter were induced for two patients and PCPS was for one patient. Overall incidence in-hospital operative mortality was 22.7% (5/22), four of them were due to cardiac related causes and one of them was due to acute renal failure. Postoperative level of max CPK enzyme was significantly higher in death cases compared to survivors, 6,330 +/- 3,649 versus 1,299 +/- 1,417 IU/dl. We considered that the most important factors in surgical strategy for acute coronary syndrome with LMT lesion were as follows: improvement of hemodynamics with mechanical cardiac support by IABP or/and PCPS, protection of broad myocardial ischemia using coronary perfusion catheter and urgent surgical revascularization by emergency CABG.

From 1979 to 1997, 146 patients had hepatectomy for metastases of colorectal cancer (curative B: 122; curative C: 24). We categorized the severity of liver metastases as follows, H1: one lobe; H2: bilateral but less than five, and H3: bilateral with five or more lesions. In H1 and H2 patients, we compared the survival rate after resection alone (including repeat hepatectomy) with that after combination therapy (resection and prophylactic arterial chemoinfusion of 12-24 g of 5-FU). In H1 patients, the 3-year survival rate of the resected group (n = 74) and combination group (n = 6) was 47.2 and 53.3, respectively. In H2 patients, the resected group (n = 16) and combination group (n = 7) had survival rates of 34.5 and 100%, respectively. In H1 cases, the 3-year recurrence rate in the remnant liver was 63.4 versus 16.7% and in H2 cases it was 58.0 versus 0%. H3 patients received one week of continuous prophylactic arterial chemoinfusion [total dose of 5-FU = 6 g]. All four patients in the H3 combination group are alive at 20, 13, 13, and 12 months after resection, while the median survival of the resection only group (n = 4) was 12.5 months. We suggest that our combination therapy may be applicable to all patients with liver metastases of colorectal cancer.

A case of paragonimiasis with a tumor of intrathoracic chest wall was reported. The patient was a 46-year-old male who complained of cough and showed abnormal findings on chest X-ray. After performing various examinations, the patient was diagnosis as having a tumor of the intrathoracic chest wall. On surgery, the tumor was enveloped in a thick capsule and its lumen was filled with yellow-white atheromatous material. Calcification was not found. Pathologically, an egg-like structure of a parasite was confirmed inside the sequestrum attached to the lining of the inner surface of the capsule. Past history of pleuritis and ingestion of freshwater crabs confirmed the diagnosis of paragonimiasis.

We have experienced a surgical correction of ECD of a 64-year-old female patient. The preoperative left ventriculogram showed typical goose-neck deformity of the left ventricle and mild mitral regurgitation. The correction consisted of repair of the mitral cleft, and patch closure of the ostium primum. Postoperative course was uneventful. The operation of ECD should be recommended even in an older patient.

We have experienced a surgical treatment of right atrial myxoma in a 76-year-old woman. The patient was admitted with complaints of palpitation and low grade fever. Echocardiography revealed the atrial tumor, which prolapsed into the right ventricle in diastole. The tumor was removed under cardiopulmonary bypass including the atrial septum where it was attached. The tumor weighed 68 g and showed typical pathological findings of myxoma. The patient is doing well 6 years after surgery.

A case of superficially infiltrating cardiac angiosarcoma damaging the right coronary artery and forming a pseudoaneurysm was studied. The patient was a 25-year-old male who had undergone cardiac tamponade twice in the past six months. Since heart murmur was audible in auscultation, thorough examination was performed. Cardioechography and cardiac angiography revealed a pseudoaneurysm of hen egg size involving the proximal right coronary artery. Although the pseudoaneurysm and right atrium ruptured during operation, a coronary bypass was placed and the right atrium was repaired with an equine pericardium. Angiosarcoma was identified by pathological examination of the excised specimen. The patient died two months after operation due to lung metastasis.

A 39-year-old man who had undergone the patch closure of the VSD 15 years ago, was admitted with a diagnosis of infective endocarditis due to Alcaligenes Xylosoxidans. Echocardiography revealed vegetation of the aortic valve and a high echoic lesion on the ventricular septum. Surgical findings showed vegetation of the aortic valve and a subannular type mycotic aneurysm. In the aneurysm, the infected pledget used in a previous surgery was found. After debridement, direct closure of the aneurysm, aortic valve replacement (AVR) using a #25 SJM prosthetic valve, and mitral annuloplasty were performed. Two months later, fever developed. The patient was diagnosed with prosthetic valve endocarditis and a second surgery was performed. The prosthetic valve was clear, but an infected Dacron patch used for VSD closure 15 years earlier was found. Debridement, patch closure of the ventricular septum, and re-AVR were performed. The post-operative course was uneventful. This is thought to be a rare case, because infection extended from the aortic valve to the VSD type II Dacron patch, and remained to the VSD type II Dacron patch.

