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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地域保健福祉計画策定における住民参画のあり方と, 住民参画を促進するための保健婦の役割を明らかにすることを目的に, 一町における2年1カ月間の介護保険事業計画策定過程から, 「住民参画を促進する」という観点で保健婦が実施した行為とその意図を抽出し分析した.その結果, 住民参画のあり方では, 行政側と参加者との対等な立場での協議, 住民自身が取り組むべき課題の明確化が重要であった.そのために保健婦は, 参加住民への働きかけに加えて, 行政側の「住民参画」に関わる意思統一を図るためのスタッフへの働きかけと, 組織的な取り組みの体制確保のための首長への働きかけとを同時並行で行うことが必要であった.また, 協議方法・協議内容の段階別設定, 参加者の理解・関心に対応した資料提示, 参加者個々の意見のフィードバック等, 住民参画の促進に有効な方法が明らかになった.これらのことを, 地域保健福祉計画策定過程において意図的に実施することの必要性が示唆された.

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表皮嚢胞は単発ないし多発性に全身, 特に顔面・頭部の真皮または皮下層に生じる.これは真皮または皮下層に生じた類表皮嚢胞と同一の疾患と思われる.
症例1 : 34歳, 女性.嚢胞は視診で左側の顎下部に境界明瞭な腫瘤として認められ, 触診で柔らかく可動性を認めた.その嚢胞は全身麻酔下にて口腔外より容易に摘出できた.筆者らは病変部に医学的な既往がないため, この嚢胞は先天的な起源を有すると考えた.
症例2 : 22歳, 男性.嚢胞は左側頬部皮膚に境界明瞭で20×15mmの腫瘤として認められた.触診にて疼痛はなく可動性を認めた.病変の摘出に困難を感じ, 口腔内と口腔外よりのアプローチを必要とした.筆者らは患者には数年前に病変部に外傷の既往が認められたため, 本嚢胞は後天的な起源を有すると考えた.

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症例は76歳の農婦.数年来, 腰痛を訴え骨粗鬆症と診断され, その後, 生じた貧血は消化管出血由来とされ, いずれも治療中, 転倒し肋骨骨折を来たし入院.検査で高度の貧血及び腎機能障害と著明な高蛋白血症を認め, 免疫電気泳動で, 血清中にIgG型のM蛋白, 尿中にκ型のベンスジョーンズ蛋白を検出した.骨は外傷性肋骨骨折のほか骨溶解性病変を呈した.これらの症候と検査成績から多発性骨髄腫 (以下MM) と確診した.高度の貧血に輸血を行い, 当初エンドキサン, 次いでプレドニンを投与し, γグロブリンは半減したが腎不全が進行し死亡した.自験例は確診に先立つかなり前からMMの手掛かりとなる骨痛, 貧血が存在し, 前者を骨粗鬆症, 後者を消化管出血由来と判断した為早期診断が遅れた.著明な貧血と腰, 背, 胸部の疼痛を呈する疾患を見た場合, 多発性骨髄腫等の悪性腫瘍も考慮し対応することが肝要と反省させられた.

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