Biomedical subjects
Publications and source records attributed to S Morinaga.
Three years after removal of a femoral osteosarcoma, a solitary, thin-walled cavitary lesion (diameter 1 cm) appeared in the lung of a young man. When the lesion enlarged, it was resected. Histology showed sarcoma metastasis with central necrosis and involving a peripheral bronchus. Cavitary metastasis can occasionally result from drainage of necrotizing tumor cells via a peripheral bronchus.
A 17-year-old man with Von Recklinghausen's disease was admitted to our hospital because of progressive dyspnea on exertion. A chest X-ray film showed a massive left pleural effusion. Thoracentesis revealed dark blood. Hemothorax was diagnosed, and digital subtraction angiography (DSA) was done. DSA revealed a large mass that was supplied with blood via the inferior phrenic artery, but revealed no active bleeding. An intercostal tube was inserted and 1700 ml of dark blood was drained. A chest X-ray film taken after drainage revealed a giant mass showing an extra-pleural sign in the left lung field. A thoracotomy was done to determine the source of bleeding. A giant tumor with hypervascular tissue was seen, and was diagnosed as a malignant schwannoma. No spontaneous hemorrhage from the artery was seen. The source of the hemothorax was believed to be hemorrhage from the tumor vessels. The tumor was treated conservatively, but it continued to grow rapidly and the patient died of respiratory failure. Five other patients have been reported to have hemothorax associated with Von Recklinghausen's disease. The sources of the hemothorax were reported to be hemorrhage from tumor vessels, or spontaneous rupture of the subclavian artery, an intercostal artery, or an intercostal vein.
A 43-year-old man was admitted suffering from dyspnea on exertion and edema of the neck and face. Chest X-ray film and CT scan revealed a mediastinal tumor and a right pleural effusion. A biopsy of the tumor revealed poorly differentiated carcinoma. Severe snoring at night and excessive daytime sleepiness were noticed after admission. Nocturnal oxygen desaturation was documented with a pulse oximeter, and obstructive sleep apnea syndrome was diagnosed on the basis of results of respiratory inductive plethysmography. The severity of snoring and oxygen desaturation during sleep correlated well with the progression of facial swelling. Combination chemotherapy (carboplatin 300 mg/m2 day 1, vindesine sulfate 3 mg/m2 day 1 and 8) was started but no improvement was seen. An expandable metallic stent was inserted into the stenotic vena cava, and the facial swelling, snoring, and oxygen desaturation during sleep were promptly relieved. In this case, obstructive sleep apnea was caused by edema and vascular congestion in the upper airway, and by the decrease in pharyngeal inspiratory muscle function caused by superior vena cava syndrome.
A 63-year-old male patient with a mass in the left chest wall was referred to our hospital. An osteoclastic area was found in the mass of the left 4th rib by computed tomography; the mass was hard and little movable. There was an irregular and poorly demarcated low-density area, 5 cm in diameter, in the liver anterior superior segment. Aspiration from the mass of the chest wall indicated adenocarcinoma (class V) and forecast of metastatic lesion. The titer of serum AFP showed an extremely high level of 1,100 ng/ml. According to these findings, the patient was diagnosed as having hepatocellular carcinoma with bone metastasis and treated by the administration of oral UFT (300 mg/day). Six months later, the mass in the left chest wall was completely eliminated, the size of the hepatic lesion changed to 2.5 cm, and the titer of AFP decreased to the normal range (8.4 ng/ml). Treatment of hepatocellular carcinoma with bone metastasis is often ineffective, but this is a rare case showing the clinical effectiveness of oral administration of UFT.
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Thirty-six different normal tissues and 13 different malignant epithelial tumours, were examined immunohistochemically for the presence of protein 1 (P1) and Clara cell 10-kDa protein (CC10). Adenocarcinomas of the lung were also examined for the expression of pulmonary surfactant apoprotein using a monoclonal antibody (PE-10). The staining results of P1 and CC10 were almost identical both in normal tissues and in malignant tumours. In normal lung, Clara cells were strongly positive for both P1 and CC10. In addition, some goblet cells and non-ciliated non-mucus cells in the upper airways were moderately positive for both proteins. In the malignant tumours, some lung cancers were positive for P1 and CC10, both of which were positive in the same tumour cells on sequential sections. In 117 lung cancers, P1 and CC10 were positive in 10.2% of adenocarcinomas, 20.5% of squamous cell carcinomas, and 12.5% of large cell carcinomas. PE-10 stained positively in 65.3% of adenocarcinomas, a frequency significantly higher than that of P1 and CC10 (P < 0.01). These results suggest that P1 and CC10 are nearly identical proteins, that both are useful markers of Clara cells, and that many pulmonary adenocarcinomas express surfactant apoprotein rather than Clara cell proteins.
