Journal of The Showa Medical Association
Online ISSN : 2185-0976
Print ISSN : 0037-4342
ISSN-L : 0037-4342
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Volume 72, Issue 4
Displaying 1-20 of 20 articles from this issue
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Feature Articles: Minimary Invasive Surgery for Chest Diseases
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  • SECOND-LINE CHEMOTHERAPY IN PATIENTS WITH RELAPSED ADVANCED NON-SMALL LUNG CANCER
    Takao SHIRAI, Takashi HIROSE, Yasunori MURATA, Yasunari OKI, Soziro KU ...
    2012 Volume 72 Issue 4 Pages 446-452
    Published: 2012
    Released on J-STAGE: March 14, 2013
    DOIhttps://doi.org/10.14930/jsma.72.446
    JOURNAL FREE ACCESS
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    The aim of this study was to evaluate the response rate, survival time, and progression-free survival (PFS) time of second-line chemotherapy in patients with relapsed advanced non-small cell lung cancer (NSCLC). Between January 1998 and December 2006, of 253 patients with advanced NSCLC who received platinum-based first-line chemotherapy and it recurred, 76 patients who received second-line chemotherapy were retrospectively analyzed. The median time from the first-line chemotherapy to the second-line chemotherapy was 3.4 months. Of these 76 patients, 51 patients received docetaxel-based chemotherapy, 15 patients received gefitinib, and 10 patients received other chemotherapies. Response rates (RR) for docetaxel-based chemotherapy, gefitinib, and other chemotherapies were 5.9%, 20%, and 20%, respectively. Median survival times and median PFS times for docetaxel-based chemotherapy, gefitinib, and other chemotherapies were 9.6 months and 2.3 months, 4.2 months and 2.3 months, and 23 months and 1.7 months, respectively. There were no significant differences in RRs, survival times, and PFS times. Performance status was significantly associated with survival time after recurrence. In conclusion, three types of chemotherapies showed similar effectiveness as second-line chemotherapy in patients with advanced NSCLC.
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  • ANTEROLATERAL THIGH FLAP: EVALUATION OF 34 CASES
    Tomoaki KUROKI, Shinya YOSHIMOTO
    2012 Volume 72 Issue 4 Pages 453-470
    Published: 2012
    Released on J-STAGE: March 14, 2013
    DOIhttps://doi.org/10.14930/jsma.72.453
    JOURNAL FREE ACCESS
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    We report a retrospective review of 34 cases in which we used anterolateral thigh (ALT) flaps over the last 7 years and 10 months. We did not perform preoperative image analysis of the vascular pedicle in all cases. We searched for perforators and elevated flaps under the fascia with the naked eye. We were able to harvest 32 flaps (94.1%) in 34 cases. In these 32 cases, 26 free flaps were raised (81.3%), and the remaining 6 were pedicled flaps (18.8%). One case (3.8%) of free flap resulted in total necrosis. The mean number of perforators included in a single skin paddle was 2.0 (range, 1-4), and 68.8% of cases had multiple perforators. The maximum area of skin paddle (length × width) was 31 × 22 cm, and the minimum was 2 × 1.5 cm. We were able to elevate the lateral half of the thigh as a skin paddle with one perforator. Sixty of the 65 perforators (92.3%) were musculocutaneous and 5 (7.7%) were septocutaneous. We were able to harvest flaps in both cases. The number of descending branches of the lateral circumflex artery included was 0 in 4 (11.8%) of the 34 cases. However, we could make flaps using the muscular branch to the vastus lateralis in these 4 cases. We conclude that an ALT flap can always be harvested without preoperative image analysis of the vascular pedicle, and even the presence of only one perforator offers a reliable blood supply to feed a large skin paddle. We believe that anatomical variations of vascular pedicles or difficulties in dissection of the pedicle can be overcome with the accumulation of such information and simplification of the operative processes.
