Background and Aims : We retrospectively analyzed the long-term clinical course of 10 patients with pineal germinomas to determine the best treatment modality for achieving a good outcome.
Methods : Subjects were treated at the Gunma University Hospital between 1980 and 1998, given a total dose of 40-50 Gy (mean : 49 Gy) delivered under a conventional fractionation schedule.
esults : Tumors had shrunk at 20 Gy in all 10 patients. Mean follow-up was 13.5 years (162 months, range, 59 to 268 months). Five-year survival for the group was 100%. None experienced intracranial disease recurrence. No new abnormalities in internal secretion considered to be due to radiotherapy were seen. Karnofsky performance scales (KPS) for 8 of the 10 were 100. KPS of the remaining 2 were 80, including easy fatiguability, mild ataxia, and recent memory disturbance.
Conclusions : Administration of doses of 50 Gy for pineal germinoma is adequate for controlling the tumor over the long term but may reduce the patient's quality of life. Further study is therefore needed to determine the optimal dosage for pineal germinoma.

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Background & Aims : We studied the efficiency of blood cardioplegic (BCP) solution as a perfusate in a combined method for long-term heart preservation. Methods : Fourteen adult mongrel dogs' donor hearts were stored in a hypothermic (4°C) University of Wisconsin (UW) solution for 12 hours and divided into two groups by the type of coronary perfusates : 15°C BCP solution (n = 7), and 4°C UW solution (n = 7). High-energy phosphate components (phosphocreatine, β-adenosine triphosphate) and intracellular pH were measured by ³¹P-nuclear magnetic resonance spectroscopy. Creatine phospho-kinase activity and lactic acid value discharged from the coronary sinus during the period of coronary perfusion were also measured. Results : BCP perfusion after simple cold immersion provided significant restoration of phosphocreatine and β-adenosine triphosphate, and lower levels of creatine phosphokinase and lactic acid compared with the perfusion using the UW solution. On the other hand, water content was significantly increased after coronary perfusion using BCP solution. However, there were no significant differences in histological findings between hearts perfused by either perfusate. Conclusion : These results suggest that blood cardioplegic solution is preferable to the UW solution for coronary perfusion following simple cold immersion.

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Background & Aims : Levofloxacin (LVFX) is a newly synthesized quinolone antibiotic, and although LVFX 500 mg once-daily has been reported to have good efficacy against with respiratory tract infections in the US and other countries, once-daily the regimen seldom been used in Japan. Methods : This randomized, parallel-group, open, multicenter clinical study was designed to compare a 7-day course of LVFX 300 mg once-daily with LVFX 100 mg three-times-daily in elderly patients with respiratory tract infections. Between February 2002 and March 2003, a total of 63 patients with significant respiratory tract infections were enrolled in this study. Results : Data were available for 49 patients. The clinical cure rate was 76.0% (19/25) in the LVFX 300 mg once-daily group and 83.3% (20/24) in the LVFX 100 mg three-times-daily group. The overall clinical cure rates and overall incidences of adverse reactions were similar in both groups. There was also no significant difference in compliance between the groups. Conclusions : LVFX 300 mg once-daily is as effective and safe as LVFX 100 mg three-times-daily in elderly patients with respiratory tract infections.

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Background & Aims : Pulmonary epithelial cells line the human respiratory tract and are covered with respiratory tract mucus. Fluid flow affects them, because they are exposed to the shearing force of the mucus slab. In this study, we investigated the effect of mechanical fluid flow on the proliferation by A549 pulmonary epithelial cells. Methods : We used a Mild mixer to produce fluid flow by rotating the stand. Results : Mechanical fluid flow enhanced proliferation by A549 cells, and the stimulation of cell proliferation was unaffected by either the competitive inhibitor of nitric oxide synthase N^G-monomethyl-L-arginine or by sodium nitroprusside, which spontaneously generates nitric oxide. However, it was reduced by the guanylate cyclase inhibitor methylene blue. Conclusions : These findings suggest that mechanical fluid flow activates guanylate cyclase. Mechanical fluid flow may enhance the proliferation of pulmonary epithelial cells and thereby facilitate the repair of the denuded epithelium in asthma.

