[Early malignant pleural mesothelioma; report of a case].

We report a case who had undergone operation of very early malignant pleural mesothelioma (MPM). A 58-year-old woman admitted to first visited hospital because of pleural effusion of the right side. She received a diagnosis of epithelial type MPM which had been confirmed from a pleural biopsy spacemen obtained by thoracoscopy under local anesthesia. An abnormal change of the pleura could not be detected on chest X-ray and thoracic computed tomography (CT) scan after chest drainage. She was referred to our hospital for surgery, and was undergone an extrapleural pneumonectomy followed by postoperative treatment with cisplatin puls gemcitabine. Pathologically, the disease was diagnosed as stage IA based on the classification of International Mesothelioma Interest Group (IMIG). There is a no evidence of the relapse 9 months after the operation. An early diagnosis of the MPM is very difficult. The thoracoscope with local anesthesia was very effective for early diagnose of a MPM.

[Uncommon procedure in tracheoplasty; thyrotracheal anastomosis and carinoplasty].

Both thyrotracheal anastomosis and carinoplasty are relative rare procedure in routine clinic. We reported each 2 cases of thyrotracheal anastomosis and carinoplasty in 51 cases of tracheobronchoplasty. Thyrotracheal anastomosis with partial cricoidectomy was performed in patients with subglottic stenosis for postintubation stenosis and thyroid cancer using suprahyoid release. Each case need re-intubation after surgery. Montage carinoplasty was performed in 2 patients with advanced lung cancer. Right upper lobe was end-to-side anastomosed to trachea in 1 case, and right basal segment was to left main bronchus in another. It was important both diameter in bronchus and mobilization of the residual lung for this procedure.

[Primary thyrotracheal anastomosis for subglottic stenosis with tracheostomy].

A case of 42-year-old man with postintubation subglottic stenosis underwent primary thyrotracheal anastomosis. Since trachea had been incised longitudinally for previous tracheostomy, tracheal resection came to be longer. Therefore, we had to anastomose the incised trachea with thyroid cartilage even after the suprahyoid release. After the operation, he suffered from the tracheal collapse at the incised portion of the trachea One week after intubation, tracheal patency was achieved. We recommend horizontal incision for tracheostomy in patient with subglottic stenosis, when the following surgical approach is considered.

Adolescent smoking behaviour and cigarette brand preference in Japan.

OBJECTIVES: As part of efforts to develop a smoking control strategy for Japanese adolescents, the results of two nationwide surveys on adolescent smoking behaviour were compared. DESIGN: Descriptive study on smoking behaviour among high school students was conducted. Self-reporting anonymous questionnaires were administered to 115,814 students in 1996 and 106,297 in 2000 through randomly sampled junior and senior high schools throughout Japan. MAIN OUTCOME MEASURES: Smoking prevalence, proportion of smokers by usual sources of cigarettes, national estimated cigarettes consumed by minors, share of cigarette brands smoked by high school students. RESULTS: The experiment rate among junior high school boys decreased in 2000 compared with that in 1996, whereas current and daily smoking rates did not. Although prevalence among Japanese girls was much lower than that among boys, prevalence among girls increased in 2000. The main source of cigarettes among high school smokers was vending machines. The proportion of smokers who usually purchased cigarettes from vending machines increased in 2000, in spite of the 1998 introduction of restrictions on night-time operations. Japanese adolescents were more likely than adults to smoke American cigarette brands, and the adolescent market share of American brands has increased rapidly, especially for menthol brands. CONCLUSIONS: This survey revealed the seriousness of the problem of smoking behaviour among Japanese high school students, and suggested that this behaviour may be influenced by social environmental factors, including the marketing strategies of the tobacco industry. Action should be taken to reduce the prevalence and impact of pro-tobacco marketing messages and to abolish cigarette vending machines.

[Primary lung cancer incidentally diagnosed in lung biopsy for diffuse pulmonary disease].

