Objective analysis of the effectiveness of facial massage using breakthrough computed tomographic technology: A preliminary pilot study.

BACKGROUND: Facial massage is empirically known to be associated with morphological changes, such as improvements in facial sagging. However, quantified objective evaluations of massage-induced changes have not been performed to date. This preliminary pilot study aimed to verify the effectiveness of facial massages by using breakthrough computed tomographic technology. MATERIALS AND METHODS: Five healthy adult volunteers (three women and two men; age, 29-37 years) were enrolled, and computed tomography (CT) examinations using a 320 detectors-spiral CT system known as 320-multidetector-row CT (MDCT) were performed before and after facial massages. Each participant performed a self-massage twice daily for 2 weeks. Massage-induced changes in the cheeks and the superficial musculoaponeurotic system (SMAS) were analyzed by two radiologists on a workstation with a high-accuracy imaging analysis system. RESULTS: After facial massage, the malar top became thinner by -0.8% ± 0.45% and shifted cranially and horizontally over a distance of 3.9 ± 1.94 mm. The SMAS-height, defined as the highest vertical distance of the SMAS, increased by 2.6% ± 2.6%. The change rate in cheek thickness and SMAS-height showed a significant correlation (r = -0.63; P < 0.05). These changes were attributed to the lifting and tightening effects of facial massage. CONCLUSION: We conducted a detailed analysis of the effects of facial massages by using the breakthrough CT technology. Our results provide useful information for beauty treatments and could contribute to the collection of objective scientific evidence for facial massages.

Early experience using the da Vinci Surgical System for the treatment of mediastinal tumors.

PURPOSE: The da Vinci Surgical System has been used in only a few cases for treating mediastinal tumors in Japan. Recently, we used the da Vinci Surgical System for various types of anterior and middle mediastinal tumors in clinical practice. We report our early experience using the da Vinci Surgical System. METHODS: Seven patients gave written informed consent to undergo robotic surgery for mediastinal tumor dissection using the da Vinci Surgical System. We evaluated the safety and feasibility of this system for the surgical treatment of mediastinal tumors. RESULTS: Two specialists in thoracic surgery who are certified to use the da Vinci S Surgical System and another specialist acted as an assistant performed the tumor dissection. We were able to access difficult-to-reach areas, such as the mediastinum, safely. All the resected tumors were classified as benign tumors histologically. The average da Vinci setting time was 14.0 min, the average working time was 55.7 min, and the average overall operating time was 125.9 min. The learning curve for the da Vinci setup and manipulation time was short. CONCLUSION: Robotic surgery enables mediastinal tumor dissection in certain cases more safely and easily than conventional video-assisted thoracoscopic surgery and less invasively than open thoracotomy.

[Atypical carcinoid of the lung with abnormal elevation of serum ProGRP level; report of a case].

We report a rare case of an atypical carcinoid of the lung with the elevation of serum ProGRP. A 79-year-old female was referred to our hospital presenting with an abnormal shadow by a chest X-ray film. Chest computed tomography (CT) scan revealed a well-defined solitary nodule in the left lower lobe. The serum level of ProGRP was elevated to 2.267 pg/ml (normal range: <46 pg/ml). Pulmonary carcinoid was pathologically suggested by a transbronchial lung biopsy. Considering the patient's general condition, a partial wide resection was performed. Pathological diagnosis was atypical carcinoid. After the operation, further increase of the serum ProGRP level was noted, and multiple liver metastases developed.

Met-RANTES ameliorates fibrous airway obliteration and decreases ERK expression in a murine model of bronchiolitis obliterans.

