Mediastinoscopy was first described by Carlens in the 1950s, and is now widely accepted as a useful surgical procedure to biopsy a mediastinal mass. It requires general anesthesia and the procedure is invasive. Computed tomography, magnetic resonance imaging, and positron emission tomography represent recent advances in diagnostic imaging but these procedures should not replace a biopsy. Equipment and techniques used in needle histopathological biopsy methods to investigate a mediastinal mass are continually improving, such as computed tomography-guided percutaneous biopsy and transbronchial biopsy using bronchofiberscopy, and these improvements may eventually supercede mediastinoscopy. However, only a limited amount of tissue is obtained by needle biopsy and repeated biopsies are sometimes necessary. Recently, video-assisted mediastinoscopy has been developed. One of the main advantages of this development is that all present in the operating room can view the images. This article reviews the use of video-assisted mediastinoscopy as an important and valuable diagnostic procedure to assess mediastinal mass.

抄録全体を表示

Clinical assessment of airway wall remodeling by means of evaluated the thickness of reticular basement membrane by endobronchial biopsy has been correlated to the central airway structural changes. It has not been known whether it also reflects airway wall remodeling in the peripheral airways. This study was performed to determine the relationship between reticular basement membrane thickening and airway wall dimensions in asthma. The thickness of the reticular basement membrane was measured from autopsy samples that are equivalent to central airway biopsies, from both central and peripheral airways. For each of these measurements the dimension of the transverse section of the airway wall was recorded. This study focused on victims who had died from asthma (fatal asthma, n=3) or from asthmatics who had died from unrelated causes (non-fatal asthma, n=3) . Cases without asthma (control cases n=4) were included as controls. Reticular basement membrane thickness correlated with smooth muscle area (p<0.05), submucosal gland area (p<0.05), and inner wall area (p<0.01) in central airways. In peripheral airways reticular basement membrane thickness correlated with smooth muscle area (p<0.05) and inner wall area (p<0.01) but not with airway size, lumen area, and outer wall area. These results show that the thickness of the reticular basement membrane of central airways reflects airway remodeling in the central airways and smooth muscle and inner wall area in the peripheral airways. Reticular basement membrane thickness measurements may be taken from endobronchial biopsies and used to assess the pathology of airways for long-term follow-up investigations of asthma patients.

抄録全体を表示

Angiogenesis is an essential process in the progression of malignant tumors. Whereas pan-endothelial markers, such as CD34, are generally used in evaluation of angiogenesis, pan-endothelial antibodies react not only with developing vessels but also with normal vessels simply trapped within tumor tissues. It has been recently reported that an anti-CD 105 antibody preferentially reacts with activated endothelial cells in angiogenic tissues such as tumor tissues. Thus the efficacy of anti-CD 105 monoclonal antibody (mAb) in evaluating angiogenesis in pancreatic tumors was assessed. We immunohistochemically investigated 27 cases of pancreatic tumor (including 16 cases of malignant tumor, 2 cases of borderline malignancy and 9 cases of benign tumor) . Intratumoral microvessel density (IMVD) was determined with an anti-CD34 mAb (CD34-IMVD) and with an anti-CD 105 mAb (CD 105-IMVD) . More vessels were generally recognized by the anti-CD34 mAb than by the anti-CD 105 mAb. The mean CD34-IMVD in malignant tumors and in borderline/benign tumors was 136.13±56.71 and 120.55±40.65, respectively, a result which exhibited no significant difference (P>0.05) . In contrast, the mean CD 105-IMVD in malignant tumors and in borderline/benign tumors was 19.44±16.53 and 6.36±8.03, a statistically significant difference with P<0.05. Hence anti-CD 105 mAb proved to be superior to anti-CD34 mAb in evaluating angiogenesis in pancreatic tumors.

抄録全体を表示

The central effects of brimonidine on intraocular pressure (IOP) in male pigmented rabbits were investigated. Twenty μL brimonidine was administered to the lateral eye, or intraorally. For intracerebroventricular (icy) treatment, the guide cannula was inserted two weeks before injection into the lateral ventriculus following Fifkova's brain map. Ten μL brimonidine was injected (5μL/min, icv) . After the treatments, IOP was measured by pneumatonometer and pupil diameter (PD) was measured using a ruler. Heart rate (HR) and mean arterial blood pressure (MABP) at metatarsus were also monitored after topical administration. IOPs were significantly decreased bilaterally by 0.05% brimonidine administered topically to the lateral eye (p<0.001, n=6), or 0.1% administered orally (p<0.001, n=11) compared to a saline treatment control group. After 0.0001 % brimonidine icy treatment, IOP was significantly decreased bilaterally (p<0.05, n=4) . PD, HR and MABP were not changed by 0.01% topical administration of brimonidine. The decrease in IOP which was induced by 0.01 % brimonidine icy treatment was inhibited by pretreatment with 0.1% yohimbin icy (p<0.05, n=4) . These results suggest that topical use of brimonidine might decrease IOP in the pigmented rabbit by a central α₂-receptor effect in addition to its local effect.