UNLABELLED: We here presented 2 cases of interstitial pneumonia with lung adenocarcinoma incidentally diagnosed by partially resected lung for diffuse pulmonary disease. CASE 1: A 78-year-old female was admitted to the hospital complaining of productive cough and general fatigue. The chest computed tomography (CT) revealed diffuse honey comb pattern in bilateral lung field especially in the right lower lung. Video-assisted thoracoscopic lung biopsy was performed and was diagnosed as diffuse spreading well differentiated adenocarcinoma. CASE 2: A 59-year-old male was admitted to the hospital complaining of dyspnea and general fatigue. The chest X-ray revealed right pneumothorax and chest CT revealed diffuse honey comb pattern and bullae in bilateral lung field and fibrous tumor-like lesion in the right middle lung. Video-assisted thoracoscopic lung biopsy was performed and was diagnosed as pulmonary fibrosis with papillary adenocarcinoma. CONCLUSION: It is important to examine carefully the specimen obtained from thoracoscopic lung biopsy even if interstitial pneumonia is strongly suspected.

[Schwannoma arising from brachial plexus with intrathoracic extension; report of a case].

We report a case of schwannoma arising from brachial plexus with intrathoracic extension. An 18-year-old man demonstrated a tumor shadow at the right pulmonary apex area. In the 2-months of follow-up, tumor size had been growing rapidly. Chest computed tomography (CT) and magnetic resonance imaging (MRI) revealed a giant tumor mass infiltrated right lung. We perfomed operation under the posterolateral incision approach. The pathological diagnosis was schwannoma. We resected this tumor safely and conserved with the seventh, eighth cervical nerve of the brachial plexus under posterolateral incision approach.

[The establishment of the styles of video-assisted thoracoscopic surgery for spontaneous pneumothorax].

Video-assisted thoracoscopic surgery (VATS) has been widely used in the treatment of a pneumothorax, but the high incidence of recurrence from spontaneous pneumothorax after VATS is an important problem. In this study, we classified the groups into two categories from the thoracoscopic observations, and discussed whether or not there was reappearance of pneumothorax. In addition, we examined whether adjunctive procedure contributes to recurrent of pneumothorax after operation or not. We concluded that there is a tendency to recurrence in the group with multiple and skip lesions in the lung, and then concluded that the cases apical covering with absorbable material sheet and the use of fibrin glue spray was thought to be effective of recurrence of pneumothorax in cases of multiple and skip lesions from the intraoperative findings through the thoracoscopes. Finally, we examined application of Foley catheter for spontaneous pneumothorax under VATS. It is possible that the application of Foley catheter to prevention against recurrence of pneumothorax is a valid method.

[The validity of repeated mail surveys concerning smoking habits for Japanese physicians].

PURPOSE: A cross-sectional study of smoking prevalence among medical doctors was performed using questionnaires. Mailing four times proved essential in order to obtain a reasonable number of responses from the subjects. The objective of the present study was to analyze the smoking characteristics of the subjects who returned the questionnaires after the second to fourth mailings. METHODS: A set of an anonymous questionnaire and a letter from the President of the Japan Medical Association (JMA) requesting cooperation was mailed with a return envelope with the subject's name and address written to 3,000 male and 1,500 female doctors randomly selected from the roster membership of the JMA. The survey was conducted between February and June 2000. RESULTS: The collection rate after the first mailing was 66%, while the subtotal collection rate for the second through fourth mailings was 21%, bringing the grand-total to 87%. The total prevalence of smoking among the subjects who had sent back the questionnaire on the second to fourth mailings was approximately 1.5 times higher than for those who had sent back the questionnaire after the initial mailing for both male and female subjects. As to other characteristics of the subjects who only responded after the second to fourth mailings were: working in hospitals (odds ratios; male: 1.39, female: 1.47), not giving smoking cessation guidance (odds ratio; male: 0.58), and not recognizing the idea that doctors should not smoke (odds ratio; female: 0.67). CONCLUSIONS: The results suggested that for future surveys on smoking to be conducted in academic institutions or work-places, efforts to obtain responses from those who do not answer the first attempt should take into consideration these points.

The widespread effect of beta 1,4-galactosyltransferase on N-glycan processing.

