[Sarcomatoid carcinoma of the thymus which caused acute epicarditis].

Thymic carcinoma is rare. Particularly sarcomatoid carcinoma of the thymus is a very rare disease it has been reported in only 15 patients to date. The prognosis is very poor and diagnosis and treatment have not yet been established. We report a case of 63-year-old man who was initially diagnosed with acute pericarditis and was finally found to be sarcomatoid carcinoma of the thymus. He underwent surgery and the tumor was completely resected. However, 6 months after surgery, local recurrence was noted. The patient was treated by radiotherapy followed by paclitaxel monotherapy. Partial remission was achieved transiently with paclitaxel, but the tumor again recurred. He died 33 months after surgery. The possibility of diseases like this tumor must be kept in mind for a patient with chest symptoms. Paclitaxel monotherapy is likely to be effective in treating sarcomatoid carcinoma of the thymus.

[Obvious enlargement of the pulmonary hamartoma: report of a case].

A 72-year-old man was admitted to our hospital due to abnormal shadow in the right hilum by a routine chest X-ray. When we had another look at a chest X-ray that had been taken 6 years before, we had found a pulmonary nodule of 18 mm in size. The chest X-ray and computed tomography (CT) taken at admission showed a round nodule with calcification in the same site, with increasing in size to 30 mm. The tumor could not be clinically diagnosed and the surgery was scheduled because the nodule had grown and the possibility of a malignant tumor was suggested. At surgery, the tumor was easily enucleated and the pathological diagnosis was chondromatous hamartoma. Although pulmonary hamartoma is a benign tumor, operation should be performed when the tumor had grown.

[Pulmonary schwannoma with hypervascularity; report of a case].

A 54-year-old female was admitted to our hospital with a mass shadow in the right pulmonary hilum. The chest computed tomography (CT) scan revealed a well-circumscribed mass in the lower lobe of the right lung. Bronchoscopic examination showed a submucosal tumor in the right basal bronchus which bled easily, and the angiogram showed a tumor with hypervascularity. The tumor was suspected to be a sclerosing hemangioma or malignant tumor. A right basal segmentectomy was performed, and the pathological diagnosis was that of schwannoma. During the 8 year follow-up period, she exhibited no evidence of recurrence.

[Small sclerosing hemangioma combined with primary lung cancer; report of a case].

A 56-year-old woman underwent a surgery for right breast cancer when she was 51-year-old. In February 2002, computed tomography (CT) was performed as a part of a follow-up study and showed 2 small nodules in the lower lobe of her right lung: one was 10 mm nodule in S9, and another was 5 mm in S6. On a follow-up CT in March 2005, the S9 nodule had enlarged to 19 mm and was looked as ground glass opacity (GGO). We thought it was primary lung cancer. In contrast, the nodule in S6 had not enlarged and it was thought to be benign. In May 2005, right lower lobectomy was performed. The S9 nodule was diagnosed as adenocarcinoma, and the S6 nodule as sclerosing hemangioma.

[Mediastinal granular cell tumor: report of a case].

Mediastinal granular cell tumor is rare. We report a case of 16-year-old woman with a granular cell tumor in the right upper-middle mediastinum. Chest computed tomography (CT) and magnetic resonance imaging (MRI) revealed a 4.0 x 2.5 x 5.5 cm well circumscribed mass in the right upper-middle mediastinum. Tumor resection was performed. It was found that the tumor involved right vagus nerve. The tumor was completely excised with combined resection of the right vagus nerve peripheral to the right recurrent nerve. Histopathologically, the tumor consisted of round to polygonal cells with abundant eosinophilic granular cytoplasm, and diagnosed a granular cell tumor.

[Positron emission tomography (PET)-computed tomography (CT) suggesting small intestinal metastasis from lung cancer; report of a case].

A 75-year-old man admitted to our hospital due to an abnormal X-ray shadow detected during an annual health check-up. Chest computed tomography (CT) revealed 3.0 cm solid nodules with chest wall invasion in the left lung. We could not get a definitive diagnosis by transbronchial lung biopsy or CT-guided needle biopsy. Positron emission tomography (PET)-CT revealed positive findings in the tumor, aortopulmonary window lymph node and splenic flexure. Under a diagnosis of suspected lung cancer, thoracotomy was performed. As intraoperative diagnosis revealed a moderately differentiated squamous cell carcinoma, the patient underwent a left upper lobectomy, mediastinal lymph node dissection, and combined chest wall resection. Pathological stage was T3N2M0, stage IIIA. Ten days after surgery, the patient suffered from ileus and emergent surgery was performed. Subsequent pathological examination revealed lung cancer metastasis in the small intestine.

