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A 77-year-old female patients developed severe hepatic injury after the administration of UFTR, which contains tegafur and uracil, for postoperative chemotherapy of colon cancer. Liver damage was recognized 10 months after its administration. Serum markers for viral hepatitis and various autoantibodies were negative. The wedged biopsied liver specimen revealed advanced chronic active hepatitis with periportal confluent necrosis, marked intralobular spotty necrosis, and significant proliferation of pseudo-bile ductules. Although the cessation of the drug and conservative therapies improved hepatic function, an accidental readministration of UFTR caused her severe hepatic damage again. These findings suggest that liver injury in the present case was caused by UFTR. Histological findings were unique. Although tegafur is known to worsen hepatic function when given to patients with liver cirrhosis, UFTR may also cause severe hepatic injury in those without preexisting liver disease.

Extracranial metastasis was found in an intracranial meningioma with low proliferative potential before the detection of the primary tumor. Pleuropulmonary tumors were incidentally detected on chest X-ray in an asymptomatic 25 year old female. Excised tumors of the right pleura and lung showed histological features similar to meningotheliomatous meningioma, which led to the discovery and excision of the intracranial tumor. Both tumors showed the same histologic pattern: meningotheliomatous meningioma with low mitotic activity. The proliferative component, determined by the monoclonal antibody Ki-67, was further evaluated in the primary tumor and the metastases of the present case, as well as in 12 other intracranial meningiomas. Ki-67 positive ratios at the primary and metastatic sites of the present cases were 1.2 and 1.1%, respectively, which is as low as other benign meningiomas, and this suggests that factors other than the proliferative potential is responsible for extracranial metastasis of meningioma.

Background. Pyothorax-associated pleural lymphomas (PAPL) occur in patients with long-standing pyothorax. Epstein-Barr virus (EBV) plays an important role in its development. Methods. An atypical case of PAPL is reported and its clinical features are compared with those of five cases of ordinary PAPL. Results. The histology of the lymphoma changed from prominent T-cell infiltration to an overt B-cell lymphoma of diffuse, large cell-type. DNA studies of the lymphoma at the first presentation demonstrated dual rear-rangement in the T-cell receptor β (TCRβ) and immuno-globulin heavy chain J region (IgJH) genes. EBV genome analysis demonstrated monoclonal expansion of EBV-infected cells. EBV gene products were present only in large lymphocytes with B-cell phenotype. The same rearranged band of the IgJH gene, but not clonal rearrangement of the TCRβ gene, was observed in the overt B-cell lymphoma at the relapse. The same EBV-infected clone was observed throughout the course of the disease. The tumor was localized at the pyothorax wall, and cell-mediated immunity, reflected by a positive tuberculin reaction, was preserved only in the current case. Conclusions. T-cell-rich lymphoid infiltration in the current case is a variant of EBV-associated PAPL, which is infiltrated by reactive T-cells with clonal accentuation. This is the first documented case of EBV-associated PAPL evolving from T-cell-rich lymphoid infiltration.

We report a compact electrochemical sensing system to implement cyclic voltammetry. This type of sensor needs a working electrode, counter electrode, and reference electrode, all of which were integrated on a single chip. The electrochemical system also needs a potentiostat and an input voltage-generating circuit, which were developed using on-chip active devices and a few discrete passive components. This is the first sensor system incorporating electrode-side input voltage generation for electrochemical measurements using an on-chip operational amplifier, which replaces a bulky external voltage controller. A continuous cyclic voltammetry measurement was conducted with a well-studied ferricyanide solution to demonstrate the operation of the intelligent sensor chip. A clear peak was observed and linearity to the target chemical concentration was obtained between the peak height and concentration of the ferricyanide solution. With potential for mass production and small size, this sensor chip could be the best candidate to realize point-of-care testing. This sensor chip is a milestone of a fully integrated electrochemical sensor chip.