抄録全体を表示

It has been reported that the lathyrogen, β-aminopropionitrile (β-APN), is an irreversible inhibitor of lysyl oxidase, an extracellular enzyme that promotes crosslink formation of both collagen and elastin. This study was designed to assess the potential therapeutic effects of β-APN on experimental glomerulosclerosis in Sprague-Dawley rats induced by Adriamycin (ADR) . Rats with ADR-induced nephropathy were divided into two groups, β-APN treated (n=11) and vehicle-only treated controls (n=11) . Urine protein increased 2 weeks after the first injection of ADR in all rats. There was no difference in urine protein levels between the two groups at 4 weeks, however at 8 weeks post-ADR injection, it was significantly higher (4 fold) in the control group compared to the β-APN treated group (p<0.01) . Albuminuria increased continually after ADR injection in all rats. Blood urea nitrogen (BUN) increased from week 4 in all rats, but the levels were suppressed in the β-APN treated group when compared to the control group at both week 4 and 8 (p<0.05) . Pathological studies showed that the development of glomerulosclerosis and collagen IV deposition in glomeruli were significantly suppressed in the β-APN treated group compared to the control. In conclusion, β-APN may act as a potential protective agent through inhibiting collagen cross-linking and suppressing the progression of glomerulosclerosis.

抄録全体を表示

The proliferative and invasive growth potentials of small-sized pulmonary papillary adenocarcinoma (PPA) were examined. A total of 23 surgically resected cases of PPA, all less than 3 cm in diameter (small-sized), were included. None of these cases had received pre-operative chemotherapy or radiotherapy. Expression of Ki-67, a marker of proliferative growth potential, was elevated in 10 out of 23 cases. High Ki-67 expression was significantly correlate with 5-year survival, but not with lymph node involvement. Cathepsin D expression, a marker of invasive growth potential, was elevated in 11 out of 23 cases, and elevated expression was also significantly associated with the 5-year survival rate, but not with lymph node involvement. These findings suggest that Ki-67 and cathepsin D may be useful markers of the malignant potential of small-sized PPA.

抄録全体を表示

In recent years, transpedicular screw fixation has emerged as one of the best techniques for stable 1) . However, in the thoracic spine, safe screw insertion is very difficult due to the anatomical complexity and a lack of morphometric data.
In this study, we established an anatomical pedicular axis in 11 cadavers for dissection then performed 3-dimensional morphological measurements. We evaluated the optimal insertion point and direction for screw fixation, the length and outside diameter of the pedicle screw, the intramedullary diameter, and the thickness of the cranial, caudal, lateral, and medial cortical bones at the site of the minimum transverse diameter of the pedicle. The pedicles in the thoracic spine showed a decrease in the angle between the pedicular axis and the sagittal plane on the horizontal plane from the upper level toward the lower level, and the minimum transverse diameter of the pedicle was less than 5 mm at some levels. The transverse diameter of the pedicle was consistently shorter than its longitudinal diameter, and the lateral cortical bone of the pedicle was consistently thinner than the medial cortical bone: These data were used to determine the optimal point of transpedicular screw insertion. Our results will aid the establishment of a safer transpedicular screw insertion method.

抄録全体を表示

A male aged 37 complained of a lower abdominal lump with pain. He had been diagnosed with Crohn's disease at our hospital in September 1995. He was referred to our department because the lump had ruptured releasing pus. The abscess formation persisted despite percutanous drainage. The inflamed descending colon was resected. A fistula had formed between an abdominal wall abscess and a left psoas muscle abscess. These fistulas were then enlarged to facilitate drainage. The patient was discharged on the 54th postoperative day. Eleven months later, he was admitted again due to slight pain around the previous drainage scar. As computed tomography findings revealed recurrent abscesses, percutaneous ultrasound-guided drainage was performed. His symptoms disappeared, and he was discharged on the 21st day of admission. Taking individual nutrition status and the cause of abscesses into account, an appropriate surgical plan for Crohn's disease patients with primary and/or recurrent left psoas muscle abscess may include percutaneous ultrasound or computed tomography-guided drainage.

抄録全体を表示