[Matured mediastinal teratoma with high levels of tumor markers in cystic fluid].

A 42-year-old woman was admitted to Gifu Municipal Hospital because of an abnormal mediastinal shadow on a chest X-ray film. The serum CA125 level was slightly high 38 U/L, normal: < 35 U/L. Preoperative examination of fluid from a cyst revealed a high level of carcinoembryonic antigen (550 ng/ ml). The tumor resected was 11 x 9 x 5 cm. Microscopic examination revealed a matured teratoma containing pancreatic cells, collagenous tissues, squamous epithelia, and hair follicle-like tissues. Biochemical analysis of the cystic fluid revealed high levels of eight tumor markers: carcinoembryonic antigen, CA125, CA19-9, SLX, Ferritin, NSE TPA, and elastase 1. Samples stained positively for the tumor markers carcinoembryonic antigen CA125, CA19-9, and NSE by ABC immunohistochemical staining. The serum carcinoembryonic antigen levels had decreased to the normal level within two weeks after the surgery. The high levels of tumor markers and materials in the cystic fluid may have been related to the biological characteristics of the various cell components in this matured teratoma.

Long-term effects of dietary fiber supplementation on serum glucose and lipoprotein levels in diabetic rats fed a high cholesterol diet.

We have shown that cholesterol-fed diabetic rats developed atheromatous lesions in the aorta and coronary arteries, which were not observed in cholesterol-fed diabetic rats receiving concomitant supplementation with 15% glucomannan, a soluble dietary fiber concentrate. The present study was designed to examine the effects of the dietary fiber supplementation on serum levels of glucose and lipoproteins in cholesterol-fed diabetic rats. Feeding a diet containing 1.5% cholesterol (wt/wt) and 0.37% cholic acid for 18 weeks to rats made diabetic by streptozotocin (35 mg/kg body weight, iv) produced moderate hyperglycemia and moderate hypercholesterolemia, the latter being characterized by high concentrations not only of low density lipoproteins but also intermediate density lipoproteins and very low density lipoproteins. These changes in serum lipoproteins and hyperglycemia were substantially reduced by 18 weeks of supplementation with glucomannan but high density lipoprotein cholesterol and triglyceride levels did not change after feeding a cholesterol-rich diet in the presence or absence of glucomannan supplementation. These results suggest that amelioration in hyperlipoproteinemia and hyperglycemia induced by the dietary fiber supplementation may help retard or prevent the atheromatous formation found in cholesterol-fed diabetic rats.

Emergency cardiopulmonary bypass support in patients with cardiac arrest caused by myocardial infarction.

Emergency percutaneous cardiopulmonary bypass support (PCPS) was instituted in 3 patients with acute myocardial infarction in cardiac arrest refractory to conventional resuscitation measures. All had severe double or triple vessel disease. Percutaneous transluminal coronary angioplasty (PTCA) was performed in 1 patient and PTCA and directional coronary atherectomy (DCA) were performed in the other 2 patients on combined intraaortic balloon pumping (IABP) and PCPS. Flow rates of 2 to 5 L/min were achieved, with restoration of mean arterial pressure to more than 60 mm Hg during PCPS. The status of all patients was improved hemodynamically with PCPS. One patient died of hemorrhage during PCPS. DCA was successfully performed in the other 2 patients, and PCPS and IABP was discontinued. Time on PCPS ranged from 10 h to 8 days. Time on IABP ranged from 10 days to 2 weeks. These 2 patients died of pneumonia or multiorgan failure after 1.5 months. In conclusion, emergency PCPS is a powerful resuscitative tool that may stabilize the condition of patients in cardiac arrest to allow for definitive intervention.

[A case of pneumothorax due to pulmonary metastasis from breast cancer].

A 38-year-old woman was admitted because of left pneumothorax on March 16, 1991. She had undergone modified radical mastectomy in Dec. 1986. Chest roentgenogram on admission show a tumor shadow in the left upper lobe. She was diagnosed to have pneumothorax due to metastatic lung tumor. She underwent left upper lobectomy. Histologically poorly differentiated papillotubular adenocarcinoma was found and the cause of pneumothorax was thought to be necrosis of the tumor and direct invasion of the pleura.

[Mitomycin C associated hemolytic uremic syndrome--a case report and review of the Japanese cases].

A 36-year-old man who developed hemolytic uremic syndrome (HUS) associated with mitomycin C (MMC) after the radical operation for early gastric cancer was reported. He was successfully treated with hemodialysis and transfusion of fresh frozen plasma. However, the pathogenesis and the effective treatment of this syndrome are still undetermined. The literature on MMC-induced HUS in Japan was reviewed, and the relationship between the prognosis and the patients conditions, such as sex, age, site of primary cancer, total dose of MMC, latent period from MMC administration, laboratory findings at the time of diagnosis and treatment with steroids or plasma exchange, were analysed. Patients less than 60 years old or treated with plasma exchange were found to be associated significantly with a favorable outcome. The most frequent cause of death was pulmonary edema or respiratory failure. In conclusion, early treatment with plasma exchange appeared to result in a better prognosis.