To determine risk factors for hepatocellular carcinoma (HOC) in Japan, we studied 575 patients with liver cirrhosis (LC) who presented to our out-patient clinics in a month; 217 patients with habitual drinking with or without viral infections (AL-LC), 235 with hepatitis C virus (HCV) infection, 40 with hepatitis B virus (HB) infection, and 82 with liver diseases from other aetiologies such as primary biliary cirrhosis (PBC). HCC was found in 28v of AL-LC, 27% of HCV-LC, and 18% of HB-LC. HCV antibody examined by the second-generation HCV antibody assay (HCV II) was positive in 49% of AL-LC without HCC, and 84% of AL-LC with HCC. HCV was significantly associated with the development of HCC with an odds ratio of 1.90 by multivariate analysis, whereas alcohol alone did not become a risk factor, with an odds ratio of 0.65. When both variables were combined (HCV+AL), however, the odds ratio was increased twice to 3.65. One-hundred and thirteen patients who had a history of blood transfusion more than 10 years ago were selected to assess the interaction between alcohol and HCV in hepatocarcinogenesis. A year-adjusted disease occurrence rate calculated by the Kaplan–Meyer method showed that HCV+AL had a significantly higher disease occurrence rate than HCV alone. These results suggest that although alcohol alone may not become a risk factor for HCC, it may potentiate the development of HCC caused by HCV. HCV+AL is considered to be the highest risk group; strict abstinence is necessary for these patients.

An electrochemical sensor has been developed on a single chip in which potentiostat and sensor electrodes are integrated. Sensor chips were fabricated using 5.0 µm complementary metal–oxide–semiconductor (CMOS) technology. All processes including the CMOS process, postprocessing for fabricating sensor electrodes and passivation layers, and packaging were performed at Toyohashi University of Technology. The integration makes it possible to measure electrochemical signals without having to use a bulky external electrochemical system. The potential between the working electrode and the reference electrode was controlled using an on-chip potentiostat composed of CMOS transistors. The chip characteristics were verified by electrochemical measurement, namely, by cyclic voltammetry. Potassium ferricyanide solution was measured to obtain results that fit well to the theoretical formula. A clear proportional relationship between peak height and the concentration of the sample solution was obtained using the proposed sensor chip, and the dynamic range obtained was 0.10 to 8.0 mM.

Seventy-six chronic alcoholics in Japan were evaluated for histological changes of liver needle biopsies, Chiron C100 antibody (C-100) for hepatitis C virus, as well as clinical and laboratory data. In biopsies, the presence of necroinflammations within the parenchyma, lymphocytic reaction in the portal tracts, or both, might indicate non-A, non-B (NANB) chronic hepatitis. Using these histological criteria, the patients were previously classified into two groups: alcoholic liver disease (ALD) alone and ALD complicating NANB chronic hepatitis. The C100-positive ratio was found to be 12% in the former group and 69% in the latter. Further clinical and laboratory comparison revealed that there were significant differences in gamma-glutamyl transpeptidase, gamma-globulin, and adenosine deaminase levels in the sera between the ALD alone and the ALD complicating NANB chronic hepatitis groups. Since some chronic alcoholics are also affected by chronic type C hepatitis, detailed evaluations of the liver biopsy and C-100 assay are required for the differentiation of these hepatic disorders.

In the case of tracheobronchoplasty combined with esophageal resection, healing of the tracheobronchial anastomosis may be compromised by interference with the blood supply to the anastomosis, as the tracheal lateral vessels are removed with the esophagus and the posterior membranous portion of the trachea is no longer supported by the esophagus. Covering of the anastomosis by the muscle flap is one of the methods for these disadvantages, but preservation of bronchial arteries and feeding vessels to the trachea is better. Indication for these procedures should be determined by precise judgement of the extent of malignancy.

From 1977 to 1988, 84 resections of pulmonary metastases were performed, and 55 patients were followed for more than two years. Their cumulative survival rates were 76. 4% at one year, 39. 6% at three years and 26. 4% at five years, with a median survival time of 35 months. The prognosis was somewhat influenced by tumor doubling time (TDT), disease free interval (DFI) and the number of metastases. A TDT of more than 70 days and a DFI of more than 12 months were favorable prognostic factors. Some metastatic tumors grow rapidly after a long dormant period. Patients with such tumors have a chance to be cured by tumor resection when there are few metastases in the lungs and no evidence of metastasis in other organs Multimodal treatment, including repeated thoracotomies, contributes to prolongation of survival.

Twenty-nine patients with hemoptysis were studied. Fifteen patients underwent operations. Eight were treated with bronchial arterial embolization (BAE) alone. Six died of large amount of hemoptysis, among which four had a hemorrhage from postoperative bronchopulmonary arterial fistula. Among operated patients, eight underwent preoperative BAE. Six patients made unfavorable results, among whom two underwent emergent operations. One patient was treated with four times BAE alone during five years seven months period. Follow up interval of five patients with single BAE does not reach two years. They require longer observation. Relative indications for operation are effective BAE, confined lesions or marked organic change. Absolute indication is in the case of ineffective BAE when patient's general status permits operative burden. Hemorrhages from bronchopulmonary arterial fistalas require emergent operation, however, most cases are fatal.

