[Chondromatous hamartoma of the lung with a unique demonstration on diagnostic imaging; report of a case].

A case of pulmonary hamartoma is reported with clinical, roentgenographical and histopathologic findings. The patient was a 53-year-old woman who had undergone right hemithyroidectomy for thyroid cancer 4 years before. An abnormal shadow, which was a non-clearly demarcated tumor, 2 cm in diameter, in the left middle lung field, was noted on her routine X-ray in February 2001. Physical examination and laboratory data revealed no significant findings, but computed tomography(CT) scans of the chest showed a gathering of small-sized high-density lesions in the nodule. She underwent left S8 segmentectomy on March 21, 2001. The pathology report on the frozen section was pulmonary hamartoma. Histopathologically, the lesion was characterized by a composition of bronchial epithelium, fat tissue and cartilage, with being diagnosed as a chondromatous hamartoma of the lung. The patient's postoperative course was uneventful, and she was discharged with no supportive therapy 14 days after the operation. To date, 14 months after the operation, the patient has been in good condition, without evidence of recurrence or distant metastasis on diagnostic imaging. This case is particularly interesting because a gathering of small-sized pulmonary hamartoma was demonstrated by imaging.

Primary mediastinal germ cell tumor in a middle-aged woman: case report and literature review.

Although primary mediastinal germ cell tumors are found much more frequently among young males than among other people, we recently encountered a middle-aged woman with the disease. The patient was a 59-year-old woman who complained mainly of anterior chest pain. Chest CT scans revealed a nonhomogeneous mass measuring 7 x 7 cm in the anterior mediastinal area, accompanied by signs suggestive of mediastinal invasion of the tumor. Reduction surgery was performed. The pathologic diagnosis was mediastinal dysgerminoma. The patient received postoperative radiochemotherapy but died due to liver metastasis 11 months after surgery.

Immunohistochemical study of p53, c-erbB-2, and PCNA in barrett's esophagus with dysplasia and adenocarcinoma arising from experimental acid or alkaline reflux model.

PURPOSE: An immunohistochemical study of p53, c-erbB-2, and proliferating cell nuclear antigen (PCNA) in Barrett's esophagus with dysplasia and adenocarcinoma, arising from experimental acid or alkaline reflux, was performed in dogs. METHODS: Cardiectomy was performed in group A (n = 26) as an acid reflux model, and total gastrectomy was performed in group B (n = 24) as an alkaline reflux model. After surgery, the esophageal mucosa was observed and biopsied endoscopically every 3 months over a period of 6 years. Immunohistochemical staining of p53. c-erbB-2, and PCNA was performed, using biopsied specimens. RESULTS: In group A, Barrett's esophagus developed in 14 of the 26 dogs. Low-grade dysplasia occurred in 5 of the 26 dogs, and in 1 of these 5 dogs, it developed into high-grade dysplasia. In this animal, adenocarcinoma arose 63 months after the operation. In group B, Barrett's esophagus developed in 10 of the 24 dogs. Low-grade dysplasia was observed in 4 of the 24 dogs. In 1 of these 4 dogs, the dysplasia became high-grade and adenocarcinoma occurred 66 months after the operation. In group A, PCNA was positive in adenocarcinoma; the PCNA labeling index (LI) was 58. c-erbB-2 and p53 were negative in all animals in group A. In group B, PCNA was positive in Barrett's esophagus with high-grade dysplasia and adenocarcinoma; the PCNA LI was 77. p53 was positive in adenocarcinoma. c-erbB-2 was negative in adenocarcinoma. CONCLUSIONS; The results of this study provided evidence of the dysplasia-carcinoma sequence arising from alkaline reflux, as well as from acid reflux. To the best of our knowledge, this is the first report of the use of an alkaline reflux model and a 6-year study using dogs to observe the course of Barrett's esophagus.

Intrathoracic free musculocutaneous flap after open-window thoracostomy for chronic empyema.

An 85-year-old man was suffering from right pyothorax caused by methicillin-resistant staphylococcus aureus (MRSA). The empyema cavity was closed by intrathoracic implantation of a free rectus abdominis musculocutaneous (MC) flap using microvascular surgery 2 months after open-window thoracostomy (OWT). Compared with a pedicled MC flap, a free flap has the advantage that it can close a larger empyema cavity since the whole flap can be inserted into the cavity. Although the use of a free MC flap requires a two-stage operation, this method is believed to be more successful for controlling chronic empyema than any other established procedure, including decortication, thoracoplasty or pleuropneumonectomy.

Clinical management of intraductal papillary mucinous tumors of the pancreas based on imaging findings.