[A case report on progressive hematomatous organizing empyema accompanied with intrathoracic hemangioma].

The patient, a 63-year-old woman, who had undergone extra-pleural plombage due to tuberculosis in 1961, was regularly treated for chronic empyema at our outpatient clinic since 1988. The patient who complained of difficulty in breathing because of a recent increase in empyema was admitted to our facility. On a test puncture, pure blood was aspirated without limitation, suggesting the presence of hematoma. On August 5, 1991, pleural decortification, excision of the left upper lobe and thoracoplasty were performed. Perioperative findings included repletion of hematoma and sphacelus in the lumen of thick fibrous capsule, with partial subcutaneous fenestration. Pathologically, cavernous hemangiomas were observed dispersely under the capsule.

[A case of Hodgkin's disease with endotracheal tumor presenting with severe airflow obstruction].

A 22-year-old woman was admitted to our hospital complaining of productive cough and dyspnea even at rest, and marked cervical lymphadenopathy. Marked stridor and orthopnea were observed, and auscultation of the chest revealed widespread expiratory wheeze which was not relieved by bronchodilators administered intravenously. Chest X-ray and CT scan revealed hilar lymphadenopathy and invasive tumor of the mediastinum. Bronchoscopy demonstrated narrowing of the trachea anteriorly and posteriorly and a submucosal nodular tumor protruding from the right anterior wall, causing approximately 90% occlusion of the lumen of the lower third of the trachea, but distal bronchi were intact. Microscopic findings of inguinal lymph node biopsy specimen revealed mixed cellular lymphoma compatible with Hodgkin's disease. Systemic chemotherapy resulted in relief of symptoms, and two months later, the endotracheal tumor had disappeared bronchoscopically, with slight residual stenosis of the trachea. Before treatment, pulmonary function tests indicated markedly impaired forced volume in 1 second in both expiratory and inspiratory cycles, especially in the latter phase. After remission, however, obstructive ventilatory dysfunction was observed. The cause of prolonged air flow obstruction was thought to be marked infiltration and almost total involvement of the tracheal wall by tumor with a nodular appearance of the lumen. Endotracheal tumor in Hodgkin's disease is rare, and there are few reports on pulmonary function associated with intrathoracic involvement of malignant lymphoma.

[A case of invasive thymoma responsive to preoperative chemotherapy].

A 38-year-old male was admitted with edema of the neck and face. Chest X-ray revealed a mediastinal tumor. On chest CT and MRI, a tumor infiltrating the superior vena cava and bilateral brachiocephalic veins in the upper mediastinum was observed. Venography revealed obstruction of bilateral brachiocephalic veins. The tumor was diagnosed as thymoma by percutaneous biopsy, but since it was of stage III according to Masaoka's classification, complete extirpation was considered to be impossible. Preoperative chemotherapy with multiple drugs (CDDP, ADM, VCR, CPA) was administered. The superior vena cava syndrome resolved and the tumor diminished in size. Because of leukopenia, rhG-CSF was also used. The tumor infiltrated the left brachiocephalic vein; therefore, total resection and left brachiocephalic vein reconstruction were performed. Histopathological examination showed extensive, necrosis and fibrosis containing residual thymoma. Postoperatively, similar chemotherapy and cobalt irradiation (40 Gy) to the superior mediastinum were performed. We thus present a case of invasive thymoma which responded to preoperative chemotherapy.

[The candida antigen titer by CAND-TEC in patients with pulmonary disease].

In order to elucidate the background of candida infection in patients with pulmonary disease, we divided 100 patients into 2 groups according to their serum titer of CAND-TEC determined by latex agglutination test for candida antigen. Group C1 (83 patients) had CAND-TEC value less than 2:1, and Group C2 (17 patients) had CAND-TEC value greater than 4:1. There was a significantly higher incidence of respiratory failure, hypoalbuminemia, and fever unresponsive to antibiotics in Group C2 compared with Group C1. Regarding the sputum culture of candida, there were significantly more positive cases in Group C2 than in Group C1. Furthermore, Group C2 showed a significantly poorer prognosis than Group C1. Generally, the candida antigen titer correlated well with clinical findings and with the course of infection and treatment with antifungal drugs. These results suggest that administration of antifungal drugs may be indicated in patients with fever unresponsive to antibiotics when the candida antigen titer is greater than 4:1.

[A probable case of burned-out tumor of the testis detected after treatment for pulmonary choriocarcinoma].

We encountered a patient who was suspected of having a burned-out tumor of the testis, which was detected after he was treated for pulmonary choriocarcinoma. The patient, a 61-year-old man, was found to have an abnormality on chest X-ray film at a medical examination in December 1989. He visited our department on December 19th, and was diagnosed as having cT1N0M0 (stage I) as a result of a thorough examination. He underwent right upper lobectomy and lymph node dissection on February 14, 1990. The lesion was pathologically diagnosed as choriocarcinoma, and after the operation he received orchiectomy and 3 courses of VAB VI therapy. After the chemotherapy, his blood HCG-beta level was normalized from 34 ng/ml to less than 0.10 ng/ml. The chest X-ray revealed complete disappearance of the coin lesion, while chest CT performed on July 25 revealed a small tumor 10 mm in diameter remaining in the left S10. For this tumor, partial resection of the left S10 was performed on August 6. The histopathological examination revealed nodular necrosis and disappearance of the tumor.