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  • ENRICHMENT AND AUTOMATED DETECTION OF NRBC FROM MATERNAL BLOOD
    Wakako SUZUKI, Ikuo HONMA, Akihiko SEKIZAWA, Michihiro KITAGAWA
    2012 Volume 72 Issue 4 Pages 471-478
    Published: 2012
    Released on J-STAGE: March 14, 2013
    DOIhttps://doi.org/10.14930/jsma.72.471
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    We are focusing on fetal Nucleated Red Blood Cells (NRBC) as a target for noninvasive prenatal diagnosis. It is important to enrich fetal NRBC from maternal blood because the number of NRBC circulating in maternal peripheral blood is very small. We report here beneficial impacts of CD45 depletion and an automated detection system on the enrichment of NRBC. CD45 depletion using CD45-magnetic beads dramatically reduced the number of nucleated cells from a fraction after density gradient centrifugation. CD45 depletion enhanced the detection rate of NRBC as well as the detection efficiency. We used a Cytogenetic Scan System (Carl-Zeiss) to automatically detect and identify NRBC on slides. Compared with manual scanning under a microscopy, the automated scanning reduced time and labor and also increased the detection rate of NRBC three fold. The identified NRBC were analyzed by fluorescent in situ hybridization (FISH) to verify their sex in five cases. We definitely detected NRBC with XY signal in two out of two male cases.
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  • CLINICAL CLASSIFICATION AND PATHOLOGICAL FINDINGS OF VESTIBULAR SCHWANNOMA REQUIRING SURGICAL THERAPY AFTER STEREOTACTIC RADIOSURGERY
    Ataru FUKUDA, Akiko SASAKI, Nobusuke KOBAYASHI, Isao KITAHARA, Toru MI ...
    2012 Volume 72 Issue 4 Pages 479-487
    Published: 2012
    Released on J-STAGE: March 14, 2013
    DOIhttps://doi.org/10.14930/jsma.72.479
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    The present study investigated imaging, intraoperative and pathological findings, and surgical indications and timing in 10 patients [5 men, 5 women; mean age, 52.3 years (range, 17-70 years)] with vestibular schwannoma who underwent surgical therapy due to poor radiotherapy-mediated tumor control; these included Gamma Knife (n = 8), X-Knife (n = 1) and proton beam (n = 1) therapies. The mean period from radiotherapy endpoint until surgery was 63.3 months (range, 30-96 months) and patients were classified according to the time elapsed between radiotherapy and surgical therapy [≥ 2 to < 5 years (n = 4); ≥ 5 to < 8 years (n = 4); or ≥ 8 years (n = 2)]. Surgical indications were classified into two groups: exacerbated or additional neurological symptoms caused by solid tumor component enlargement (n = 2); and exacerbated or additional neurological symptoms with extraparenchymal extension of the tumor cyst (n = 8). Imaging findings were classified as large cystic (LC; n = 8), multi-micro cystic (MC; n = 2), or solid component enlargement (SC; n = 0) types. Pathological findings revealed no malignant changes in any patient, and primary pathological conditions comprised radiotherapy-induced exacerbation of vascular occlusion and permeability. MC patients presented marked hemosiderosis and recurrent small hemorrhage was predicted. Intraoperative findings included marked adhesions with peripheral neurons and the cerebellum, as well as arachnoid thickening, rendering complete resection difficult. Decompression surgery was relatively straightforward for LC, which presents little bleeding, but it was challenging for MC due to its hemorrhagic nature. SC cases have been previously reported, but were not found in the present study, which had an inclusion criterion of ≥ 2 years follow-up after radiotherapy. Other than a single case that became malignant, all of the previously reported cases were within 2 years of radiotherapy and transient swelling may have been present.
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  • CYTOLOGIC DIFFERENCES BETWEEN MESOTHELIOMA AND REACTIVE MESOTHELIAL CELLS
    —Appearance ratio of intracytoplasmic vacuole cells—
    Takeo ISOZAKI, Masafumi TAKIMOT, Hidekazu OTA, Takashi KITAMURA, Yoshi ...