A 25-year-old male complaining of fever and cough was admitted to our hospital.Bronchofiberscopy revealed a polypoid tumor nearly obstructing the right main bronchus. Biopsy of the tumor proved it to be a bronchial carcinoid. Endoscopic Nd-YAG laser treatment was done to identify the base of the polyp and the extent of tumor involvement before operation. After the laser delivery of 13276 Joules in three times the obstruction was relieved. To preserve pulmonary function, a bronchoplastic procedure was performed as follows : the truncus intermedius was cut just above the middle lobe bronchus, then the right main bronchus was cut below the upper lobe bronchus to remove the tumor. The resected edge proved to be tumor free by frozen section during the operation. Preoperative laser treatment for polypoid bronchial neoplasms may be useful in preserving pulmonary functions by effective bronchoplasty

An immunological process is suggested to play some role in the pathogenesis of alcoholic hepatitis; however, its nature has not been clarified. In the present study, we examined, in 30 patients with alcoholic liver disease, an in vitro effect of prednisolone on suppressor T cell activity to see whether an altered cellular immunoregulatory mechanism is affected by corticosteroid. Suppressor T cell activity, which was induced by concanavalin A (Con A), was assessed by inhibition of phytohemagglutinin-stimulated blast transformation of autologous lymphocytes, and prednisolone (10 micrograms/ml) was added when suppressor T cells were induced. Low suppressor T cell activity was found in alcoholic patients with hepatic fibrosis, alcoholic hepatitis, and cirrhosis with hepatitis; these reductions recovered to a normal range when lymphocytes were incubated in vitro with prednisolone, suggesting an improvement in the altered immunoregulation by prednisolone. Although immunotherapy is shown to be of no benefit in the treatment of alcoholic hepatitis, we propose a need to elucidate further the therapeutic modalities for correction of the immunoregulatory abnormalities in such patients.

Seventeen patients with malignant tumors of the trachea or main bronchus have been treated with the Nd-YAG laser under topical anesthesia. Eleven of these patients had bronchogenic carcinomas (5 primary and 6 recurrent) and the rest of them had miscellaneous malignant tumors. Two of the 5 patients with primary bronchogenic carcinomas could be resected after laser treatment and the other 3 cases were treated with irradiation. However, 6 patients with recurrent bronchogenic carcinoma, though opening of the air ways could be achieved, did not survive more than 8 months. One patient with recurrent oesophageal carcinoma survived 2 years and 9 months with laser treatment and chemotherapy repeated 3 times. Laser treatment provides an excellent method for resuscitating patients with life threatening obstruction and enables subsequent management to be carefully planned.

To investigate the immunological mechanisms underlying corticosteroid therapy in chronic active hepatitis (CAH), in vitro effects of prednisolone on suppressor T-cell and interleukin 2 (IL-2) activities were examined in six corticosteroid therapy-effective and six therapy-ineffective patients with CAH prior to the therapy. Whereas low suppressor T-cell activity and decreased response to IL-2 in T cells were found in the corticosteroid therapy-effective group, these reductions recovered to the normal range when the activity or response was tested in the presence of prednisolone (1 and 10 micrograms/ml). Corresponding with these recoveries, suppressor T-cell activity arrived at normal values after corticosteroid therapy for 8 weeks. By contrast, in the corticosteroid-ineffective group, no apparent effects of prednisolone on suppressor T-cell activity and the response to IL-2 were observed. The relationship between the clinical effect of corticosteroid therapy and in vitro improvement in suppressor T-cell activity or in the response to IL-2 by prednisolone suggests that, in CAH, the corticosteroid effect is likely to be due to an immunomodulation in T-cell function.

We consider that in the majority of cases, bloody sputum or hemoptysis in nonmalignant diseases is derived from the bronchial circulatory system. Selective bronchial arteriographic examination was performed in 122 patients with benign pulmonary diseases. In the markedly hypervascular group, the patients who had blood in sputum were significantly larger in number than those of moderate or mild groups. Bronchopulmonary anastomosis was found in 45 patients. Out of the 45 patients, 23 had blood in sputum or hemoptysis whereas 19 of the remaining 77 without anastomosis had this episode. The difference in frequency of blood in sputum or hemoptysis between these two groups with or without the anastomosis was statistically significant (P