OBJECTIVES: Bronchiolitis obliterans (BO) is the main cause of late mortality among long-term survivors of lung transplantation. Chemokine-chemokine receptor (CCR) interaction and subsequent recruitment of infiltrating cells to the graft are early events in the development of chronic rejection of transplanted lungs. The present study investigated whether blockade of chemokine receptors CCR1 and CCR5 with Met-regulated-on-activation, normal T cells expressed and secreted (RANTES), an amino-terminal modified derivative of RANTES/CCL5, affects the development of BO in murine model and we sought to determine the expression of RANTES/CCL5 and their relationship with extracellular signal-regulated kinase (ERK). MATERIALS AND METHODS: BALB/c mouse tracheas were heterotopically transplanted into C57Black6 recipients and treated for 21 days with either Met-RANTES at 20 microg/day or vehicle. Animals were killed at 21 days after transplantation for histologic examination of ERK expression. RESULTS: RANTES/CCL5 was highly expressed in allografts compare to isografts. Met-RANTES treatment ameliorated fibrous airway obliteration in a mouse model of BO and decreased ERK expression. CONCLUSION: Blockade of chemokine receptors by Met-RANTES ameliorated airway obliteration and decreased ERK expression. These findings suggest that chemokine receptors CCR1 and CCR5 play significant roles in the development of chronic rejection and ERK may be a new molecular target for chronic rejection.

[A case report of local recurrence of esophageal cancer after chemoradiation successfully treated by placement of tracheal stent].

We have experienced a case of esophageal cancer demonstrating a progressive stricture, due to local recurrence after chemo-radiotherapy, successfully treated by placing a tracheal stent into the esophageal lumen. After placing the stent, the patient's quality of life has improved. For the patient who received radiation for esophageal cancer, esophageal stenting often caused a serious complication such as perforation due to tissue stiffness. Tracheal stent with a smaller diameter successfully improved a food passage without any adverse complications. Development of the covered esophageal stent with a smaller diameter to prevent a perforation after radiation is desired.

[Two cases of colon cancer after resection of recurrence at peritoneal dissemination were for long-term survival with adjuvant chemotherapy].

Generally the peritoneal dissemination of digestive cancer was difficult to control. The symptom of dissemination will decrease quality of life (QOL) for these patients. The diagnosis for the range of dissemination was difficult. Therefore, the decision of the treatment was wavered between an operation and chemotherapy. The effect of chemotherapy was controversial so the cure was inconsistent. We experienced with two recurrent colon cancer patients who underwent resection of peritoneal dissemination and adjuvant chemotherapy. Case 1 was a 62-year-old man. He was operated for left colectomy against descending colon cancer with perforation. After two years, the recurrence of peritoneal dissemination and short bowel obstruction appeared. He was performed short bowel resection and FOLFIRI chemotherapy after surgery. Case 2 was a 72-year-old woman. She was operated on sigmidectomy against sigmoid colon cancer. After three years, the recurrence of peritoneal dissemination at the anastomotic lesion appeared. She was performed low anterior resection (LAR) and S-1 chemotherapy after surgery. But after 3.5 years, the peritoneal dissemination at the anastomotic lesion appeared once more. We decided to have LAR operation and FOLFOX 4 chemotherapy. Both cases maintained a good QOL for a long time. The operation against peritoneal dissemination was one of the good treatments if the range of peritoneal dissemination was clearly restricted.

[A case of perforated metastatic small intestine tumor from the lung].

We report a case of perforated metastatic small intestine tumor from the lung. A 56-year-old male admitted for lung cancer with multiple distant metastases developed severe epigastralgia. As radiographic examination revealed free air below diaphragm, we have suspected perforation of upper digestive tract. Exploratory laparoscopy carried out the next day demonstrating perforation of proximal jejunum. Despite jejunal resection, the patient has died of respiratory failure. Pathological evaluation of resected intestine showed a metastatic jejunal tumor with perforation. Metastatic tumor in the digestive tract from lung is a rare condition, and it usually occurs as a part of systemic involvement. To achieve an early diagnosis and treatment, perforation of metastatic tumor should be taken into notice.

[A case report of small cell carcinoma of the esophagus successfully treated by irinotecan and cisplatin].