We investigated beta 1,4-GalT (UDP-galactose: beta-d-N-acetylglucosaminide beta 1,4-galactosyltransferase) in terms of intracellular competition with GnT-IV (UDP-N-acetylglucosamine: alpha1,3-d-mannoside beta1,4-N-acetylglucosaminyltransferase) and GnT-V (UDP-N-acetylglucosamine: alpha1,6-d-mannoside beta 1,6-N-acetylglucosaminyltransferase). The beta 1,4-GalT-I gene was introduced into Chinese hamster ovary (CHO) cells producing human interferon (hIFN)-gamma (IM4/V/IV cells) and five clones expressing various levels of beta 1,4-GalT were isolated. As we previously reported, parental IM4/V/IV cells express high levels of GnT-IVa and -V and produce hIFN-gamma having primarily tetraantennary sugar chains. The branching of sugar chains on hIFN-gamma was suppressed in the beta 1,4-GalT-enhanced clones to a level corresponding to the intracellular activity of beta 1,4-GalT relative to GnTs. Moreover, the contents of hybrid-type and high-mannose-type sugar chains increased in these clones. The results showed that beta 1,4-GalT widely affects N-glycan processing by competing with GnT-IV, GnT-V, and alpha-mannosidase II in cells and also by some other mechanisms that suppress the conversion of high-mannose-type sugar chains to the hybrid type.

Diagnostic results before and after introduction of autofluorescence bronchoscopy in patients suspected of having lung cancer detected by sputum cytology in lung cancer mass screening.

For the purpose of early detection, we have conducted population-based mass screening for lung cancer by sputum cytology since 1982. Although detection of lung cancer in its early stage is important for a good prognosis, it is often difficult to localize lesions in roentgenographically occult cancer. To clarify the role of autofluorescence bronchoscopy in localizing tumors in patients with roentgenographically occult cancer, we analyzed our diagnostic results. Fifty patients who had been detected by sputum cytology were screened by the light-induced fluorescence endoscope (LIFE)-Lung System from November 1997 to April 1999. We compared the results according to the screening methods: conventional bronchoscopy alone versus LIFE with conventional white-light bronchoscopy (November 1997 to April 1999). Twenty-eight cancerous lesions and 39 borderline lesions were detected by LIFE. Of the 39 borderline lesions, nine were detected only by LIFE. Multicentric lesions including cancer or dysplasia were also detected in 21 of the 50 patients by LIFE. The sensitivity by white-light bronchoscopy alone was 85.3%, whereas that of the LIFE-Lung System with white-light bronchoscopy was 94.1% (P=0.078). There were no cancerous lesions in the area observed as normal by LIFE. We also compared the diagnostic results of two localization methods: brushing of all bronchi (September 1986 to December 1990) and the LIFE-Lung System (November 1997 to April 1999). Although this was a historical comparison, the number of detected borderline lesions increased, which led to a high detection rate in patients with suspected-positive sputum (P=0.0006) by the LIFE-Lung System. In conclusion, the LIFE-Lung System is a safe and non-invasive system for detecting small intraepithelial lesions of the tracheobronchial tree. Autofluorescence bronchoscopy is more efficacious for localizing intraepithelial lesions and places fewer burdens on the patient than brushing of all bronchi.

Subjective sleep quality and sleep problems in the general Japanese adult population.

To dimensionally describe subjective sleep quality using the Pittsburgh Sleep Quality Index (PSQI) and estimate the prevalence rate of sleep problems (PSQI global score > 5) in the general Japanese adult population, 1871 subjects randomly selected from the 1995 Census were examined. The PSQI component scores (mean +/- SD) widely ranged (e.g. 0.04 +/- 0.31 in hypnotic medication use for males aged 20-29 years, 0.03 +/- 0.18 in hypnotic medication use for females aged 20-29 years, 1.10 +/- 0.94 in sleep latency for males aged 80 or older, 1.52 +/- 1.03 in sleep latency for females aged 80 or older). Statistical significance was found in each component score among age groups by gender. The PSQI global scores (mean +/- SD) by age groups ranged from 4.00 +/- 2.59 to 5.02 +/- 3.89 for males (P < 0.39) and 4.30 +/- 2.34 to 6.75 +/- 4.10 for females (P < 0.001). The respective prevalence rates of sleep problems were 26.4% (95% CI = 23.6, 29.3) for males and 31.1% (95% CI = 28.1, 33.9) for females.

Smoking prevalence and attitudes toward smoking among Japanese physicians.

