The PERCIVAL detector: first user experiments.

The PERCIVAL detector is a CMOS imager designed for the soft X-ray regime at photon sources. Although still in its final development phase, it has recently seen its first user experiments: ptychography at a free-electron laser, holographic imaging at a storage ring and preliminary tests on X-ray photon correlation spectroscopy. The detector performed remarkably well in terms of spatial resolution achievable in the sample plane, owing to its small pixel size, large active area and very large dynamic range; but also in terms of its frame rate, which is significantly faster than traditional CCDs. In particular, it is the combination of these features which makes PERCIVAL an attractive option for soft X-ray science.

[Intracavity drainage under local anesthesia for giant emphysematous bulla and infected bulla].

We performed a retrospective review of 9 patients who underwent intracavity drainage under local anesthesia for emphysematous bulla and infected bulla between 1996 and 2010. Three patients with giant emphysematous bulla were treated intracavity drainage. Pneumothorax occurred and was treated by chest tube in all cases. Radiographic and symptomatic improvement occurred in all patients. After that, bullectomy was performed safely in 2 patients and intrabullar suction with fibrin glue was performed in 1. There were 6 cases with infected bulla that was not improved by the administration of antibiotics. After intracavity drainage, control of infection was achieved, and all but 1 patient were discharged without drain and complications. Intracavity drainage under local anesthesia is a safe and effective treatment for giant emphysematous bulla and infected bulla.

[Lung cancer combined with idiopathic interstitial pneumonias].

It is known that patients with idiopathic interstitial pneumonias (IIPs) have an increased incidence of lung cancer. The purpose of this study was to evaluate the outcome of surgical treatment and to establish the surgical strategy for lung cancer with IIPs. Twenty-five patients with lung cancer and IIPs who were admitted in our hospital from 1996 to 2004 were examined. Eight patients underwent lobectomy with mediastinal lymph node dissection, while 17 patients underwent limited resection. The actuarial 3-year survival rate was 43%. There were no postoperative acute exacerbation of IIPs. We considered most patients were in a stable state of IIPs preoperatively, and we made effort to treat IIPs with limited resection. The prognosis of IIPs was poor. It is difficult to decide whether to carry out limited resection.

[Limited resection for small peripheral lung cancer using intraoperative pathologic examination].

From 1996 to 2002, we performed intentional limited resection for small peripheral lung cancer using intraoperative pathologic examination. Wedge resection was performed in patients who had small peripheral adenocarcinoma (< or = 20 mm), suspected of being Noguchi type A or B, and confirmed by intraoperative pathologic examination. Extended segmentectomy was performed in the rest of patients (tumor diameter < or = 20 mm), and not suspected of being Noguchi type A or B. Hilar and mediastinal lymph nodes sampling was performed in this group. If lymph node metastasis was detected by the intraoperative pathologic examination, the surgical procedures was converted into a lobectomy with lymph node dissection. Limited resection was performed in 27 patients, wedge resection in 8, and extended segmentectomy in 19. All patients received wedge resection are alive without sign of recurrence. In extended segmentectomy, 17 patients are alive with no evidence of disease, 1 patient died of non-pulmonary disease, and 1 patient is alive with recurrent disease. The overall survival rate at 5 years was 100% in wedge resection, 91% in extended segmentectomy, and 79% in standard lobectomy. We conclude that limited resection for small peripheral lung cancer using intraoperative pathologic examination may be safe and effective procedure.

Pulmonary complications after surgical treatment of lung cancer in octogenarians.

OBJECTIVE: The purpose of this study was to analyze the risks associated with pulmonary resection for primary non-small cell lung cancer in octogenarians to help better management in these patients. METHODS: We reviewed the outcome in our 35 patients aged 80 years and older who underwent pulmonary resection between 1981 and 1998. RESULTS: The 5-year survival rate was 39.8%. The operative mortality rate was 0% and the morbidity 60%. There were ten major pulmonary complications, including respiratory insufficiency following bacterial pneumonia and sputum retention. Preoperative arterial pO(2) was significantly lower, A-aDO(2) was significantly higher, and operation time were significantly longer in patients with pulmonary complications after surgical treatment than in patients without complications (P<0.05). CONCLUSIONS: Surgical treatment was not contraindicated for octogenarians with lung cancer. However, a relatively preoperative low arterial pO(2), high A-aDO(2), and long operation time may be risk factors for postoperative pulmonary complications in such patients. Surgeons must assess the preoperative data prudently to determine appropriate surgical strategy.