Small cell carcinoma of the esophagus is regarded as having a poor prognosis with frequent and early recurrence against various treatments. We have experienced a case of small cell carcinoma of the esophagus manifested by massive lymph node metastasis in the upper mediastinum successfully treated by CPT-11 and CDDP, and that a patient survived for 17 months after the initial treatment. A 62-year-old man underwent endoscopy due to a disturbance of the food passage. Pathological evaluation of biopsy specimen revealed small cell carcinoma of the esophagus. As he was diagnosed with bilateral lymph node metastasis in the upper mediastinum by CT scan, a systemic chemotherapy with CPT-11 and CDDP was adopted. After 2 courses of chemotherapy he could be discharged as the size of the tumor was reduced. After 3 courses of additional chemotherapy 8 months after the initial treatment, a recurrent tumor was indicated at the right side of the lymph node of the neck. A weekly radiation with concurrent administration of docetaxel was carried out as a second line treatment. He is surviving for 17 months after the initial treatment without any evidence of recurrence. Due to histo-pathological similarity, a treatment for small cell carcinoma of the esophagus resembles that of the lung. Recently, the combined treatment of CPT-11 and CDDP was reported to demonstrate a better influence on a patient's survival for small cell carcinoma of the lung. For the esophagus, CPT-11 and CDDP was also an effective treatment.

[A case of a gastric cancer patient who obtained good treatment in spite of a nontreatment decision].

The patient was a 57-year-old male who had received schizophrenia and alcoholism treatments for ten years. Hospitalization and release was repeated many times over in the psychiatry department of the hospital up to the present time. He received an upper endoscopy because of a stomach ache in May, 2004. He was diagnosed as having gastric cancer (L, post, Type 2, T2 (SS), N2, stage IIIA). Neoadjuvant chemotherapy TS-1+CDDP was begun from the beginning. However, he refused the operation afterwards and we changed the treatment. The chemotherapy was maintained until January, 2005, to enforce seven courses of the treatment and to maintain the long NC for about ten months. Afterwards, he refused the treatment again and did not come to the hospital. After six months, he came to hospital again for pyloric stenosis due to a stomach cancer that developed. We placed a PEG to keep the route for access to the pylorus in August. And we used it to induce the self-expandable metal stent (EMS) to the pylorus. As a result, oral ingestion became possible. He was able to obtain a good QOL for three months until dying thereafter. It is thought that stenting is one of the most effective treatments to correspond to the diversification of the treatment policy.

[A case of unresectable hilar cholangiocarcinoma treated with an insertion of biliary stent and herbal medicine obtaining a good quality of life].

An advanced hilar cholangiocarcinoma was poor in prognosis and required a biliary duct drainage tube insertion to prevent jaundice. An endoscopically placed metallic biliary stent is efficient for improving QOL of patients with the disease. This case was of a 65-year-old man. He was admitted to our hospital with obstructive jaundice. Hilar cholangiocarcinoma was diagnosed by computed tomography (CT) and MR cholangiopancreatography (MRCP). Abdominal angiography revealed an unresectable cholangiocarcinoma through the portal vein obstruction and stenosis of the left hepatic artery for tumor invasion. After a second opinion and informed consent, he was inserted a biliary stent (non-covered metallic stent) under an endoscopy. The jaundice was improved further and other laboratory data showed normal results except for tumor markers. After the patient left the hospital, he came to our hospital as an outpatient basis for observation. He was prescribed herbal medicine from the other hospital. Now after ten months since the biliary stent insertion, he has been free from symptoms with normal laboratory data.

Microwave coagulation therapy in canine peripheral lung tissue.

BACKGROUND: New modalities for local treatments that destroy tumor effectively but which are less invasive and less damaging to normal lung tissue must be developed for patients who are unable to undergo even video-assisted thoracic surgery (VATS) due to poor cardiopulmonary function, severe adhesion, or advanced age, etc. We evaluated the use of microwave coagulation therapy (MCT), which has been used successfully for coagulation of hepatic tumors, in normal canine lung tissue to evaluate its efficacy and safety. MATERIALS AND METHODS: Measurements of thermal response and coagulation area and histological examinations after microwave coagulation were performed in normal canine lung tissue. RESULTS: The temperature in normal canine lung tissue increased to 90-100 degrees C at 5 mm from the electrode after 60 s and 70-80 degrees C at 10 mm after 90 s at 40 or 60 W. The coagulation area was approximately 20 mm in diameter at 40 W and 60 W. Histological analysis demonstrated thickening of collagen fiber shortly after coagulation, stromal edema and granulation tissue after 3 months, and, finally, scar tissue was seen after 6 months. CONCLUSIONS: Microwave coagulation therapy (MCT) is a useful modality for minimally invasive therapy in peripheral lung tumors.