Details of positive blood cultures obtained from 357 inpatients attending the Toyama University Hospital were collected over a 10-year period in order to document changes in microbiological and clinical features of bacteraemia. Fifty-one per cent of patients were over 60 years old, 48% had intravascular catheters in-situ, and 17% had had surgical procedures within 30 days prior to the isolation of organisms from the blood. The proportion of underlying diseases other than malignancies increased over the 10-year period (42-60%, P < 0.05). Patients from surgical departments other than the Academic Department of Surgery increased over the study period (16-55%, P < 0.05). Staphylococcus aureus bacteraemia increased significantly (29 to 49%, P < 0.05) as did pseudomonas and anaerobic bacteraemia. Most bacteria showed no significant changes in their antibiotic sensitivity pattern over the 10 years. Clinical features in patients with bacteraemia varied with the infective organisms and the underlying disease. Mortality was high in patients with haematological malignancy, usually in association with Pseudomonas aeruginosa.
The patient was a 59-year-old female with cervical thymic cancer infiltrating the trachea and right lobe of the thyroid, with associated metastasis to a cervical lymph node. The tumor was completely resected along with the infiltrated organs, in addition to dissection of the cervical and mediastinal lymph nodes, total thymectomy and tracheoplasty. Histologically the tumor consisted of lymphoepithelioma-like carcinoma and mucoepidermoid carcinoma. Postoperative radiotherapy for the neck and upper mediastinum was performed at a total dose of 44 Gy. The patient is alive without recurrence 8 months after surgery.
A surgical case of teratoma with malignant transformation (TMT) of the mediastinum in a 66-year-old man is reported. The unilocular, cystic, mediastinal mass, which had been seen in a chest radiograph 7 years earlier, was extirpated. The mass was histologically revealed to be a mature cystic teratoma containing skin and respiratory epithelial tissues, with some areas of well-differentiated adenocarcinoma. Surgical cases of TMT in the mediastinum, which have not received any preoperative chemotherapy or radiation therapy, are rare. By reviewing the previous literature on TMT in various organs, the authors distinguished two types of TMT, chemotherapy- or radiotherapy-induced TMT and naturally occurring TMT. The pathogenesis of these two types are discussed.
STUDY OBJECTIVE: To assess the usefulness of preoperative respiratory muscle training to increase muscle strength and its effects on postoperative pulmonary complications. DESIGN: We measured maximum inspiratory (MIP) and maximum expiratory (MEP) mouth pressure before and after training in 50 patients undergoing thoracic surgery. For control purposes, MIP and MEP were measured in 50 age- and sex-matched healthy subjects at two different times without training. RESULTS: Preoperative respiratory muscle training increased both MIP and MEP significantly (p < 0.01), while the control subjects showed no increase in these parameters. Eight patients who had postoperative pulmonary complications had significantly lower values (p < 0.01) and did not show significant increases in either MIP or MEP even after the training, unlike the other patients, who were without postoperative pulmonary complications. On the other hand, there were also another six patients who had equally low MIP and MEPs before training, but who raised their values with training and avoided the postoperative pulmonary complications. CONCLUSION: Preoperative respiratory muscle training may prevent postoperative pulmonary complications by increasing both inspiratory and expiratory muscle strength in patients undergoing thoracic surgery. Patients with respiratory muscle weakness have a higher risk of postoperative pulmonary complications.
In a 49-year-old man, large-cell carcinoma of the lung was accompanied by raised serum levels of growth hormone (GH) and growth hormone-releasing hormone (GHRH) and hypertrophic osteoarthropathy. Immunohistochemically the tumour contained GHRH but not GH. The osteoarthropathy disappeared after resection of the primary tumour and did not reappear after its recurrence. The high serum GH level presumably was due to ectopic GHRH production in the tumour. The hypertrophic osteoarthropathy was not clearly attributable to these hormones.