Improved sensitivity in the measurement of residual leukocytes in platelet products using an automated leukocyte counter.

BACKGROUND AND OBJECTIVES: Leukocytes remaining in platelet concentrates may be responsible for side effects caused by platelet transfusion. A simple method of high sensitivity for determining trace numbers of leukocytes is currently needed. MATERIALS AND METHODS: An automated leukocyte counter, the LD-1000, the principle of which is a combination of spinning down on the observation field of stained nuclei derived from a 100 microl neat sample and image digitization with a charge coupled device camera, was newly developed and tested for sensitivity and reproducibility. RESULTS: While the theoretical lower limit of detection was 0.01 cells/microl, the limit of detection of the LD-1000 was verified to be 0.2 cells/microl. A good correlation (r = 0.86) was observed between the results obtained using the Nageotte method and the LD-1000. Repeated measurements also confirmed satisfactory reproducibility. CONCLUSIONS: The instrument provides a new method of enumerating residual leukocytes in platelet products with better sensitivity and easier procedure compared to the Nageotte method and will be useful for quality assurance purposes at blood centers.

[A case of advanced esophageal carcinoma successfully treated with chemoradiation therapy with low-dose cisplatin and 5-fluorouracil].

We have experienced a case of advanced esophageal carcinoma successfully treated with chemoradiation therapy together with low-dose cisplatin and 5-fluorouracil, having only minor toxicity. A 55-year-old man was admitted to our hospital because of dysphagia. Cervical esophageal carcinoma was found to have invaded the larynx through endoscopy, and invasion to thyroid gland and trachea was suspected from a cervical CT. We diagnosed the condition as advanced esophageal carcinoma (A2N(-)M0Pl0 Stage III). We then treated the patient by chemoradiation therapy. After the treatment, the carcinoma could not be detected by CT and endoscopy, and endoscopic biopsy revealed there were no active carcinoma cells. The side effects of the therapy were very mild, therefore the patient could be discharged after a short time. No evidence of a tumor relapse was found 5 months after the therapy. We treated 4 patients with esophageal carcinoma using the same regimen, and the results of the therapy were 2 CR, 1 PR, and 1 PD, with an overall response rate of 75%.

[The role of IL-1 beta in murine model of otitis media with effusion].

Recent studies have demonstrated the presence of inflammatory cytokines such as IL-1 beta, TNF-alpha, IL-6, and IL-8 in the middle ear effusion (MEE) of patients with otitis media with effusion (OME). IL-1 beta is known to be produced from macrophages and monocytes in an early stage of inflammation by stimulation with microorganisms and endotoxins. Also, these studies have shown that endotoxins frequently are found in MEE and can induce OME in experimental animal model. These findings suggest that endotoxins in MEE cause a chain reaction of cytokines through IL-1 beta. However, the precise role of IL-1 beta in the pathogenesis of OME has not yet been clarified. In the present study, a murine model of OME was developed by intra-tympanic injection with endotoxin or recombinant mouse IL-1 beta (rIL-1 beta) and the effects of IL-1 beta on the production of MEE were investigated. OME was induced in specific pathogen-free male BALB/c mice by intra-tympanic inoculation with endotoxin purified from nontypeable Haemophilus influenzae or with rIL-1 beta. The presence of MEE in the subjects was observed through the ear drum under a microscope and samples of MEE were collected by aspiration and washing with phosphate-buffered saline. The concentrations of IL-1 beta in each sample of MEE were determined by ELISA and the histological changes were compared. The mice inoculated with endotoxin showed signs of the production of MEE and it was noted that the levels of IL-1 beta in MEE were significantly increased on day 3. Intra-tympanic inoculation with rIL-1 beta also produced MEE and these cytological findings of MEE as well as the histological findings of middle ear mucosa were similar to those found in the endotoxin-induced OME. Further, the influence of anti-IL-1 receptor antibodies on the production of OME was examined 3 days after intra-tympanic injection with anti-IL-1 receptor antibodies together with endotoxin or rIL-1 beta. The incidence of OME was lower in mice injected with anti-IL-1 receptor antibodies than that in mice injected with endotoxin or rIL-1 beta only. These findings suggest that IL-1 beta may play an important role in the pathogenesis of OME.

