Positron emission tomography (PET) is a nuclear medicine imaging technique. Through the use of various radiopharmaceuticals, PET allows in vivo imaging of regional cerebral functions, including cerebral blood flow, molecular metabolism, and receptor binding capacity. PET is useful not only for diagnosis and therapeutic planning but also for neurological science research.

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Objective: Transurethral enucleation of the prostate (TUE) is designed for complete removal of the prostate lobes. On the basis of TUE and holmium laser enucleation of the prostate, we developed a new technique of transurethral detachment prostatectomy (TUDP) using a tissue morcellator.
Materials and Methods: In TUDP, enucleation is performed with a prostate-detaching blade and the tip of a resectoscope, followed by removal of the tissue with a morcellator. This study reports our experience with TUDP in which the weight of retrieved tissue was greater than 30 g in 76 patients with benign prostate hyperplasia.
Results: The mean preoperative total prostate and adenoma volumes were 70.7 and 47.4 mL, respectively. The mean times required for enucleation, morcellation, and total operation time were 28.5, 14.4, and 66.3 minutes, respectively. The mean weight of removed prostate tissue was 61.1 g. The mean decreases in the levels hemoglobin and serum sodium were 1.73 mg/dL and 2.41 mEq/dL, respectively. The mean preoperative maximum flow rate (Qmax), International Prostate Symptom Score (IPSS), and quality of life score (QOL) improved from 9.8 mL/sec, 20.2, and 4.9, to 22.3 mL/sec, 3.1 and 1.2, respectively. Complications included mild morcellator-induced mucosal injury in 2 patients (2.6%), nausea in 4 patients (5.2%), transient urinary retention in 2 patients (2.6%), transient urge incontinence in 5 patients (6.4%), and urethral stricture in 2 patients (2.6%). The mean prostate volume and serum prostate-specific antigen level measured 6 months postoperatively in 46 patients were 10.68 mL and 0.89 ng/mL, respectively.
Conclusions: TUDP is effective for complete removal of large prostate lobes in patients with large benign prostate hyperplasia and is associated with lower perioperative morbidity.

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The combination of general anesthesia and epidural anesthesia has been considered to worsen the degree of hypothermia. However, epidural anesthesia reduces cardiac output, which may prevent redistribution hypothermia. Twenty-four patients undergoing gynecologic surgery were randomly assigned to one of two groups: recipients of epidural injection of 1% ropivacaine and general anesthesia (epidural and general group, n=12) and recipients of epidural injection of saline and general anesthesia (general group, n=12). Fifteen minutes after epidural injection of 12 mL of 1% ropivacaine (epidural and general group) or saline (general group), general anesthesia was induced with propofol, and tracheal intubation was facilitated with vecuronium. Anesthesia was maintained with 35% oxygen and 0.4% to 2% isoflurane with a nitrous oxide mixture. Tympanic (core), forearm, and fingertip temperatures were recorded before the epidural injection, just before induction of general anesthesia, just after tracheal intubation, and every 15 minutes up to 90 minutes after tracheal intubation. The core temperature was significantly higher in the epidural and general group than in the general group from 30 to 90 minutes after tracheal intubation. Epidural anesthesia with 1% ropivacaine may prevent redistribution hypothermia during general anesthesia for gynecologic surgery.

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Purpose: The postoperative recurrence rate of pneumothorax tends to be higher with thoracoscopic bullectomy than with conventional plication of bullae by axillary thoracotomy or posterolateral thoracotomy. We analyzed the risk factors for postoperative recurrence of pneumothorax in young patients treated with thoracoscopic bullectomy alone for primary spontaneous pneumothorax.
Methods: Univariate and multivariate analyses were performed of a consecutive series of 53 patients (62 sides) who underwent video-assisted thoracoscopic bullectomy from March 1994 through March 2004.
Results: Pneumothorax recurred after 10 operations (16.1%). Eighty percent of postoperative pneumothorax recurrences developed within 5 months after surgery. Univariate analysis of postoperative pneumothorax recurrences revealed significant risk factors to be the early period of video-assisted thoracoscopic surgery (VATS) experience for primary spontaneous pneumothorax and a low number of pack-years (p<0.05 and p<0.05, respectively). Multivariate logistic regression test revealed that the early period of VATS experience was the single significant risk factor (odds ratio, 0.275; 95% confidence interval, 0.095-0.797; p value, 0.0174). Seventy percent of postoperative pneumothorax recurrences probably developed because of overlooked bullae and incomplete resection of bullae in the early period of VATS experience. Close observation of the pleural cavity to find bullae and bullectomy with a sufficient margin of normal pleurae and pulmonary parenchyma prevented postoperative pneumothorax recurrences significantly in the middle and recent periods.
Conclusion: Close observation of the pleural cavity to find bullae and bullectomy with a sufficient margin of normal pleurae and pulmonary parenchyma are important measures for preventing postoperative recurrence of pneumothorax.