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Aims : Focusing on changes in the Barthel index (BI), we studied the improvement in activities of daily living (ADL) among patients hospitalized more than 5 months after onset of apoplexy.
Methods : Subjects were 20 patients hospitalized from June 2000 to June 2001. We measured changes in BI for 3 months after hospitalization.
Results : The rise in BI among those hospitalized within 5 months after development of symptoms averaged 17.5 points, while that among those hospitalized more than 5 months after averaged 5 points. 6 subjects hospitalized more than 5 months after onset had the rise of BI. 5 subjects were the rise of the item of movement among those. The correlation coefficient of the period from development of symptoms in all subjects to hospitalization and the rise in BI was-0.4534 (P<0.05).
Conclusions : The rise in BI due to improved wheelchair use was accepted by the chronic phase rehabilitation of the apoplexy in the received type hospital of medical treatment, improving ADL.

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Backgrounds and Aims : Hepatocellular carcinoma (HCC) is recently increasing in number and the gender differences have been epidemiologically demonstrated.
Patients and Methods : Patients with HCC treated in National Sanatorium Nishigunma Hospital in recent 10 years were clinicopathologically analyzed for their gender difference.
Results : Male patients with HCC were approximately 2.5 times more than female (189 : 74), namely 18. 9 male and 7.4 female patients with HCC were diagnosed in a year (P <0.01). The age at the diagnosis of male HCC was 62.89 and that of female was 66.91 This difference was significant in HCV positive patients (63.1 : 66.5, P < 0.01). The rate of habitual alcohol drinking, HBsAg positivity and progression of HCC itself was significantly more in male than female. The number of tumors and portal invasion were more in male than female. The functional reserve of the liver is not different between male and female in HCC patients. The male patients tended to survive shorter than female but in cases with hepatic tumor resection at the early stage, no differences of survival between them were demonstrated.
Conclusion : Distinct gender differences were demonstrated from the development to the progression of HCC. Gender differences should be taken into account for the clinical approach in patients with HCC.

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Background and Aims : To investigate the usefulness of intraarterial chemotherapy (IAC) with CDDP powder and lipiodol suspension (LCS) for invasive bladder cancer as a dose escalation modality of conventional IAC, we administered LCS into the internal iliac artery of dogs and evaluated pharmacokinetics of CDDP. Methods : An angiographic catheter was inserted to the internal iliac artery of an anesthetized dog under fluoroscopic guidance. CDDP solution, LCS, or a combination of CDDP solution and LCS were intra-arterially infused. For comparison, CDDP solution was also intravenously infused. The dose of CDDP ranged from 1 to 3 mg/kg. For combination study, the dose of CDDP ranged from 3 to 5 mg/kg. In all groups, blood samples were collected 5, 15, 30, 60, 120, and 180 minutes after administration, and serum Pt levels were measured. Results : In the LCS group, the serum Pt level was lower than those after intravenous or intraarterial infusion of CDDP solution. In the combination therapy group, the serum Pt level increased with the total dose of CDDP. Conclusions : Intraarterial infusion of LCS showed a lower systemic CDDP level. This method may reduce the incidence of side effects, suggesting the usefulness of intraarterial infusion therapy with LCS for invasive bladder cancer.

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We experienced an unusual case of occult thyroid cancer, which was diagnosed by incisional biopsy of the cervical lymph node. The patient is a 64-year-old male, who visited our hospital because of his left neck tumor detected by screening. The tumor was 3.7cm in size, elastically firm, and fixed to the surrounding tissues. Thyroid function was within normal range except for elevated thyroglobulin levels. CT showed an irregular solid mass without any connection to the thyroid gland. Core needle biopsy of the tumor suggested squamous cell carcinoma. Incisional biopsy was performed to obtain the accurate diagnosis. The tumor was finally diagnosed as lymph node metastasis of thyroid cancer with squamous carcinoma components. Total thyroidectomy with lymph node dissection was performed. Histopathologically minimal thyroid cancer, about 0.2cm in size, was detected in the right lobe of the thyroid.