CONTEXT: The World Health Organization has advocated that physicians should not smoke cigarettes and surveys on this issue should be conducted among medical professionals. However, no nationally representative surveys of smoking among physicians in Japan have been reported. OBJECTIVES: To estimate the nationwide prevalence of smoking and determine the attitudes toward smoking among Japanese physicians. DESIGN, SETTING, AND PARTICIPANTS: Descriptive study in which anonymous questionnaires were mailed to 4500 randomly selected physician members of the Japan Medical Association in the year 2000, which represents 63% of all Japanese physicians; 3771 (84%) respondents were included in the analysis. MAIN OUTCOME MEASURES: Smoking prevalence among physicians, history of smoking, and attitudes toward smoking. RESULTS: The prevalence of cigarette smoking among physicians was 27.1% for men and 6.8% for women, about half the age-adjusted prevalences among the general Japanese population. Smoking prevalence was higher among male physicians in Japan than those in the United States (3%-10%) and the United Kingdom (4%-5%). Smoking prevalence differed by age, with the highest prevalence among male past smokers aged 70 years or older (51.8%; 95% confidence interval [CI], 47.4%-56.2%). Among male current smokers, the highest rates were for those aged 40 to 49 years (31%; 95% CI, 27.5%-34.5%); rates for female past smokers were highest among those aged 50 to 59 years (10.7%; 95% CI, 6.6%-14.8%) and for female current smokers were highest among those aged 70 years or older (8.2%; 95% CI, 4.8%-11.6%). Nonsmoking physicians had more unfavorable views toward smoking and were more active in encouraging patients not to smoke than those physicians who smoked. CONCLUSION: Smoking cessation programs should be introduced among Japanese physicians to reduce the number of smoking physicians. Also, a continuing education program should be instituted to motivate physicians about their role in society.

[Drinking behaviors of Japanese adolescents' problem drinker--report of 1996 national survey].

The first national survey of Japanese adolescent drinking behaviors was conducted in 1996. Based on the survey results, this study focused on high risk drinking behaviors of Japanese adolescent problem drinkers. The subjects were 42,183 junior high school students and 72,396 senior high school students who responded to questions on drinking frequency and drinking quantity among the national survey subjects. The subject students were divided into three groups: normal adolescents, drinkers and problem drinkers by the QF scale. The problem drinkers according to the QF scale accounted for 3% of the junior high school students and 14% of senior high school students. Problem drinkers among both junior and senior high school students had characteristic drinking behaviors such as various drinking occasions, obtaining alcoholic drinks by various methods, drinking hard liquor, and many instances of vomiting or blackouts due to drinking. Many problem drinkers considered that the national law prohibiting minors from drinking was unnecessary because they have the right to decide whether to drink. Both junior and senior high school problem drinkers showed high risk drinking behaviors.

Smoking behavior and related factors among Japanese nursing students: a cohort study.

BACKGROUND: Although there have been several surveys on smoking behavior among Japanese nursing students, most have been cross-sectional studies. No longitudinal studies, such as a prospective cohort study, have ever been carried out. We therefore conducted a cohort study on, and analyzed smoking behavior and related factors among, Japanese nursing students. METHODS: A survey on smoking behavior using a confidential questionnaire was conducted on nursing students at two vocational schools of nursing and two nursing colleges/universities located in the Tokyo metropolitan area. Another survey was subsequently conducted in the same manner among the same subjects 1 year later. The surveys were conducted between 1997 and 1999. RESULTS: Over the 1-year period, the prevalence of smoking among nursing students increased by 10% for students at the vocational schools of nursing (n = 224) and by 3% for students at the nursing colleges/universities (n = 222). The average score for nicotine dependence for students who were daily smokers at both time points rose from 3.6 to 4.4 (P < 0.05). Two factors found to significantly predict smoking behavior were having friends who smoke and living alone. CONCLUSION: Smoking prevalence is increasing among Japanese nursing students. Smoking prevention and cessation interventions should be instituted in all nursing training programs.

Factors associated with earthquake deaths in the great Hanshin-Awaji earthquake, 1995.

The authors conducted descriptive and case-control studies to find factors associated with earthquake deaths due to the Great Hanshin-Awaji earthquake on January 17, 1995, in Nishinomiya, Japan. In the case-control study, cases included all 1,104 deaths. Controls were randomly selected from survivors. Earthquake mortality increased for people over age 50 years. Mortality among people who had lived in dwellings that were completely destroyed was much higher. One risk factor was physical disabilities (odds ratio = 1.9, 95% confidence interval (CI): 1.0, 3.4). When the analysis was limited to the people who had lived in intact or partially destroyed dwellings, the odds ratio rose to 5.6 (95% CI: 1.6, 19.8).