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Clinical studies have demonstrated that gefitinib, an epidermal growth factor receptor inhibitor, is an effective treatment for some patients with advanced non-small cell lung cancer and is generally well-tolerated. However, several reports have also suggested that gefitinib is associated with acute lung injury and subsequent fibrosis. One hypothesis is that gefitinib exacerbates lung injury induced by radiation therapy. It is important to confirm the safety of gefitinib in radiotherapy for patients with lung cancer. In this preclinical study we aimed to clarify the effect of gefitinib on thoracic radiotherapy. Six-week-old female C57BL/6 mice were immobilized in a plastic frame, and the thorax was irradiated once with a dose of 12 Gy on day 0. Gefitinib (20, 90 and 200 mg/kg/day) was administered on days 0 to 5 (acute phase) or days 14 to 19 (late phase) postirradiation. Thoracic irradiation induced lung injury and subsequent fibrosis 5 months later. Gefitinib, administered in the acute phase, had no effect on lung fibrosis or collagen levels induced by irradiation. A high dose of gefitinib (200 mg/kg/day) administered during the late phase significantly reduced fibrosis scores and collagen levels. These results suggest that gefitinib does not exacerbate radiation-induced lung injury and fibrosis in this strain of mice. Therefore, thoracic irradiation is unlikely to be a risk factor for lung injury associated with gefitinib treatment.

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Chorioamnionitis (CAM) has been recognized as a common cause of neonatal morbidity and mortality. The effect of CAM on fetal heart rate (FHR) remains unclear. The purpose of this descriptive retrospective study was to evaluate the clinical significance of the FHR pattern in cases that involved delivery during the third trimester and the diagnosis of histopathological CAM. The study group consisted of 65 singleton live births delivered at 28 to 41 weeks gestation from January 2003 through December 2005 in which histopathological CAM was diagnosed at the Nippon Medical School Tama Nagayama Hospital. We reviewed the cases using medical records and examined FHR data and the severity of histopathological CAM. The rate of tachycardia according to the severity of CAM was as follows: 3.0% (1 of 33 cases) in intervillositis, 12.5% (3 of 24 cases) in chorionitis, 37.5% (3 of 8 cases) in CAM (in a narrow sense); however, this tendency had no statistical significance. Baseline variability and decelerations were not correlated with the severity of histopathological CAM. Maternal fever exceeded 38.0°C in only 3 cases, and 1 fetus had exhibited an abnormal FHR pattern. The present study suggests that FHR monitoring is not a reliable means of diagnosing histopathological CAM, because the FHR pattern was normal in most cases of histopathological CAM.

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Colestimide has been reported to lower blood glucose levels in patients with type 2 diabetes and hypercholesterolemia. We investigated the mechanism of the hypoglycemic activity of colestimide by examining changes in serum cholecystokinin (CCK) and insulin concentrations before and after its 2-week oral administration. A total of seven type 2 diabetes inpatients with hypercholesterolemia received colestimide after their blood glucose levels had stabilized. We daily measured plasma glucose levels and serum lipid concentrations, calculated Body Mass Index (BMI), and determined whole-day changes in serum immunoreactive insulin (IRI) and CCK concentrations in all study subjects. We daily measured plasma glucose levels, as well as serum IRI and CCK concentrations at 10 time points for measurement. Plasma glucose levels, as well as serum IRI and CCK concentrations before and after the 2-week oral administration of colestimide were compared. The means of total cholesterol levels and BMI decreased significantly after administration. At time points for measurement (10 : 00 and 12 : 00), plasma glucose levels decreased significantly after administration (P=0.026 and P=0.009, respectively). Diurnal changes in serum IRI and CCK concentrations were not observed after administration, except for the IRI concentration at 20: 00. The effect of colestimide on CCK may not explain the mechanism of its blood glucose-lowering activity in patients with type 2 diabetes and hypercholesterolemia.

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We report on a patient with male choriocarcinoma. The patient was a 31-year-old male patient with jejunal choriocarcinoma that metastasized from the mediastinum. He was admitted complaining of melena and severe anemia. Upper and lower gastrointestinal endosocopy was performed, but no source of bleeding was seen. Chest X-ray and CT revealed a mediastinal tumor 7 cm in size anterior to the arotic arch. Superior mesenteric arteriography showed irregularities and macular opacity in the jejunal artery. An emergency laparatomy was performed because of massive gastrointestinal bleeding. A jejunal tumor approximately 4 cm in size was resected and numerous metastases were observed in the liver and mesentery. Histopathological examination showed metastatic jejunal choriocarcinoma. Gynecomastia was not present and the testes were normal. Serum beta-human chorionic gonadotropin (HCG) was at an abnormally high level of 4,396 ng/mL. Because of metastases to the brain and invasion to the trachea, he died on postoperative day 20. We report this rare case of a male patient with metastases of choriocarcinoma to the gastrointestinal tract from the mediastinum, together with a review of the literature.

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A 38-year-old man was referred to our hospital with perineal and micturition pain. Transrectal ultrasound (TRUS) revealed a cystic mass in the outer prostate. Pelvic cyst and left renal agenesis were confirmed by magnetic resonance imaging (MRI) and computerized tomography (CT), and we diagnosed seminal vesicle cyst. The symptoms have since subsided, the possibility of sterility has been ruled out, and the patient is showing good improvement.

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