The aim of this study was to assess the imaging findings of pathologically proven intraductal papillary-mucinous tumors of the pancreas and the natural history of follow-up cases, and to optimize the therapeutic management of patients with these tumors according to their imaging findings. All nine patients with main duct type tumors were histologically diagnosed as having adenocarcinoma or adenoma, with no hyperplastic lesion. The images failed to discriminate between the two histologic types. In 26 patients with branch duct type tumors, all but one with intraductal mural nodules or tumors of > or = 30 mm had adenocarcinoma or adenoma, regardless of the caliber of the main duct. Of the nine patients with tumors < 30 mm and no mural nodules. three had adenoma, and six had hyperplasia. All of four patients had hyperplasia, with the additional caliber of the main duct being < 6 mm. In a series of 23 cases in which the patient was followed-up, no apparent progression was found in 17 patients who had no mural nodules and tumors of < 30 mm. Given these results, patients with main duct type tumors, and those with branch duct type tumors showing mural nodules or a tumor diameter of > or = 30 mm, are at high risk of developing neoplasms, including adenocarcinoma, for which surgical resection should be considered, whereas those patients with tumors < 30 mm and no mural nodules can be followed.

Gluteal abscess caused by perforating rectal cancer: case report and review of the literature.

An unusual case is described in which an abscess developed remote from a carcinoma of the rectum. A 52-year-old Japanese man developed a gluteal abscess six months after radiation therapy for unresectable carcinoma of the rectum. This case is presented with a review of the literature. Perforating carcinoma of the colon and rectum with abscess formation is best treated by preliminary total diversion colostomy and local drainage of the abscess. However, the mortality rate is still high.

Desmoid tumor of the chest wall following chest surgery: report of a case.

Desmoid tumors of the chest wall following chest surgery are a rare occurrence. A case of this disease is reported herein together with a review of the literature. A 74-year-old man, who had previously undergone a right lower lobectomy for squamous cell carcinoma of the lung, was referred to our hospital with an abnormal shadow on his chest X-ray. The tumor, located in the right lateral chest wall, was successfully resected by an aggressive, wide extirpation, and a final diagnosis of a desmoid tumor originating in the chest wall was made. When following up patients after surgery for lung cancer, the possibility of desmoid tumors developing in the incised chest wall should therefore be kept in mind.

[The effects of marital communication and social activity on alienation in married women and men].

Effects of marital communication and friendship- and job-related social activities on emotional support and alienation among married women and men were examined. Causal analyses of questionnaire responses by 259 women and 185 men indicated that for both women and men, richness of marital communication made the spouse more important as the agent of emotional support, and at the same time decreased alienation. Job-related activities decreased women's alienation, while they tended to increase men's alienation. Men's social activities had a negative influence on their marital relation. In short, women and men appeared to seek different psychological functions in social activities, which in turn determined their levels of alienation.

[Social network and social support for married women and their spouses].

This study investigated various psychological aspects of social networks of married women and their spouses A survey data for 259 women and 185 men were analyzed, and main findings were as follows: 1. With marriage, support agents of women and men change extensively in their social networks. Wives have more variety in support agents within their social network, through children to their friends' parents. On the other hand, husbands' agents are likely to be confined to their wives and children. 2. Wives and husbands are similar in that their first choice for seeking advice is their spouse. A friend is the second choice for both of them. While parents, brothers and sisters serve as wives' third choice, there is no third for husbands. 3. Enrichment of wives' social network, based on a well-functioning relationship with husbands, leads to a lower degree of social isolation experienced by them.

[The role of catalase in histologic changes of acute experimental pancreatitis].

We produced acute biliary reflux pancreatitis by an injection of auto-bile in 31 young mongrel dogs. We divided into control group (n = 10), catalase administration group (B1 group, n = 17) and no-administration group (B2 group, n = 14). We studied the histologic changes of the brain tissue in those groups. There was no significant difference in the survival rate between group B1 and B2. In the histologic findings, ischemic cell changes were dominant in both groups within one month, but after 3 or 6 months after operation in group B2, satellitosis and/or neuronophagia was recognized as the irreversible changes. The lipid peroxides level was significant high in group B2. Consequentially, it is natural to think that the production of free radicals have been inhibited by catalase and the histologic changes in the brain in group B1 have been light.

A new surgical procedure consisting of ligation of the common hepatic artery and auto-transplantation of hepatocytes into the spleen for end stage liver cirrhosis accompanied by ascites.