Household size related to prevalence of smoking in women in Japan.

We investigated the relationship between the prevalence of smoking in females and various social factors, such as household size. Ten thousand and sixty-nine subjects over 20 years of age were randomly selected from the general population of Mie Prefecture. The results showed that the habit of smoking was significantly associated with household size in women (P< 0.01), but not in men. Regarding household size, current smoking rate of women aged 20-59 who live in three-generation household was lower than those who live in others. Therefore, the steady replacement of the traditional three-generation household by smaller households in Japan may lead to an increase in the number of young women who smoke.

Behaviors and attitudes towards smoking among the nurses in Japan.

The study was carried to investigate on the actual conditions related to smoking of the nurses working in all medical institutions under a regional medical association in Mie Prefecture (regional medical institutions). Results obtained were as follows: smoking prevalence of female nurses is considered to be equal to that of the general female population in Japan. About 35% of the nurses with the smoking habit had an opinion to quit it, and about 45% of them practiced it seriously. Nearly 80% nurses favored restriction. In the way of thinking related to smoking, more than 90% of the nurses answered that women should not smoke for the health of the fetuses and infants, while only about 30% of them agreed to stop smoking working as members of the medical staff. The survey suggests that anti-smoking program is necessary to develop for smoking nurses working at medical facilities.

[Factors related to smoking behavior of nursing students revealed by a cohort study].

PURPOSE: Through a cohort study, changes in smoking behavior of nursing students and the factors related to their smoking behavior were examined. METHOD: Research through anonymous questionnaires concerning smoking behavior was conducted on nursing students in the first to third grades (as of 1997) at two vocational schools of nursing located in the Tokyo Metropolitan area. The same research was conducted in the same manner on the same subjects the following year. RESULTS: The smoking prevalence among nursing students of the first and second grades as of 1997 had increased by 10% in one year, and that of nursing students of the third grade (to graduate in 1998) had increased by 5%. The average degree of nicotine dependence of the subjects, who replied that they smoked every day in both surveys, increased from 4.25 to 5.00. As to factors related to smoking behavior, the smoking behavior of friends largely influenced that of the nursing students. CONCLUSIONS: Education to prevent nursing students from smoking should be started as soon as possible at vocational schools of nursing, because the research showed that more than 70% of the smokers had actually thought of quitting and that their views toward smoking influenced later smoking behavior.

Study of the smoking behavior of medical doctors in Fukui, Japan and their antismoking measures.

We conducted a survey on smoking among all members of the medical association in Fukui Prefecture, using a questionnaire to be filled in by the subjects. The survey was conducted from December of 1996 to February of 1997, and the return rate was 90.8%. The main results of this survey were as follows: the prevalence of current smoking among medical doctors was 26.0% (male: 27.8%, female: 5.2%), which was lower than that of adults in the general population. The prevalence of past smoking among doctors 20 to 34 years old by age cohort was highest and that among doctors 35 years old and higher declines as age cohort increased. Doctors' participation in activities for the prevention of smoking in the general society was also found to be at a low level.

Japanese national survey of adolescent drinking behavior in 1996.

BACKGROUND: Despite legal prohibition of drinking by minors, there has been no systematic attempt to monitor drinking by young Japanese. This research, the first Japanese national survey of Japanese adolescent drinking behaviors, was conducted in 1996. METHODS: In this survey, information on drinking frequency was obtained from questionnaires completed by 42,183 junior high school and 72,396 senior high school students in randomly selected schools representing all areas of Japan. RESULTS: Sixty percent of junior high school students and 70% of senior high school students reported having drinking experiences; 5% of junior high school students and 10% of senior high school students drank one or more times per week. Many of the junior high school students usually drank with their families and consumed small amounts, but many of senior high school students drank on various occasions and consumed larger amounts. These Japanese high school students reported being offered alcohol frequently by their parents, found it easy to buy alcoholic beverages, and believed that they had the right to determine whether to drink. Japanese adolescents' drinking has increased over the past 20 years, whereas drinking by U.S. adolescents has decreased. CONCLUSIONS: Japanese policies aimed at decreasing adolescent drinking are inadequate. A system for monitoring and potentially modifying adolescent drinking behavior is needed.