We present two cases of pericardial cyst diagnosed by cyst puncture and the injection of contrast medium. The first patient was a 48-year-old man. He was admitted for the evaluation of an abnormal chest X-ray which demonstrated a mass lesion inseparable from the right heart border. CT scan confirmed the mass in the anterior cardiophrenic angle. The mass was quite homogeneous, with an attenuation value of -0.3 HU. Under CT guidance a 21-G needle was inserted into the cyst and 3 ml of clear fluid was obtained, and then contrast medium was injected. A thin smooth walled cyst was outlined by the CT scan. A presumptive diagnosis of pericardial cyst was made. Surgery was performed and the diagnosis was confirmed. The second patient was a 24-year-old woman. An abnormal shadow was noted at annual check up. CT scan confirmed the mass in the anterior cardiophrenic angle. The mass was quite homogeneous, with an attenuation value of +10.4 HY. We made the diagnosis of pericardial cyst by cyst puncture and injection of contrast medium. The CT scan after three months showed no recurrence of the pericardial cyst. We consider that pericardial cyst can be diagnosed clearly by cyst puncture and the injection of contrast medium, and only percutaneous aspiration of the cyst fluid may be sufficient for the treatment.
The relations between the number and cell area of Clara cells and smoking were examined in the lung tissue of 71 subjects by immunohistochemistry, using an anti-protein 1 antibody, which is a marker of Clara cells. The smokers showed significantly lower numbers of Clara cells than the non-smokers (p < 0.05). Although the mean non-smoking time in the ex-smokers was as long as 9 years, the ex-smokers showed a somewhat lower number of Clara cells than the non-smokers. The cell area of Clara cells was the same for smokers and non-smokers. We found that smoking reduces the number of Clara cells.
A 44-year-old man with neurofibromatosis suffered from severe diarrhea and progressive hypoproteinemia. Enteric protein loss was confirmed by an alpha 1-antitrypsin clearance test. An x-ray study showed irregular mucosa in the distal segment of the ileum. Protein loss has subsided after ileocecal resection. Laparotomy and radiological examinations failed to demonstrate neurofibroma or other tumors in the abdomen. The resected ileum revealed marked edema of the wall and a pseudomembranous enteritis-like appearance in the luminal surface. Microscopically, lymphatic vessels in the intestinal wall were dilated. Marked thickening of the intima with spindle cell proliferation was observed in the mesenteric arteries and veins. This finding is consistent with vascular changes in neurofibromatosis. These vascular changes in the mesentery due to neurofibromatosis may cause protein-losing enteropathy by altering the hemodynamic state and microvascular permeability in the intestine.
An expandable metallic stent was used in 9 patients with tracheobronchial stenosis. Of the 8 patients with malignant stenosis, 6 had extrinsic compression and 2 had intraluminal tumor invasion. The 1 patient with nonmalignant stenosis had postreconstruction bronchomalacia and granulation tissue affecting different parts of the tracheobronchial tree. The expandable metallic stent successfully dilated tracheobronchial stenosis due to extrinsic tumor compression and malacia. However, it was not effective for stenosis due to intraluminal tumor invasion or granulation tissue because of the growth of tumor or granulation tissue between the wires of the stent. However, an expandable metallic stent covered with Dacron mesh was effective in 1 patient with intraluminal tumor invasion because tumor growth was blocked by the mesh. We conclude that an expandable metallic stent is effective for tracheobronchial stenosis due to extrinsic tumor compression, but not for stenosis due to intraluminal tumor invasion or granulation tissue.
A 61-year-old man presented with a skin tumour in the right axilla of 2 months' duration. An excision biopsy revealed a malignant lymphoma, of diffuse mixed small and large cell type, morphologically suggestive of T-cell lymphoma, but shown to be a T-cell-rich B-cell lymphoma by subsequent immunohistochemical staining. A review of the literature revealed 47 cases of T-cell-rich B-cell lymphoma with descriptions of primary sites, 35 nodal and 12 extranodal, of which only one was a cutaneous primary.
We describe a 41-year-old Japanese man with metastases of the lung, bone, lymph nodes and the base of the tongue 34 months after right radical nephrectomy. One month after systemic administration of human lymphoblastoid interferon (IFN), the metastasis to the base of the tongue completely disappeared, while other metastases increased both in size and number. Though the true effect of IFN-alpha on the metastatic renal cell carcinoma to the base of the tongue is still unknown, our case indicates that the tongue is a possible sensitive site to IFN-alpha therapy.
A 31-year-old woman who had been diagnosed as having idiopathic thrombocytopenic purpura at her first delivery (July, 1991) was admitted to our hospital on 17 July, 1992 for dry cough and abnormal chest shadow. Chest CT showed a hemisphere-like shadow in the left upper lung field. The TBLB specimen showed a mild eosinophilic pneumonia. When the patient was observed without medications, a ring-like shadow appeared newly in the right middle field and the both shadows became gradually wider and lighter. Cases of eosinophilic pneumonia showing such shadows are considered to be very rare and interesting.