Effect of cardiopulmonary bypass on cytokine release and adhesion molecule expression in alveolar macrophages. Preliminary report in six cases.

Although recent studies have shown that adhesion molecules on alveolar macrophages are important in a variety of pulmonary diseases, there have been few studies on the phenotypic and functional changes of alveolar macrophages during cardiopulmonary bypass. To investigate the possible role of alveolar macrophages in activating pulmonary immunity during cardiopulmonary bypass, we measured the expression of adhesion molecules on alveolar macrophages and peripheral blood monocytes in patients undergoing cardiopulmonary bypass. Antigens were stained with monoclonal antibodies against adhesion molecules, and the expression of antigens was quantified by flow cytometry as the ratio of specific to nonspecific linear fluorescence. On alveolar macrophages obtained after the release of aortic cross-clamp, macrophages as compared with alveolar macrophages obtained before cardiopulmonary bypass, there was a significant enhancement of CD11a, CD11b, CD11c, and CD18. In addition, alveolar macrophages, but not peripheral monocytes, produced higher levels of TNF-alpha and IL-8 when they were cultured in vitro. A higher expression of CD11 and CD18 on alveolar macrophages and enhanced production of cytokines after release of the aortic cross-clamp may contribute to immune activation in lung by macrophage-lymphocyte interaction.

[A case of multicentric intraosseous well differentiated osteosarcoma originating in the rib].

We have experienced a rare case of multicentric intraosseous well differentiated osteosarcoma originating in the left 7th and 9th rib. A 35-year-old man was admitted to our hospital with slowly growing mass of the left chest wall. From radiographic appearance the mass was suspected multicentric tumor of bone originating from the left 7th and 9th rib, and from needle biopsy the mass was suspected giant cell tumor of bone. Tumors were completely resected en bloc, and chest wall defect was covered with Marlex mesh. Pathological diagnosis was multicentric intraosseous well differentiated osteosarcoma originating in the left 7th and 9th rib. At 8 months after operation, the patient is doing well and there is no evidence of recurrence and lung metastasis.

[A case of advanced gastric cancer showing complete disappearance of cancer cells in multiple liver metastases due to low-dose PMUE therapy].

A case of gastric cancer with liver metastasis who responded well to low-dose PMUE (CDDP, MMC, UFT, etoposide) therapy is reported. A 65-year-old man underwent distal partial gastrectomy with D2 lymph node dissection under the diagnosis of type 5 gastric cancer with multiple liver metastases. Pathological findings revealed papillary adenocarcinoma in the primary lesion and metastatic lymph nodes (No. 8a). Low-dose PMUE therapy after resection of primary lesion was effective for the liver metastases. Exacerbation was suspected, so the lesions of metastases were resected again after 2 years and 11 months postoperative course. All 4 resected lesions of metastases became old fibrous tissue with hyalinization, and 2 of 4 lesions were necrotic and surrounded by fibrous connective tissue. None of these 4 lesions included viable cancer cells. The patient has now been followed with no evidence of exacerbation. It was suggested that low-dose PMUE therapy was effective for liver metastasis of gastric cancer, especially the differentiated type.

Single- and double-strand breaks in pBR322 plasmid DNA by monochromatic X-rays on and off the K-absorption peak of phosphorus.

Using a synchrotron irradiation system pBR322 plasmid DNA was irradiated under vacuum by monochromatic X-rays having five specific photon energies (2.147, 2.153, 2.159, 2.168 and 2.199 keV) both on and off the K-absorption peak (2.153 keV) of phosphorus. The single- and double-strand breaks (ssb and dsb) were measured as conversions of the closed circular form of DNA (form I) to open circular (form II) and linear (form III) forms respectively. Exposures to induce one strand break per molecule were lowest at the peak (2.153 keV), and highest at 2.147 keV; the ratios were 2.7 for ssb and 3.0 for dsb. The exposures for dsb were 21-26 times higher than those for ssb. When the exposures were converted to absorbed doses in grays the absorbed doses per ssb were almost independent of photon energy. This result indicates that a certain absorbed dose was necessary to induce a ssb, regardless of whether photons were absorbed by the K-shell of phosphorus or by other shells, or by other atoms. However, the absorbed dose per dsb at 2.147 keV was 1.17 times higher than that averaged over four X-ray energies above 2-153 keV, indicating that the K-shell absorption, and the subsequent Auger event, efficiently induce dsb. The results are also discussed concerning the number of photo-absorptions of the constituent atoms per DNA strand break.