大腸癌は初回手術時すでに非治癒切除におわるものが, 2割前後存在し, その治療について近年積極的に切除をおこない良好な成績も報告されている. しかし非治癒因子が複数の場合予後は不良である. 癌研外科における単一非治癒因子のみをもつ非治癒切除症例の平均生存期間は, 肝転移22.2ヵ月, 腹膜播種21.6ヵ月, リンパ節転移15.2ヵ月, 局所浸潤12.3ヵ月である. 肝転移, 腹膜播種, リンパ節転移においてこれら単一非治癒因子であった場合, reductive Surgeryの効果は十分認められる. 非治癒切除病例を考える場合, 血行転移をおこしやすいもの. 腹膜播種をおこしやすいものなど, 異なる性格をもった集合体として, とらえることが重要と思われる.

Resection of the oesophagus together with the bifurcation of the trachea has been performed in three patients with oesophageal carcinoma or mucoepidermoid carcinoma of bronchial origin. Two patients had an uneventful recovery and survived five and 10 months but one patient died in the immediate postoperative period from aspiration pneumonia and respiratory failure. There has been no report of combined resection of the oesophagus and carina since Thompson's paper in 1973, but it appears to be indicated occasionally in patients with tracheobronchial or oesophageal malignancy, particularly when it is associated with an oesophagobronchial fistula.

肺癌の縦隔リンパ節転移に対する評価は, sensitivityとspecificityについてそれぞれCTが89.5%, 58.8%, 67Gaシンチが36.1%, 79.6%, 気管支動脈造影が56%, 71.6%であった.CTはsensitivityが高く術前評価に有用で, 67Gaシンチはsensitivityは低いがspecificityが高いので大きいリンパ節を有する肺癌の縦隔の評価に効果的で, また気管支動脈造影は67Gaシンチとほぼ同等の評価が得られたが侵襲的検査法のため67Gaシンチほどには実施されなくなるものと考えられた.

例の原発性非小細胞性肺癌患者に対してcisplatin 25mgの気管支動脈内注入 (BAI) を行なった.BAI施行2週間後において50%以上の腫瘍縮小効果を示した例はなく, 20%以上の縮小を3例に認めたのみで, vincristine併用mitomycinC投与群に比して, 縮小率は有意に劣っていた.以上より, cisplatinをBAIの対象薬剤として使用するには, 今後, 投与量やcisplatinの代謝機構の問題等をより詳細に検討する必要があると考えられた

We have treated surgically 7 patients with tracheal injury, 6 patients with tracheal stenosis caused by tracheostomy, and 20 patients with primary or secondary tracheal tumors in the past 20 years. Five of the 20 patients with tracheal tumors had resection of the carina. In 3 of the 5 patients, a new carina was created by anastomosing the trachea with the left main bronchus and the right intermediate trunk. In 4 patients, 9 rings or more the trachea were resected.All of the 33 patients were treated by primary anastomosis.Eight of the 33 patients died. In 3 of the death cases, the cause was unrelated to the surgery. Eight patients had complications.

The patient of osteogenic sarcoma develops pulmonary metastasis with high incidence. To estimate the duration of a given tumor and the time of inception, we calculated retrospectively the growth rate of tumor. If the growth rate of tumor before treatment is assumed to be constant, the majority of patients of osteogenic sarcoma had already developed pulmonary metastasis when symptoms from primary tumor appeared. Patients who are diagnosed as osteogenic sarcoma should be treated for pulmonary metastasis as well as for primary tumor even if there is no abnormal density on the chest roentgenogram.Bronchial artery or pulmonary artery infusion using anticancer agents for osteogenic sarcoma without visible metastasis on the chest roentgenogram is a treatment of choice.

This paper presents the unusual case of a patient with a histologically benign giant cell tumor of the femur that resulted in bilateral multiple pulmonary metastases having the appearance of benign giant cell tumor. An aggressive surgical approach was used to eradicate the pulmonary metastases; 25 nodules excised from the left lung and 33 nodules from the right lung were proved histologically to be benign giant cell tumors. Three years after bilateral thoracotomies, he remains well, without evidence of recurrent disease, and his lung function is almost normal.