[A case of dumbbell type extradural spinal meningioma].

We reported a case of dumbbell type extradural spinal meningioma. The patient was a 45-year-old female. An abnormal shadow in the right middle lung field was pointed out in a mass survey. We recognized a dumbbell type tumor in the posterior mediastinum by chest CT and MRI. The tumor invaded the intervertebral canal through the spinal foramen. Operation was performed firstly with a longitudinal skin incision of the back and Th 6 laminectomy in a prone and secondly with a right posterolateral thoracotomy in a left lateral position. The dumbbell type tumor was completely removed by this operation. The pathological diagnosis was meningioma. The postoperative course was good.

Effects of long-term high-fiber diet on macrovascular changes and lipid and glucose levels in STZ-induced diabetic SD rats.

The effects of long-term high-fiber diet on lipid and glucose levels and the histological changes in the coronary arteries and thoracic aorta in STZ-induced diabetic SD rats were investigated. During the first 4 weeks of the study period, all diabetic rats were given regular chow plus water after which, all were grouped according to the following diet regimen: group II, no added cholesterol and glucomannan; group III, no added cholesterol but with glucomannan supplement, group IV, with added cholesterol but no glucomannan supplement; and group V, with both cholesterol and glucomannan supplements. 15% weight of glucomannan and 1.5% weight of cholesterol in regular rat chow were used as supplements when indicated. Non-diabetic rats which received only regular chow served as the control group (group I). In the 18th week all rats were sacrificed and weight gain, glucose, total cholesterol, HDL-cholesterol, triglyceride and lipid peroxidase concentrations were determined. Selected portions of the heart and thoracic aorta were histologically examined. Weight gain was higher in rats supplemented with glucomannan than in those without glucomannan supplements, but the difference is not significant. A lowering tendency in glucose levels was likewise observed. Furthermore, total cholesterol and HDL-cholesterol levels were lower and higher, respectively in diabetic rats receiving glucomannan. Although the triglyceride levels were similar in all rats, lipid peroxidase levels were significantly lower in rats with high-fiber diet.(ABSTRACT TRUNCATED AT 250 WORDS)

[A case of pulmonary leiomyoma].

We report a case of pulmonary parenchymal leiomyoma. The patient was a 35- year-old female with a tumor in anterobasal segment of the left lung. Enucleation was performed. The tumor was ball type and 2 cm in diameter, showing smooth and reddish brown cut surface. Microscopic and electron microscopic histology proved it to be leiomyoma.

Cisplatin suppository: preparation, release characteristics and clinical evaluation.

Cisplatin (CDDP) has attracted attention as a chemotherapeutic agent for the treatment of uterine endometrial carcinoma but causes serious side effects, including renal toxicity. CDDP suppositories containing NaCl at different concentrations were prepared to enhance the efficacy and to reduce the side effects of CDDP. The release characteristics, melting point and viscosity of the suppositories were first studied. The rate of CDDP release increased as the NaCl concentration increased: it was 12% 12 h after administration of suppositories containing no NaCl, but 32% with 0.2% NaCl. The melting point was raised by addition of NaCl: 35.5 degrees C without NaCl and 36.5 degrees C with 0.2% NaCl. Addition of 0.2% NaCl doubled the viscosity. Clinically, the suppository containing 0.06% NaCl was given to 3 patients with endometrial carcinoma twice a week for 3 weeks to examine serum CDDP levels and endometrial absorption. Patients with endometrial carcinoma showed different peak plasma platinum (Pt) levels which were as low as 0.12, 0.06 and 0.22 micrograms Pt/ml with similar patterns of change in the level. Radiographic analysis revealed many Pt particles in sections of necrosed endometria after 21d of the treatment. No side effects of CDDP were found in biochemical testing or subjective symptoms.

[A case of fulminant psittacosis showing Chlamydia in TBLB specimens].

A 55-year-old female was admitted to our hospital because of high fever, nonproductive cough and dyspnea. Initially she had been treated with cephem antibiotics by a local doctor. However, acute respiratory failure due to severe pneumonia developed. The partial pressure of oxygen in arterial blood was 55.5 Torr. Her chest X-ray revealed wide-spread infiltrates with air bronchograms throughout the entire left lung, and pleural effusions were also present in the chest CT scan. Because the patient had a history of the contact with birds, we suspected psittacosis and administered Minocycline immediately. As a result, her clinical condition improved and the abnormal shadow on the chest X-ray film improved markedly in three days. Because the serum titer of a complement fixation test against Chlamydia rose to 1:512, we made the diagnosis of psittacosis. In addition, femoral muscle pain, and a high level of serum GOT, GPT, CK, Aldolase and Myoglobin indicated hepatitis and myositis. In the lung tissue specimens obtained by TBLB performed on the 10th hospital day, slight interstitial pneumonia and intracellular inclusion bodies were found by light microscopy and Chlamydial agents were found electron microscopically.

[A case of thymic carcinoid].

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.