[Recovery from descending necrotizing mediastinitis and multiple organic failure after seven months of mechanical ventilation].

A 61-year-old man with a history of hypertension and diabetes mellitus had a tooth extracted. Nine days later, he was admitted to the hospital with complaints of high fever, dyspnea, and anterior chest pain. Physical examination revealed a drowsy man with a fever of 38.2 degrees C, blood pressure of 66/44 mmHg, and marked redness and swelling from the neck to anterior part of the chest. Laboratory examination indicated severe infection and multiple organ failure, consisting of cardiac, respiratory, renal, and hepatic failure, with disseminated intravascular coagulation. Chest X-ray and CT-scan films showed abscesses extending from the neck to the mediastinum, and bilateral pleural effusion. Immediately, he was treated with catecholamines, furosemide, mechanical ventilation with a high concentration of oxygen, continuous drainage, repeated skin incisions, and broad-spectrum antibiotics. In addition, steroid pulse therapy was administered for persistent respiratory failure. On the 28th hospital day, a fistula developed between the trachea and the mediastinum, and an intratracheal tube had to be inserted through the fistula. On the 212 th hospital day, after intravenous hyperalimentation, continuous intravenous insulin infusion, and administration of broad-spectrum antibiotics, catecholamines, and furosemide, the patient was weaned from mechanical ventilation. A restrictive ventilatory defect due to ankylosis and atrophy of underused muscles was noted after weaning, but the PaO2 was high with a low dose of oxygen (1 to 2 l/min), and 21 months later, the blood gases were normal while the patient was breathing room air. As of January, 1996, he was undergoing rehabilitation to promote his recovery from ankylosis, muscle atrophy, and speech dysfunction.

[Natural history of cloudy zone of pulmonary adenocarcinoma on HRCT].

Seven pulmonary adenocarcinomas with cloudy zone (CZ), which was defined as a lower density zone in the pulmonary lesion than pulmonary vessels in the surrounding normal lung on high resolution computed tomography (HRCT), were followed up for at least 3 months. There were three tumors with homogeneous CZ, one of which showed no change when rescanned after three months, the others showed enlargement with or without replacement by high density areas on rescanned images obtained after more than one year. Two tumors containing some high density areas on the initial scans showed slight decreases in size on rescanned images obtained after 1 to 3 months. However, on rescanned images obtained after more than 1 year and 9 months, these tumors also showed enlargement of CZ. Pathologically, CZs corresponded to well-differentiated adenocarcinoma of the bronchioloalveolar type with no or mild interstitial change, whereas high density areas mainly corresponded to papillary adenocarcinoma with severe interstitial fibrosis. In conclusion, long-term careful follow-up of CZ is necessary to detect enlargement or the appearance of high density. Unchanged CZ in short-term follow-up should be considered a finding suggestive of malignancy.

[Clinical study of ten cases with acute abdomen after eating raw firefly squid (Watasenia scintillans, Hotaruika), which are probably due to type X larvae of the suborder spirurina].

We studied ten cases with abdominal pain after eating raw firefly squid, Watasenia scintillans, Hotaruika. Characteristic clinical features were abdominal pain, nausea, vomiting, diarrhea, creeping eruption and ileus with ascites. In ten patients, there were all cases with abdominal pain, nine with nausea and vomiting, four with diarrhea, one with creeping eruption, six with ileus. Laboratory examination revealed eosinophilia on peripheral blood in ten cases and high serum IgE value in nine cases. The infection rate of type X lavae of the suborder spirurina in Watasenia scintillans is almost 3%, so we measured the antibody to type X larvae of the suborder spirurina in nine patients by indirect fluorescent antibody method and the antibody titer was positive in seven cases. Most patients recovered in several days from first visit. But one patient was diagnosed peritonitis and operated with partial ileectomy. Pathological finding of resected specimen showed an erosion in the mucosal layer and an inflammation with marked eosinophilia in the submucosal layer. These results suggest that abdominal complaints after eating Watasenia scintillans are due to type X larvae of the suborder spirurina.