There were 1151 patients who underwent PTCA at our facilities from August 1984 to December 1990. The records of 298 patients were reviewed from August 1984 to June 1988 (former period), and were compared with records of 853 patients undergoing treatment after June 1988 (latter period). Of 852 elective PTCA procedures, complete occlusion of the lesion increased from 2.3% in the former period to 17.5% in the latter period, while for partial occlusion there were 60.4% in the former and 60.5% in the latter. Emergency PTCA for acute myocardial infarction decreased from 37.2% in the former to 22% in the latter. The number of patients with multivessel disease increased slightly from 43.6% in the former to 46.8% in the latter. The success rate for patients who underwent elective PTCA for complete occlusion was 42.8% in the former and 49.6% in the latter, while for partial occlusion it was 87.2% in the former and 91.8% in the latter. The success rate for patients requiring emergency PTCA was 73.8% in the former and 90.4% in the latter. Of the patients undergoing elective PTCA, acute coronary closure occurred in 3% of the former and in 1% of the latter, while for patients requiring emergency PTCA, there were 4.4% in the former and 2.7% in the latter. Of the 8 patients who required emergency CABG, elective PTCA was unsuccessful in 4 cases and emergency PTCA was also unsuccessful in the other 4; in other words, 4 of a total 852 elective PTCAs (0.47%) and 4 of 299 emergency PTCAs (1.3%) for an overall figure of 8/1151 (0.7%).(ABSTRACT TRUNCATED AT 250 WORDS)

A variety of vasoactive substances including biogenic amines, neuropeptide Y, somatostatin, enkephalin, ACTH, corticotropin-releasing hormone, growth hormone releasing hormone, vasoactive intestinal peptide, calcitonin, and atrial natriuretic factor have been extracted from intra-adrenal and extra-adrenal pheochromocytomas in men. Some of them appear to play an important role for the development of hypertension or clinical serious symptoms. However, informations on the molecular forms of other substances in pheochromocytomas are still limited, and precise amount of the peptides or hormones in the tumors has not yet been quantitated. Numerous in vitro or in vivo studies of this documented neoplasm over the years have been reviewed in this manuscript. Clinical analyses of early diagnosis, localization diagnosis, treatment of multiple endocrine neoplasia, preoperative and operative treatments are also evaluated in this paper. These informations will probably provide additional evidence for the multi-secretory APUD cells of neural crest origin and will contribute the therapy in patients with pheochromocytoma.

Simple method of venoarterial (V-A) bypass was developed for neonatal ECMO. Technical aspects in the management of our device was shown in this report. The most important technique was to keep the flow of ECMO less than 60-80 ml/min/kg. The low flow circulation less than 80 ml/min/kg made puppies alive under apnea experimentally. Clinically we experienced four newborn cases. All cases had severe respiratory failure with AaDO2 above 580 mmHg due to congenital diaphragmatic hernia. Two cases of them were able to survive. Other two cases died from intracranial hemorrhage during ECMO. The oxygenation of all cases was satisfactory under relative low flows. Our simple ECMO circuit was not only easy to operate but also to give less damage to blood.

Thymic carcinoid is rare disease. The frequency, treatment and prognosis of thymic carcinoid are discussed. This report presents a case of a 55-year-old man who underwent rt-hemithymectomy and radiotherapy postoperatively. The patient had no complaint but chest roentgenogram and CT scan revealed an abnormal mass in the anterior superior mediastinal region. Through median sternotomy, rt-hemithymectomy including partial resection of the pericardium was performed. The tumor was 6 X 5 X 5 cm in size, and diagnosis of thymic carcinoid was histologically established. The patient was discharged after postoperative irradiation of total dosage of 54 Gy to the mediastinum. He was no evidence of recurrence twelve months after operation.

Red cell deformability (RCD), by a filtration method, was studied on patients with chronic arterial occlusive diseases: Arteriosclerosis obliterans (ASO) and Buerger's disease (TAO). RCD decreased significantly in both ASO and TAO. Furthermore, RCD decreased in patients with gangrene and complications in other organs much more than in those without them in ASO. In ASO positive correlation was observed between RCD and serum HDL-cholesterol level, while negative correlation between RCD and serum lipid peroxide level. The deformability of the red cells resuspended in a standard plasma protein fraction was also studied to assess the influences of plasma factors on RCD. As the result decreased RCD was considered probably due to a change in red cells rather than plasma factors in ASO.

Despite the recent advent of total parenteral nutrition (TPN), the long-term survival of the patients with short gut syndrome is not satisfactory with complications of catheter-related sepsis and cholestasis. The causes of short gut syndrome in pediatric surgery are multiple intestinal atresias, necrotizing enterocolitis (NEC), and midgut volvulus. For the multiple atresias, multiple anastomosis without resection has been successfully undertaken to avoid developing short gut syndrome for the last 17 years. For the massive involvement of the intestines due to NEC or volvulus, high jejunostomy and peritoneal drainage with TPN support have been tried for the last two patients and successfully weaned from the TPN within two months after closure of jejunostomy. However, in case 2 malabsorption has been persistent presumably due to a severe degree of mucosal damage occurring in the remaining intestines. Whether this eventually gets back to the normal or not is unknown. For the patients with short gut syndrome, small bowel reversal procedure was successfully done and now doing well 10 years after surgery. This paper reports details of these 3 cases.