Immunohistochemical prognostic factors in resected colorectal lung metastases using tissue microarray analysis.

AIMS: Immunohistochemical prognostic factors of pulmonary metastatic colorectal cancer lesions have not been well investigated. The study was conducted to identify the immunohistochemical prognostic factors of metastasized colorectal cancer. METHODS: We immunohistochemically investigated the expression of insulin-like growth factor-1 receptor (IGF1-R), E-cadherin, beta-catenin, and p53 using a tissue microarray in the surgical specimens of 86 metastatic lesions. RESULTS: The univariate analysis revealed E-cadherin and membrane beta-catenin positive to be prognostic factors. IGF1-R and p53 were not significantly associated with the patient's survival. In multivariate analysis, the reduced expression of E-cadherin, aerogenous spread with floating cancer cell clusters and vascular invasion were independent prognostic factors. CONCLUSIONS: The reduced expression of E-cadherin in the pulmonary metastatic lesions was an independent predictor of poor survival after pulmonary metastasectomy.

[Surgical resection of metachronous multiple lung cancer after complete response of small cell lung cancer; report of a case].

A 76-year-old man underwent combination chemotherapy with cisplatin and etoposide and 50 Gy radiotherapy for left-sided small cell lung cancer in 1999. He achieved clinical complete response and showed no sign of recurrence on follow-up study. In December 2004, chest computed tomography (CT) revealed a 1 cm nodule in the right lung. Although no diagnosis could be made by bronchoscope, we suspected metachronous multiple lung cancer because of high 18fluorodeoxyglucose uptake with positron emission tomography (PET). The patient underwent video-assisted thoracoscopic surgery in May 2005; the frozen section diagnosis was adenocarcinoma.

[Stenting for postoperative airway stenosis due to traumatic tracheobronchial rupture].

A 43-year-old man underwent repair for the broken trachea, left main bronchus and right main brouchus due to trauma. Twenty-seven months after the initial surgery, he developed dyspnea and required ventilatory support. Computed tomography showed severe stenosis of the left main bronchus, tracheomalasia and bronchomalasia of right main bronchus. A self-expandable metallic stent (SEMS) was placed in the bilateral main bronchus and T-tube in the trachea. SEMS developed granulatory and cicatricial stenosis of the airway, which caused severe dyspnea. Replacement of SEMS with Dumon stents was successfully done and dyspnea was disappeared. A silicon stent should be used for treating postreconstructive airway stenosis including tracheobronchomalasia.

[Lung cancer with both sarcoid reaction and metastasis in the mediastinal lymph nodes; report of a case].

A 66-year-old man was admitted to our hospital for detailed investigation of an abnormal shadow on his chest X-ray. Chest radiography and computed tomography(CT) of the chest showed mediastinal lymphadenopathy and a tumor shadow in the left upper lobe. Biopsy of the mediastinal lymph nodes by mediastinoscopy showed that sarcoid nodules existed in all the biopsies nodes. Therefore, the lymphadenopathy was thought to be sarcoidosis or sarcoid reaction accompanied with lung cancer. Left upper lobectomy and dissection of hilar and mediastinal lymph nodes were performed. Although sarcoid nodules were seen in all the dissected lymph nodes, the cancer involved #5 and #14 lymph nodes. He died of brain metastasis 10 months after surgery.

[Intrapleural streptokinase-streptodornase in the treatment of empyema and hemothorax].

Fourteen of 15 patients (93%) with retained pleural collections underwent successful enzymatic debridement and tube drainage with streptokinase-streptodornase (SK-SD) injections. No significant adverse reactions occurred. One patient required decortication when SK-SD therapy failed. Intrapleural SK-SD is a safe, effective means of removing retained proteinaceous collections in the pleural space. It may obviate the need for more invasive procedures.

Duodenal wall cysts may be derived from a ductal component of ectopic pancreatic tissue.