    2012 Volume 72 Issue 4 Pages 488-496
    Published: 2012
    Released on J-STAGE: March 14, 2013
    DOIhttps://doi.org/10.14930/jsma.72.488
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    Mesothelioma is one of diseases that is showing an increase in incidence in recent years. The cytologic characteristics of mesothelioma are widely variable. To distinguish mesothelioma from adenocarcinoma or reactive mesothelial cells is difficult, and consequently the diagnostic accuracy by cytology is not high. Here, we analyzed the appearance ratio of intracytoplasmic vacuole cells as it seems to be a useful means to distinguish mesothelioma from reactive mesothelial cells. Body cavity effusions in 17 cases of epithelial mesothelioma and 10 cases of reactive mesothelial cells were analyzed. Intracytoplasmic vacuole cells were classified as: 1) peripheral vacuole-like (PV) cells, 2) central vacuole (CV) cells, and 3) vacuole (V) cells that lack PV and CV cell features. Comparison of the appearance of intracytoplasmic vacuole cells between mesothelioma and reactive mesothelial cells revealed that the appearance ratio of PV cells was significantly high in mesothelioma. We further analyzed the structural features of mesothelioma. Mesothelioma was subclassified into two groups; group A shows a solid cluster and group B shows a flat cluster or isolated cells, namely a non-solid cluster. Comparison of the vacuole cells in groups A and B indicated that the appearance of PV and CV cells was significantly higher in group B. These findings suggested that the appearance ratio of PV and CV cells is useful to distinguish mesothelioma from reactive mesothelial cells, particularly in cases of mesothelioma that show a flat cluster or an isolated cell and mimic reactive mesothelial cells. Thus, when PV or CV cells are identified, intensive clinical examinations are necessary for the diagnosis of mesothelioma. The present findings provide a clue for the diagnosis of mesothelioma that may be misdiagnosed as reactive mesothelial cells in effusion cytology.
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  • STAGING, CLASSIFICATION AND VASCULAR FORM OF OSTEONECROSIS OF THE FEMORAL HEAD
    Yuto MURAKAMI, Koji SAITO, Koudai HIRABAYASHI, Kenji HARADA, Keita YAM ...
    2012 Volume 72 Issue 4 Pages 497-502
    Published: 2012
    Released on J-STAGE: March 14, 2013
    DOIhttps://doi.org/10.14930/jsma.72.497
    JOURNAL FREE ACCESS
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    Osteonecrosis of the femoral head is largely due to a blood flow disturbance, but the mechanism of occurrence is not well understood. We observed the vascular morphology of the femoral head in the removed head of osteonecrosis cases; the objective group included 28 osteonecrosis cases, and the control group included six osteoarthritis cases. We observed the vessel's shape of the femoral head sectioned on the coronal plane, and the number and diameter of the vessels in the band region. Although we found an ‘island-shaped elevation’ in the vessel in 15 osteonecrosis cases (53.6%), there was no such elevation in the control group. Necrosis and restoration are very well-known mechanisms of osteonecrosis. Vascular endothelial cells and fibroblastic cells are thought to be shifted to the lumen in the process of restoration, which seems to be a characteristic of osteonecrosis because such structures were not observed in the control group. The total number of vessels in Stage 4 was significantly higher than that in Stages 2 + 3. Unlike a typical inflammatory reaction, the course of the disease is prolonged due to the repetitive necrosis and restoration phases. As a result, the number of vessels increases in Stage 4. Taken together, these two findings (the existence of ‘island-shaped elevation’ in the vessel and the vessel number dominance in Stage 4) are thought to be proof of the repetitive necrosis and the restoration.