Peripheral lung carcinomas associated with central fibrosis and mixed small cell and other histologic components.

Three cases of peripheral small cell lung carcinoma (SCLC) with central fibrosis are presented. Central fibrosis is usually present in adenocarcinomas. Cases 1 and 2 are combined SCLCs with components of papillary adenocarcinoma, and case 3 is a mixed SCLC with a large cell component. Small cell components showed intermediate cell type in all cases. In cases 1 and 2, there was a gradual transition between small cell carcinoma and papillary adenocarcinoma. Small cell components showed Grimelius argyrophilia, but other neuroendocrine markers such as neuron specific enolase, chromogranin A, Leu-7 and synaptophysin were negative. The chest X-ray examination of case 1 demonstrated rapid enlargement of a tumor shadow, which was present two years before, for a recent year. Central fibrosis, coexistence of small cell carcinoma and papillary adenocarcinoma, and a change of growth rate in the chest X-ray may suggest that some SCLC derive from papillary adenocarcinomas.

Cloudy nodule on HRCT: a new clinico-radiologic entity of pulmonary adenocarcinoma.

We propose cloudy nodule (CN) on HRCT as a special type of pulmonary adenocarcinoma. CN was defined as a cloudy nodular shadow in the peripheral part of the lung with lower density than pulmonary vessels on HRCT. Radiologic images of nine CNs in eight cases were correlated with the pathological findings of the resected specimen. All CNs were clearly demarcated on HRCT. They were pathologically composed of well differentiated adenocarcinoma, mainly bronchioloalveolar type with little or no central scar. Plain films were negative in six of nine cases. CN on HRCT may indicate well-differentiated adenocarcinoma with good prognosis.

Pulmonary myxoid leiomyosarcoma.

A primary myxoid leiomyosarcoma arising from the peripheral bronchus of the right middle lobe was removed from a 20 year old man and examined by immunohistochemistry and electron microscopy. The tumor was well circumscribed, yellow-whitish focal polypoid growth into the bronchial lumen and consisted of spindle cells with abundant myxoid substance in the stroma. Intrapulmonary metastasis, invasion to the bronchial wall and a few mitotic figures were found. Immunohistochemically, several, but not all, tumor cells were positive against anti-vimentin, anti-S-100 protein, anti-myosin and anti-muscle specific actin. Ultrastructurally, tumor cells had thin filaments with dense bodies, pinocytic vesicles and discontinuous basal lamina. These findings indicate a myoxoid variant of leiomyosarcoma arising from mesenchyme in the peribronchial area.

[Successful surgical repair of tracheo-innominate artery fistula in a case of ALS patient with long-term mechanical ventilation].

A 59-year-old man with ALS developed dyspnea and was performed tracheostomy in September 1987. The cuff volume of a tracheostomy tube increased gradually in four years of mechanical ventilation. His chest X-ray in December 1992 showed a marked enlargement of the cuff. In March 1993, massive hemorrhage suddenly occurred through the tracheostomy site. This was controlled by hyperinflation of the cuff. He was diagnosed as tracheo-innominate artery fistula. An emergent operation was done by median sternotomy and right oblique cervical incision. The innominate artery, the subclavian artery and the common carotid artery were severed and occluded with sutures. The tracheal fistula was closed with a suture of monofilament. The postoperative course was satisfactory, however he died of respiratory failure ten months after the surgery.

Multiple angiomyolipoma of the liver.

Angiomyolipoma (AML) of the liver is extremely rare; we believe only about 60 cases, all solitary, have been reported. We present here the first reported case, to our knowledge, of multiple AMLs in the liver. Two masses were found in the liver of a 43-year-old Japanese woman complaining of abdominal discomfort by ultrasonography and computed tomography. With a preoperative diagnosis of hepatocellular carcinoma, a tumor in the right lobe 4.0 cm in largest diameter and one in the left lobe measuring 2.4 cm were resected. Histologically, both tumors were composed of smooth-muscle cells, fat cells, and blood vessels, and contained foci of extramedullary hematopoiesis. Although the smooth-muscle cell component was predominant and both tumors exhibited some pleomorphism, no mitosis was found. These histologic findings are consistent with the diagnosis of AML.