We have treated surgically 11 patients with thyroid carcinoma that had infiltrated into the trachea. Three patients had primary tumours, and eight had recurrent tumours after previous operations. Sleeve resection of trachea was performed where thyroid carcinoma had proliferated; the trachea was reconstructed by end-to-end anastomosis. In two patients 10 rings of the trachea were resected. In three patients the anterior half of the cricoid cartilage was resected along with the cervical trachea. In one patient tracheoplasty was performed using partial extracorporeal circulation because severe tracheal stenosis prevented endotracheal intubation. Two of the 11 patients died from the surgery and one from disseminated metastases. One patient who had undergone tracheal resection for thyroid carcinoma three years and five months previously had a recurrence of the tumour in the trachea adjacent to the anastomosis, and a second tracheal resection was performed. In three patients postoperative laryngeal stenosis occurred. Five patients are alive and well two years and one month to four years and seven months after their operations. The histological pattern of the tumour was papillary adenocarcinoma in all 11 patients.

In 3 cases in which lung cancer had occurred in the right upper lobe bronchus and had infiltrated the carina, the right upper lobe (including the lower part of the trachea, the carina, and the right main bronchus) was resected, and a new carina was created by anastomosing the trachea with the left main bronchus and the right intermediate trunk. Surgical techniques and the method for anesthesia were described in these 3 cases. To evaluate the function of the reconstructed trachea and bronchus, we made cinebronchograms at the high speed of 100 or 150 frames per second. This bronchographic movie film helped us to determine the state of the reconstructed trachea and bronchus.

Ikeda, T., Ishihara, T., Yoshimatsu, H., Kikuchi, K., Murakami, M., Kobayashi, K., Inoue, H., and Kasahara, M. (1974) . Thorax , 582-588. Primary osteogenic sarcoma of the mediastinum . A 22-year-old man with primary osteogenic sarcoma of the superior mediastinum is reported. This case is the second instance of primary osteogenic sarcoma of the mediastinum and the first case of superior mediastinal origin to be reported. The patient had local recurrence one year after the first operation. After resection of the recurrent tumour with left upper lobectomy and partial pericardectomy followed by radiation, he has been well for more than five years without recurrence. Extraosseous osteogenic sarcoma of soft tissue is very rare and has been reported in 103 patients. The five-year survival of patients with extraosseous osteogenic sarcoma is 22·4%. The distribution and prognosis of this tumour are similar to those of rhabdomyosarcoma in soft tissue. Primary amputation or wide excision is the treatment of choice.

Two cases of the thymoma of the unusual sites were examined immunohistochemically. The one was intrapulmonary, and the other was diffuse pleural tumors. The infiltrating lymphocytes were T-cells showing OKT 6 positivity and nuclear immunoreactivity for terminal deoxynucleotidyl transferase (TdT) in the intrapulmonary tumor, like lymphocytes in the mediastinal thymoma of predominantly lymphocytic or mixed types. Although lymphocytes were dispersed in the pleural tumor, there were some TdT(+) OKT 6(-) lymphocytes and the similar finding was observed in the thymoma of predominantly epithelial type. In lung carcinomas and pleural mesotheliomas, there were no TdT(+) OKT 6(+/-) lymphocytes. Immunohistochemical studies using lymphocyte markers may be an useful tool for the diagnosis of the thymoma of ectopic site or unusual presentation.

Many have made great efforts to improve the results of treatment for pulmonary metastasis. There are many problems to be solved in this field. We calculated the growth rate of a tumor based on the time interval and change in tumor size and divided the patients into two groups in relation to the tumor growth rate. We have made a study of how the growth rate of tumor influences the results of treatment in the two groups and have sought to determine what kind of treatment is most reliable for a metastatic lesion. Our study indicates that pulmonary resection is the most reliable treatment for metastatic pulmonary disease. The result of surgical treatment for a patient with a rapid tumor growth rate was inferior to that of a patient with a slow growth rate, though this result was not necessarily disappointing.

An autopsy case of prostaglandin E-producing hepatocellular carcinoma with hypercalcemia is presented in this article. A 72-year-old man showed high serum calcium levels (14.2 to 17.3 mg/100 ml) and hypophosphatemia. The plasma level of immunoreactive parathyroid hormone was below the normal range. Administration of oral indomethacin 50 mg daily was effective in decreasing the serum calcium concentration. However, this effect lasted only 5 days, after which it returned to pretreatment levels. The patient died in a hypercalcemic coma. By an autopsy, hepatocellular carcinoma was found in the right lobe of the liver. However, no obvious bone metastases nor abnormalities in the parathyroid glands were detected. The immunoreactive prostaglandin E level assayed in the neoplastic tissue (2278 ng/g) was significantly high when compared with level in the nonneoplastic liver tissue (194 ng/g). The production of prostaglandin E by the tumor itself appears to be the most likely mechanism for the hypercalcemia in this patient.