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We describe the case of a 38-year-old woman with pulmonary alveolar proteinosis in whom a CT (computed tomography) scan of the chest showed patchy peripheral air-space disease, but in whom the central air-space in the lungs was relatively clear. The distribution of pulmonary alveolar proteinosis is usually predominantly central, and only rarely peripheral.

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A 75-year-old male was admitted because of dyspnea. A chest X-ray showed interstitial shadows in both lung fields, and hematology studies revealed a normochronic anemia. Examination of bone marrow smears led to a diagnosis of myelodysplastic syndrome. The rheumatoid factor test was positive, but the patient did not have arthritis. Twenty-one months later, he began to experience joint pain and swelling, and he fulfilled the diagnostic criteria for rheumatoid arthritis. This is the first case ever reported of rheumatoid arthritis preceded by interstitial pneumonia associated with myelodysplastic syndrome.

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A 44 year-old man admitted for exacerbated chronic hepatitis B was administered lamivudine for severe hepatic damage, and intensively transfused with fresh frozen plasma. Viral titer decreased immediately and transaminase improved. Continuous administration of lamivudine normalized serum alanine aminotransferase, prothrombin time, and serum albmine within 8 months.
“Acute on chronic” liver damage in patients with hepatitis B is frequently fatal. Even though the fulminant changes were avoided, severe exacerbation made prognosis poor. We conclude that lamivudine treatment for severe exacerbation of hepatitis B at the initial phase can prevent fulminant change and markedly improve the hepatic functional reserve.

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A 78-year-old man consulted our hospital after experiencing nipple discharge although there was no pain or itching. A firm tumor with irregular surface was palpable at the right nipple. No swelling of axillary lymph nodes was noted. The levels of tumor markers, carcino-embrionic antigen and carbohydrate antigen 15-3, were within a normal range. Mammograms showed a tumor shadow with spicula and microcalcification. Computed tomography (CT) of the right breast indicated no invasion of the tumor into the right major pectoralis muscle. Chest and abdominal CT and systemic bone X-ray showed no evidence of distant metastasis. Diagnosis following biopsy was ductal carcinoma of the breast. A simple mastectomy was performed in November 1997. The cut-section was composed of a white-color solid mass. The values of estrogen and progesterone receptors were 110 fmol/mg and 270 fmol/mg, respectively. As an adjuvant therapy, tamoxifen at a dose of 20 mg/day was administered for 2 years and 10 months after the operation. There have been no recurrence or metastasis of breast cancer for 5 years after the operation. (Kitakanto Med J 2003 ; 53 : 299302)

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A 31-year-old female was admitted because of dyspnea. A chest X-ray showed pneumothorax. A computed tomography (CT) scan of the chest revealed scattered thin-walled cystic lesions in both lung fields. Pulmonary lymphangioleiomyomatosis (LAM) was confirmed by a thoracoscopic lung biopsy, which revealed the nodular proliferation of immature smooth muscle cells that stained positive for HMB-45, desmin, α-smooth muscle actin, progesterone receptor and estrogen receptor when examined using immunostaining techniques. Medroxyprogesterone was prescribed. This report describes the early detection of LAM using chest CT scans and a thoracoscopic lung biopsy in a patient that experienced a spontaneous pneumothorax.

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A 36-year-old man was admitted because of back pain. A chest CT showed a mass shadow with a fatty density in the mediastinum. On subsequent examination, the mass shadow had enlarged markedly. The mass was excised surgically. Pathological examination revealed a liposarcoma with bleeding necrosis. One month later, the patient experienced a recurrence of the liposarcoma and died. This case describes a liposarcoma that markedly enlarged as a result of bleeding.