The authors developed a new surgical procedure for end stage liver cirrhosis associated with ascites. This procedure consists of ligation of the common hepatic artery and hepatocyte inoculation into the spleen (method A) and in this study is compared with common hepatic artery ligation alone (method B). Six of the eleven dogs operated by method A survived for six months or more with a significant (P < 0.01) difference in the three month survival in comparison with method B. In the hemodynamic study of both methods, the portal vein pressure and portal resistance decreased as a result of operation, but in method B, they returned to preoperative levels and in method A the low levels persisted for more than one year. In our method, liver function improved remarkably after three months. The hepaplastin and the cholinesterase levels increased after three months in method A with a significant difference (P < 0.01) in comparison with method B. The labeling index (L.I.) of intrasplenic hepatocytes also increased three months later. We emphasize that our method is an ideal procedure not only to improve portal haemodynamics but also to improve liver function, in end stage cirrhosis.

Predicting histologic findings from endoscopic appearance of early gastric cancer.

In 156 cases of depressed early gastric cancer in the antrum or corpus, the differences between differentiated and undifferentiated carcinoma were studied by comparing the histological diagnosis of the resected specimens and their endoscopic appearance. We reached the following conclusions: (a) Younger patients more often had undifferentiated carcinoma (mean age: 59.8 years) than differentiated carcinoma (mean age: 77.2 years). (b) One hundred and twenty-five of 156 cases were limited to the mucosa and 29 cases were limited to the submucosa. (c) Undifferentiated gastric cancers more often invaded beyond the mucosa even when the tumor was small than did differentiated tumors. (d) Many differentiated tumors showed a smooth depressed surface, erythema at the edge of the cancer, and tapering of the gastric rugae. (e) In undifferentiated lesions the depressed tumor surface had a varied appearance, with various sized granules and nodules, as well as fading of the mucosal color and fusion of the rugae. It is important at endoscopy to consider not only whether a lesion is benign or a malignant, but also to consider its histological type. In particular, it is vital to detect small, undifferentiated gastric cancers as early as possible.

[Adenomyoma in association with early gastric carcinoma].

Described is a gastric adenomyoma associated with superficial gastric adenocarcinoma that was found in a 72-year-old male. This uncommon benign gastric lesion is believed to be developmental in origin and sometimes categorized as belonging to a subgroup of a heterotopic pancreas. Besides its rarity, an adenomyoma is also known to be a possible cause of a gastric malignancy. Although the focus of the carcinoma in our case was located in the center of the adenomyoma, this finding cannot support the etiology of a gastric carcinoma originating in an adenomyoma. However, the present case appears to imply some relationship between an adenomyoma and a gastric carcinoma.

[A hepatocellular carcinoma revealed by paraplegia caused by a vertebral metastasis].

Described is a 57-year-old male with a complaint of a gait disturbance. On admission to hospital, he was suffering from almost complete paraplegia. Roentgenograms of the spine showed extensive destruction in the body of the second thoracic vertebra. Magnetic resonance computed tomography revealed a vertebral tumor that was compressing the vertebral cord. Thus, a laminectomy of the 1st to 3rd thoracic vertebra was performed to relieve the compression. Histological examination of the tumor showed it to be a metastatic vertebral tumor from a hepatocellular carcinoma (HCC). Subsequently, by abdominal computed tomography and an examination of the AFP serum level the existence of the HCC was confirmed. This is a very rare case of an HCC that was revealed by paraplegia caused by bone metastasis.

[Comparative study of tegafur (p.o.) and mitomycin C (MMC) plus tegafur in cases of unresectable gastric cancer].

Sixteen cases of gastric cancer with liver metastases (H2 less than) as group A, fifteen with distant peritoneal metastases (P2 less than) as group B, twenty-five with distant lymph nodes metastases (N3 less than) as group C, twenty-eight with two prognostic factors as group D, and seven with three factors as group E were treated. A1, B1, C1, D1 and E1 groups were treated with mitomycin C (MMC) (4 mg) + tegafur (FT) (400 mg) (i.v.-weekly) and A2, B2, and C2 group with FT (600 mg) (p.o.-daily). Partial response in the evaluable cases was found in 7 cases and a total response rate was 11.7%. The 50% survival interval was as follows; 8.5 months (M) in A1 group, 10.0 M in A2, 7.2 M in B1, 2.3 M in B2, 10.4 M in C1, 14.2 M in C2, 5.2 M-7.2 M in D1, and 3.1 M in E1. In the cases with H2 less than or N3 less than, FT (p.o.) and with P2 less than, MMC + FT (i.v.) were effective respectively. Chemotherapeutic effect was better in A1 and A2 group from the aspects of prognostic factors and in the cases of poorly differentiated adenocarcinoma from histological types than in B1 and B2 group and well or moderately differentiated adenocarcinoma.