Median sternotomy for lung and tracheal surgery

Median sternotomy was used in 30 cases of lung surgery; (1) lung cancer with impaired pulmonary function or local invasion to the mediastinum-12 cases. An average FEV1.0, 960ml, 38% FVC was only reduced to 890ml one month after lobectomy. (2) concomitant heart disease-2 cases. A 5 year old boy, with tracheal stricture and tetralogy of Fallot, was successfully treated by one stage operation. Stenotic cartilage trachea, 2mm in diameter, was resected 15mm in length and anastomosed end to end under total extracorporeal circulation after cardiac operation. A left upper lobectomy for lung cancer was performed under partial extracorporeal circulation after mitral valve replacement and valvoplasty of tricuspid valve on a 62 year old man. Both patients are well two years after operation. (3) bilateral pulmonary lesions--11 cases. (4) others--5 cases. Median sternotomy provides less operative loss of lung function, and excellent exposure for selected cases. But these advantages may be lost in some cases in No. (3) when fragile metastatic nodules must be gently manipulated and when an autosuture must be used in different direction for bullae. Whether or not the median sternotomy or posterolateral skin incision is favorable, may be decided by CT findings preoperatively.     

Clinical results of N0 tongue cancer treated with interstitial brachytherapy and management of occult cervical node metastases

One hundred patients with T1-2NO squamous cell carcinoma of the oral tongue were treated with interstitial brachytherapy at the Hyogo Medical Center for Adults between 1962 and 1983. These patients were followed for more than two years. The cumulative five-year survival rate was 89% in T1N0 and 66% in T2N0. The relapse-free survival rate was 88% in T1N0 and 51% in T2N0. The two-year local control rate in the primary site was 100% in T1N0 and 73% in T2N0. Cervical node metastases developed in 41% (T1N0: 33%, T2N0: 43%) of the patients. The five-year survival rate of the patients with subsequent cervical node metastases was 42%, while that of patients without subsequent cervical node metastases was 92% (p less than 0.001). Twenty-seven patients also received prophylactic neck irradiation (average dose: 33.8 Gy). In patients treated with prophylactic neck irradiation, the rate of subsequent cervical node metastases was 37% and the cumulative five-year survival rate was 62%. In the patients without prophylactic neck irradiation, these figures were 41% and 73%, respectively. There was no statistically significant difference between the two groups. Between 1984 and 1986, 28 patients with T1-2 N0 squamous cell carcinoma of the oral tongue were treated with interstitial brachytherapy. These patients were prospectively examined for the ability of chemotherapy to prevent the development of cervical node metastasis. In 13 patients treated with chemotherapy (CDDP 80 mg/m2 + PEP 6 mg/m2 x 5 days), the two-year local control rate was 90%, the incidence of cervical node metastases was 38% and the incidence of distant metastases was 15%.(ABSTRACT TRUNCATED AT 250 WORDS)     

Combination therapy with renin-angiotensin system inhibitors and the calcium channel blocker azelnidipine decreases plasma inflammatory markers and urinary oxidative stress markers in patients with diabetic nephropathy

A calcium channel blocker (CCB), azelnidipine (AZ), is reported to inhibit oxidative stresses, particularly when administered under blockade of the renin-angiotensin system (RAS). The purpose of this study was to investigate whether AZ inhibits oxidative stresses more potently than other CCBs under blockade of RAS and exerts renoprotection in type 2 diabetic nephropathy. Subjects were hypertensive type 2 diabetics with nephropathy, taking RAS inhibitors. The patients were randomly assigned to two groups, an AZ group (n=21, 16 mg/d) and a nifedipine-CR (NF) group (n=17, 40 mg/d). The plasma levels of monocyte chemoattractant protein-1 (MCP-1), interleukin-6 (IL-6), high-sensitive C-reactive protein (hsCRP), adiponectin and tumor necrosis factor-alpha (TNF(alpha)), the urinary excretion of 8-epi-prostaglandin F(2alpha) (8-epi-PGF(2alpha)) and 8-hydroxydeoxyguanosine (8-OHdG), and the urinary albumin-to-creatinine ratios (ACR) were determined before and after 16-week treatment. Neither metabolic parameters nor blood pressure levels differed between the two groups not only at baseline but also after the treatment. However, significant decreases in MCP-1, IL-6, hsCRP, TNF(alpha), 8-epi-PGF(2alpha), 8-OHdG and ACR levels, and a significant increase in the plasma adiponectin level were detected in the AZ group, but not in the NF group. The % change in the urinary oxidative stress markers correlated with that in ACR. Our results indicate that, in hypertensive patients with diabetic nephropathy, a combination therapy of RAS inhibitors and AZ is an effective therapeutic modality for decreasing not only blood pressure but also inflammations and oxidative stresses.     

A prospective randomized trial of KRN8602 and cytosine arabinoside vs. daunorubicin and cytosine arabinoside in adult patients with newly diagnosed acute myelogenous leukemia. The KRN8602 Leukemia Study Group.

A prospective randomized study was conducted to compare the efficacy and toxicity of two anthracyclines for the treatment of patients with acute myelogenous leukemia (AML). Fifty-eight patients were randomized and received induction therapy consisting of cytosine arabinoside (AraC) 100 mg/m2/day for 7 days combined with either KRN8602 (3'-deamino-3'-morpholino-13-deoxo-10-hydroxycarminomycin hydrochloride [KRN]) 15 mg/m2/day for 5 days (KRN/AraC group) or daunorubicin (DNR) 40 mg/m2/day for 3 days (DNR/AraC group). Complete remission rate was 78.6% (22/28) in the KRN/AraC group and 73.1% (19/26) in the DNR/AraC group. There was a higher incidence of nausea/vomiting and anorexia observed in the KRN/AraC group compared to the DNR/AraC group, while the incidence of other adverse effects (stomatitis, diarrhea, and infectious complications) were similar between both groups. No electrocardiogram (ECG) abnormalities were observed after treatment in the KRN/AraC group, while in the DNR/AraC group, one patient showed ECG abnormality and three patients exhibited either arrhythmia, heart failure, or tachycardia. Mental disorder was reported in two cases in the KRN/AraC group. These findings suggest that KRN/AraC is similar in effectiveness to DNA/AraC but more toxic in central nervous system and gastrointestinal symptoms and less toxic regarding cardiac function in patients with previously untreated AML.     