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A thyroid carcinoma with a tumor thrombus in the great cervical veins is an extremely rare condition. We report herein a case of a 74-year-old woman with papillary thyroid carcinoma together with an internal jugular vein thrombus. The patient with a right anterior neck tumor, diagnosed as papillary carcinoma, was referred to our hospital. Computed tomography identified a low-density mass with heterogeneous enhancement at the right thyroid lobe and a right internal jugular vein stenosis. During surgery, a tumor thrombus was detected in the right jugular vein. Both a total thyroidectomy with a modified neck dissection and a segmental resection of the right jugular vein with the tumor thrombus were performed. The pathological examination verified poorly differentiated papillary carcinoma with muscle invasion and lymph node involvement. The patient received postoperative treatment of 100 mCi of ¹³¹I, followed by thyroid stimulating hormone suppression therapy with thyroxine. The patient is free from recurrence 6 months after the operation. Computed tomography was the most useful tool in the preoperative diagnosis of thyroid carcinoma with a tumor thrombus. More precise preoperative diagnosis is an important factor in the clinical outcome. (Kitakanto Med J 2003 ; 53 : 315318)

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Breus' mole, a massive hematoma developing directly beneath the chorion on the fetal side of the placenta is a rare disease. With this disease, it is said that a massive hematoma develops in the placenta, that the fetus-placenta circulation is impaired, that the incidence of intrauterine growth retardation (IUGR) and intrauterine fetal death is high, and that fetal prognosis is often poor. This time we have encountered a case complicated by IUGR and gestosis, which was suspected of having Breus' mole before childbirth and gave birth to a live baby. A 38-year-old primigravida had been under observation at the out-patient clinic of this hospital since her first trimester. Examination at 32 weeks of gestation revealed hypertension, proteinuria and edema, so diagnosis of gestosis was made. With hematoma found in the placenta at 33 weeks and 5 days of gestation, she was admitted to this hospital. The hematoma on admission measured 41.6 mm in major diameter and 38.4mm in thickness. It grew slowly to 48.6mm in major diameter, 43.4mm in thickness at 35 weeks and 1 day and 100.6mm in major diameter, 100.4mm in thickness at 36 weeks and 2 days when fetal asphyxia appeared. Emergency cesarean section was then performed for delivery (baby boy weighing 1730g, Apger score 8-10-10). The placenta showed clots and infarct layers, which led to the diagnosis of Breus' mole.

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Follow-up pelvic MRI incidentally revealed that a 35-year old female patient had an urachal cyst on the bladder dome. A hysterectomy for cervical cancer had previously been performed. The urachal cyst was 1.1cm in diameter and transurethral en bloc resection was successfully performed. Histopathologically, the cyst was surrounded by a smooth muscle layer with the wall consisting of columnar and glandular epithelial cells. Transurethral en bloc resection is a useful procedure to excise and confirm the pathogenesis for a limited case of a small urachal cyst that extrudes into the urinary bladder.

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Background : Gefitinib (Iressa) proved to be effective in patients with non-small cell lung cancer who had been placed on chemotherapy. Although Gefitinib was reported to cause limited serious toxic effects, a case of death by acute pulmonary disorder was reported in July 2002.
Method : We administered Gefitinib to 55 patients during the period from August to December 2002 and three of them died of acute interstitial pneumonia.
From these 55 patients, we selected 16 individuals who had a history of a certain lung disease or thoracic irradiation and discussed risk factors.
Result : Of these 16 patients, three developed acute interstitial pneumonia approximately one month after the administration of Gefitinib. These patients were microbiologically and serologically diagnosed with acute interstitial pneumonia resulting from the treatment with Gefitinib.
Conclusion : In the present study, we regarded fibrogenesis as a major risk factor for acute pulmonary disorder although we did not obtain this finding from all cases.

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