AIMS: To clarify the mechanism of origin of duodenal wall cysts in patients with chronic pancreatitis, developing into duodenal stenosis. METHODS AND RESULTS: Specimens from 12 pancreatoduodenectomized patients with chronic pancreatitis and 51 controls were studied histopathologically and immunohistochemically. Variously shaped cystic lesions, averaging about 15 mm in diameter, were found in the duodenum in six of the 12 patients with chronic pancreatitis, but were not observed in the controls. Each case had an average of two cysts, which were located mainly in the muscularis propria of the duodenum with or without submucosal or extraduodenal-peripancreatic extensions. The inner part of the cyst wall consisted of a moderate rim of granulation tissue, with both myofibroblasts and smooth muscle proliferation in the tissue surrounding the cyst and the submucosal layer of the duodenum, occasionally accompanied by an epithelial lining. A ductal structure in the muscularis propria of the duodenum, possibly a ductal component of ectopic pancreatic tissue, was found in five of the six cases. Some of these structures showed cystic changes. Three of the six patients had accompanying duodenal stenosis. CONCLUSIONS: Duodenal wall cysts occur mainly in the muscularis propria of the duodenum associated with both myofibroblasts and smooth muscle proliferation, and may result in duodenal stenosis. These cysts may be derived from a ductal component of ectopic pancreatic tissue.

[Tarantulas bite: two case reports of finger bite from Haplopelma lividum].

The risk of envenomations by venomous exotic spiders have not been well recognized in Japan. Two cases of finger bite from Asian pet tarantula, Haplopelma lividum (Cobalt blue), are reported. In both cases, initial severe pain and inflammatory signs were completely healed with only symptomatic treatments within several hours. In one case, arthritic stiffness lasted for a few weeks following bite but resulted no permanent deficit. Bites from Haplopelma lividum seemed relatively harmless like other various tarantulas, although the composition of the venom has been unknown.

A case of biliary atresia with cystic dilatation of the extrahepatic bile duct and polysplenia syndrome.

A 79-day-old girl presented with jaundice and acholia. Laboratory findings disclosed elevated levels of bilirubin, transaminases, and gamma-glutamyl transferase. A chest X-ray film showed dextrocardia. A computed tomographic scan revealed a cystic mass at the porta hepatis, multiple spleens in the right side of the abdomen, and absence of the inferior vena cava. Under the diagnosis of biliary atresia (BA) (I-cyst) associated with polysplenia syndrome, a hepatic portojejunostomy was performed at 80 days of age. The postoperative course was uneventful, and the jaundice cleared. Although the occurrence of associated anomalies in BA is rare, polysplenia is most commonly seen, and its incidence is reported to be 2% to 10%. Patients with BA and polysplenia usually have a poor prognosis, however, this patient may have a good prognosis due to uneventful recovery from the jaundice.

Removal of cartilage rings of the graft and omentopexy for extended tracheal autotransplantation.

BACKGROUND: One of the serious problems in longer-size tracheal transplantation is infection or severe stenosis of the graft, probably caused by an inadequate blood supply even with omentopexy. For obtaining an appropriate blood supply, we experimentally developed a new technique that included removal of some cartilage rings of the graft and omentopexy. METHODS: Twenty-one adult mongrel dogs were used. In group A (n = 11), a nine-cartilage ring length of the trachea in which six of nine rings were removed, leaving one cartilage ring at each end of the graft and another in the center, was autotransplanted with omentopexy. Two artificial tracheal rings outside the graft were used for maintaining the lumen. In group B (n = 10), a nine-cartilage ring length of the trachea was autotransplanted with omentopexy. RESULTS: In group A, all dogs survived until being sacrificed, whereas 5 group B dogs died of graft infection and mediastinitis (p<0.05 versus group A). Mucosal blood flow of the graft in group A was normal and higher than in group B (p<0.05). Grade of the graft stenosis at death or sacrifice was 14%+/-1% in group A and 58%+/-25% in group B (p<0.05). CONCLUSIONS: Removal of some cartilage rings improved blood supply to the graft and resulted in satisfactory survival and nonsignificant tracheal stenosis in extended tracheal autotransplantation.

[Mediastinal mature teratoma with elevated serum SCC levels--a report of 2 cases].

