This study discusses an optimal treatment for patients with pleural dissemination, which was first revealed in operation, retrospectively.
We performed thoracotomy for 710 patients with lung cancer between 1982 and 1998 at National Sanatorium Nishi-Gunma Hospital. The pleural dissemination of non-small cell lung cancer was found at thoracotomy in 24 cases (3.4%). We study prognosis of the patients with pleural dissemination, and compare survival between patients with pleural dissemination undergone lobectomy and stage IIIB other than pleural dissemination.
Five-year survival (5 YS) of all the 24 patients was 24.3%. 5 YS of 17 under lobectomy (Lob-D group) was 32.4%. 5 YS of 29 patients having stage IIIB without pleural dissemination (Stage IIIB group) was 0%. No statistical significant difference was observed in the survival rates between Lob-D group and Stage IIIB group.
This suggests that lobectomy for pleural dissemination found at thoracotomy is one of the procedures that should be chosen.

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Phospholipase D (PLD) catalyzes the hydrolysis of phosphatidylcholine to generate phosphatidic acid (PA) and choline. Since PA and its metabolites have a number of biological activities, PLD is thought to be important in a variety of physiological functions. Three PLD activities have been previously reported in mammalian tissues : PLD1, PLD2, and oleate-dependent PLD, but at present time the distinction between the latter two is obscure. The aim of this study is to clarify the distinction. PLD activities in pig lung membranes were investigated about the characteristics in solubilization by high salt concentrations and in separation by column chromatography. Three types of PLD activities corresponding to oleate-dependent PLD, PLD1, and PLD2 were identified. Oleate-dependent PLD activity was scarcely solubilized with high salt concentrations, but considerable amounts of the other two activities were extracted. Furthermore, oleate-dependent PLD activity solubilized with heptylthioglucoside following a cation exchange column were separated from the other two PLD activities in chromatography on a hydroxyapatite column. In the present study, for the first time, we provide the evidence that there are three activities of PLD in pig lung membranes and that oleate-dependent PLD activity is distinguished from PLD2 activity by solubilization and chromatography.

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Six patients who underwent a reconstruction of the superior vena cava (SVC) area were reviewed. The mean age of the patients was 50 years. Only one patient complained of preoperative SVC syndrome. Pathologic diagnoses were invasive thymoma in five patients including two redo cases, and thymic carcinoid tumor in one patient. Polytetrafluoroethylene (EPTFE) grafts were used for vein reconstruction. The left innominate vein was reconstructed in all six patients. The right innominate vein and the SVC were reconstructed in three patients. Extracorporeal circulation (ECC) was used in one patient with a tumor extension into the right atrium. All patients except for one with a thymic carcinoid tumor received both postoperative irradiation therapy and chemotherapy. Two patients died during the postoperative late periods and four patients survived for three to 18 years (mean ; 10) after the initial operation. Three out of four patients underwent additional surgery during the postoperative late periods. The graft patency rate was 67 % in the SVC area and 50% in the left innominate veins. In conclusion, a radical operation with reconstruction of SVC is treatment of choice for long-term survival and bilateralvenous reconstruction is recommended The indication of ECC for tumor resection is still controversial.

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The purpose of this study is to identify the challenges to citizens and to identify the role of public health nurses (PHN) to ensure participation of the citizens in the establishment of a community health and welfare plan. From the process of establishing a care insurance project plan practices in a town for two years and a month, the activities of PHN and their intention were identified and analyzed from the viewpoint of promoting the participation of the citizens. The results were as follows ;
1) On the challenges to the citizens of participating, it is important that the administrators and the citizens talk on equal terms with each other to clarify issues they must tackle with.
2) PHN had to work not only with the citizens but also with the administrators to have a shared view about the participation of the people. At the same time, they also had to work with the town mayor to secure the system for organized activities.
3) The methods to promote citizens' participation were identified, including how to hold conferences, how to select topics of discussion, how to present information to the level of their understanding and to their interests and how to give them feedback.

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One or more epidermal cysts may occur anywhere in the the body but mostly on the face and head and in the inner or subcutaneous layer of the skin. They are considered to be the same type of lesion as epidermoid cysts, which also occur in the inner or subcutaneous layer of the skin.
Case 1 : A-34-year-old woman had a cyst seen as a well-demarcated mass in the left submandibular region, soft and able to be moved by finger pressure. The cyst was easily removed extraorally under general anesthesia. We believe this cyst was congenital, because the patient did not have any medical history concerning the site.
Case 2 : A-22-year-old man had a cyst seen as a well-demarcated mass, 20×15 mm in the left cheek skin. It was not painful and was able to be moved by manipulation. We had difficulty in removing the lesion and needed both intra-and extraoral approaches. We believe this cyst had an acquired factor in its origin because the patient had an external injury to the involved site several years ago.

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A 76-year-old woman farmer, who had been treated for anemia presumably due to alimentary bleeding, complained left side back pain due to traumatic fracture of the left 8th and 9th ribs and was admitted to our hospital on August 15 1999. The first examination on admission revealed severe anemia, hyperproteinemia with monoclonal gammopathy (IgG) and proteinuria. During hospitalization, immunoelectrophoresis demonstrated M protein type IgG in the serum and light chains, Bence Jones' protein, type κ in the urine. The diagnosis of multiple myeloma was confirmed, and then cyclophosphamide (Endoxan) initially administered followed by corticosteroids folllowingly were used. Regretfully, the patient died of acute renal failure October 13 1999.

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