Case report: periodical infliximab administration enabled closure of colostomy in fistulating perianal Crohn's disease]

A 29-year old woman with Crohn's disease was performed colostomy due to severe perianal abscess. Her disease had been easy to recur and she was admitted to hospital for intestinal bleeding caused by acute exacerbation in Crohn's disease on October 2006. The bleeding was stopped rapidly and clinical remission was maintained with bimonthly administration of infliximab. Finally, her colostomy was closed after 5 years 8 months. Periodical treatment of infliximab not only prevented recurrence but also enabled closure of colostomy in fistulating perianal Crohn's disease.     

Assessment of brain cell function using 123I-IMP SPECT of cerebral blood flow and visual evoked potential by photic stimulation in normal and demented elderly subjects]

Cerebral blood flow was quantitatively measured using 123I-IMP SPECT by photic stimulation and visual evoked potential (VEPs) in normal and dementia subjects: 8 with Alzheimer-type dementia, 9 with cerebrovascular dementia and 7 normal elderly subjects were divided into the three groups based on the Clinical Dementia Rating (CDR) grade: Group I (CDR 0), Group II (CDR 0.5-1), Group III (CDR 2-3). The 123I-IMP SPECT measurement was conducted at rest with the eyes closed and also during photic stimulation. VEPs were measured simultaneously. The results reveal prolongation of the P2 latency of the VEPs prolonged in accordance with the increasing severity of the dementia, and quantitative cerebral blood flow was lower in Group II and Group III than in Group I at rest, while during photic stimulation it significantly increased in Group I and II, but showed no change in Group III. The results suggest that quantitative measurement of cerebral blood flow using 123I-IMP SPECT by photic stimulation may enable more detailed assessment of brain cell function.     

Current status of combination chemotherapy

The current status of clinical investigations of combination chemotherapies was reviewed. A randomized trial comparing low-vs high-dose cisplatin conducted in cases of testicular cancer indicated that a high-dose regime (120 mg/m2 D1) was superior to a low-dose regime (15 mg/m2 D1-5) while similar studies conducted in head & neck cancer and cervical cancer showed no significant differences. PVB or BEP in testicular cancer and CAP in ovarian cancer appear to have on established clinical role, but other combinations containing CDDP for use on various tumors are in the stage of phase II trial. Alternating non-cross combination is an attractive direction in clinical investigation but no such regimes tested in the past has shown any significant superiority over the results obtained from standard combinations.     

Low-dose-rate teletherapy combined with hyperthermia as a boost therapy

The efficacy of the low dose rate teletherapy (LDRT; 1 Gy/hr, 4 Gy/day, 2-3 times/week) combined with hyperthermia as a boost therapy (H (+) group) against far advanced carcinomas was examined. The treatment results in H (+) group (17 esophageal carcinomas, 3 pancreatic and bile duct carcinomas and 5 other carcinomas) were compared with the ones in H (-) group (38 esophageal carcinomas, 5 pancreatic and bile duct carcinomas and 13 other carcinomas) which were treated with the LDRT (1 Gy/hr, 7 Gy/day, every day) as a boost. A total dose of 14-24 Gy by the LDRT was followed after the irradiation of 50-60 Gy by conventionally fractionated method (1.5-2 Gy/day). H (+) cases were treated with 42.5 degrees C, 1 hour hyperthermia immediately before the LDRT and 19 cases (76%) were successfully heated. There were no significant differences between H (+) group and H (-) group in local control, late severe complication and survival rates, even when they were corrected by primary sites and stages. The incidence of metastases was higher in H (+) group. It was considered that the gain of the combination of the LDRT and the hyperthermia as a boost therapy was a little.     

Analysis of the intraoperative shunt flow and its effect on late prognosis after Blalock-Taussig shunt in single ventricle

Single ventricle (SV) seems to likely to develop congestive heart failure after Blalock-Taussig shunt (BT), particularly when the regurgitation of atrioventricular valve (AVVR) is combined. Analysis of the relation between operative result and intraoperative BT shunt flow is made in order to draw a safety limit or shunt flow in SV. Twenty-six patients (pts) with SV who underwent BT had shunt flow measurement at surgery, 20 pts showed right ventricular (RV) type of SV, 5 had left ventricular (LV) type, and 1 undivided type. The common atrioventricular valve was associated in 19 patients. The age at operation ranged from 6 days to 14 years of mean 3.2 years and the flow ranged from 6 to 146 of mean 49 ml/min/kg. Seven developed congestive heart failure at late follow-up with 4 late deaths. The average flow in this group (poor result) was 68 +/- 40 (mean +/- SD) ml/min/kg, and the remaining pts with favorable results (n = 16) had a mean flow of 41 +/- 22 ml/min/kg (p less than 0.05). In the group of LV type (n = 5), there was one late death caused from apparently excessive shunt flow (146 ml/min/kg). In the group of RV type without AVVR (n = 10), three pts of poor result had flow over 50 ml/min/kg. In those with AVVR (n = 8), pts with poor result were found with flow below 50 ml/min/kg.(ABSTRACT TRUNCATED AT 250 WORDS)