This is a report of two cases of mature mediastinal teratoma associated with elevated serum SCC levels. The first patient was a 17-year-old female admitted to our hospital for severe left chest pain. Chest x-ray film and CT scan showed a mediastinal tumor. The preoperative serum SCC level was elevated. Resection was performed and the pathological diagnosis was mature teratoma. The second patient was a 32-year-old male admitted to our hospital for severe anterior chest pain. A chest CT scan showed a mediastinal tumor. The preoperative serum SCC level was high. Surgery was performed and the pathological diagnosis was mature teratoma. The cause of the high serum SCC levels was unclear, but we suspect that the pulmonary atelectasis may have caused it.

[Postoperative chylothorax treated with fibrin glue and absorbent mesh: a case report].

A 66-year-old man was treated by graft replacement for a thoracic aortic aneurysm. Chylothorax occurred on postoperative day 2. In spite of cessation of oral intake and IVH management, chest tube drainage did not decrease, the patient became malnourished. A chest X-ray and CT scan revealed the massive pleural effusion. Reoperation assisted with a thoracoscopy was carried out for chylothorax on postoperative day 27. Because we were unable to find the thoracic duct and the leakage point, the fibrin glue and absorbent mesh was applied to parietal and mediastinal pleura. Four days after reoperation, the chest tube was removed. This method is useful for this type of a chylothorax and lymphorrhea.

Aprotinin reduces the expression of p-selectin on the surface of platelet and leukocyte-platelet conjugates.

P-Selectin, an adhesion molecule expressed on the surfaces of activated platelets and the vascular endothelium, mediates platelet binding to monocytes and neutrophils. Monocytes and neutrophils produce superoxide anion by activated platelets through p-selectin. Aprotinin, a serine protease inhibitor, inhibits plasmin to activate platelets during cardiopulmonary bypass (CPB). A total of 25 patients were studied to clarify the effects of aprotinin on p-selectin expression during CPB. Nine patients were not given aprotinin (control group), and 16 were given aprotinin of 2 million U in the priming solution (aprotinin group). The platelet count and soluble p-selectin in the plasma, p-selectin on the surface membranes of platelets, and leukocyte-platelet conjugate levels were measured during and after CPB. The platelet count was maintained well in the aprotinin group. The increases of soluble p-selectin in the plasma, platelet surface p-selectin, and leukocyte-platelet conjugates were less in the aprotinin group than in the control group (p < 0.05). In conclusion, aprotinin in patients undergoing CPB may reduce the early inflammatory reactions induced by p-selectin.

Reinforcement learning to train a cooperative network with both discrete and continuous output neurons.

We propose a reinforcement learning algorithm to train a cooperative network with both discrete and continuous output neurons based on the finding that discrete and continuous motorneurons coexist in the gill-withdrawal neural network of the sea mollusk, Aplysia. The network was trained to control an inverted pendulum. Simulation experiments showed that the two output neurons had distinct but cooperative roles: the discrete output neuron was essential for fast learning while the continuous output neuron was necessary for learning fine control. To achieve both fast learning and fine control, the shape of the sigmoid function in the continuous output neuron should be set before learning.

Optical recording of neural signals evoked by greater superficial petrosal nerve stimulation in rat.

Electrical responses to greater superficial petrosal (GSP) nerve stimulation in a rat geniculate ganglion (GG) preparation were assessed by simultaneous multi-site-optical recording. The GG/GSP nerve preparations were dissected out and were stained with a voltage-sensitive dye (RH155). Application of depolarizing square pulses to the GSP nerve fibers using a suction electrode evoked optical (absorbance) signals that were recorded simultaneously from many contiguous regions using a 24 x 24 photodiode matrix array with 448 active elements. Those optical signals were observed along the left half area of the GSP nerve. As the distance from the site of stimulation increased, the optical signals appeared to conduct with increasing time-delay. From the relationship between the peak latency and distance, the conduction velocity was estimated to be about 0.4 m/s. Tetraethylammonium affected the duration of the optical signals, and the signals disappeared in solutions containing tetrodotoxin (TTX) or in Na(+)-deficient solutions. The optical signals evoked by the GSP nerve stimulation are considered to be due to the action potentials propagating along the GSP of unmyelinated axons.