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Case Report
  • A CASE REPORT OF SIX CONSECUTIVE PATIENTS WITH ACCIDENTAL HYPOTHERMIA
    Shuji KIKUSHIMA, Hidetoshi ITO, Shigeru KANESAKA
    2012 Volume 72 Issue 4 Pages 503-508
    Published: 2012
    Released on J-STAGE: March 14, 2013
    DOIhttps://doi.org/10.14930/jsma.72.503
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    We report herein consecutive 6 patients (3 males) admitted to our hospital with accidental hypothermia, between April 1, 2010 and March 31, 2011. These patients were 74 + 17 (50 to 95) years old. All patients developed hypothermia indoors; 5 of 6 cases (80%) occurred in the winter season (December to February). One patient had primary hypothermia and 5 patients had secondary hypothermia. At the time of admission, rectal temperature was 31.2 + 2.0 (28.3 to 28.1) °C. The electrocardiogram in 4 patients showed a J wave, which disappeared after rewarming. In all cases, active external warming measures were initiated. Two patients had a higher skin temperature than rectal temperature. Three patients died, after rewarming was completed, due to an underlying condition (liver cirrhosis, chronic obstructive pulmonary disease and severe pneumonia). Body mass index was lower in the death group (12.07 ± 1.85 kg/m2) than in the survival group (22.4 ± 0.46 kg/m2). These results indicate that the prognosis of accidental hypothermia was poor in those with a lower body mass index.
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  • A CASE OF HERPES ZOSTER WHICH NEEDED DIFFERENTIAL DIAGNOSIS OF DEGENERATIVE LUMBAR DISEASES WITH FORMER LOWER EXTREMITY PAIN
    Hironori TANAKA, Satoshi FURUMORI, Kazunari TOMITA, Souichirou TAKIGAW ...
    2012 Volume 72 Issue 4 Pages 509-513
    Published: 2012
    Released on J-STAGE: March 14, 2013
    DOIhttps://doi.org/10.14930/jsma.72.509
    JOURNAL FREE ACCESS
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    A 67-year-old man complained left leg pain from five days before visiting our clinic. He had been receiving adjacent chemotherapy for rectal cancer, following two operations.
    He complained of pain at L 5 nerve root area of his left lower extremity, therefore we started treatment and examination for his pain under the diagnosis of lumbar spinal canal stenosis. His pain worsened and we observed rash of L 4 and L 5 nerve root area after five days. Therefore, herpes zoster on the lower extremity was diagnosed, and antiviral drugs administration was started. The bullas became dry and the lower extremity pain had decreased one month later.
    It is difficult to differentiate herpes zoster from degenerative nerve root diseases in patients who have lower extremity pain, without vesicles. Therefore, it is important to carefully check elderly patients, especially compromised patients.
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  • A CASE OF MULTIPLE FACIAL FRACTURES WITH SELECTIVE ENDOVASCULAR TREATMENT FOR FACIAL HEMORRHAGE AFTER HELICOPTER EMERGENCY MEDICAL SERVICE TRANSPORT
    Takaaki ONODERA, Hideyuki MURAMATU, Minoru HAYASHI
    2012 Volume 72 Issue 4 Pages 514-519
    Published: 2012
    Released on J-STAGE: March 14, 2013
    DOIhttps://doi.org/10.14930/jsma.72.514
    JOURNAL FREE ACCESS
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    Helicopter emergency medical service (HEMS) was started in 2009 at Maebashi Red Cross Hospital. Some reports have shown that HEMS is useful for multiple trauma patients.
    Multiple facial fractures sometimes cause massive facial hemorrhage, and some reports indicate that emergency endovascular treatment for facial hemorrhage is effective.
    We report a case of multiple facial fractures with selective endovascular treatment for facial hemorrhage after transport by HEMS. A 32-year-old man was involved in a traffic accident and was transported to the Critical Care Center of our hospital by HEMS. He was diagnosed as having multiple facial fractures, a fracture of the base of the skull, a brain contusion, a traumatic subarachnoid hemorrhage, a fracture of the left clavicle, a fracture of the left scapula, and a fracture of the left first rib. Since the hemorrhage from his face was poorly controlled, open reduction and fixation were performed after emergency endovascular treatment of the maxillary artery.
    We considered HEMS effective for a lifesaving outcome in this case.
    The advantages of HEMS are early primary survey, prehospital orders, and shortening of the transport time. Multiple facial fractures with massive facial hemorrhage can be fatal. We conclude that HEMS is effective in severe trauma patients.
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