Airbronchogram sign in small peripheral bronchogenic carcinomas

18 bronchogenic carcinomas (16 adenocarcinomas, one squamous cell carcinoma, and one large cell carcinoma) in 17 patients and the control group (benign nodules) were examined with high resolution and thin section CT. Thin-section CT images showed airbronchogram or airbronchiologram in 63%, multiple small cavitations in 63%, and heterogeneous densities 50% of the adenocarcinomas with excellent spatial and contrast resolution. Airbronchogram or airbronchiologram was not seen in other types of bronchogenic carcinomas and benign nodules. Therefore, demonstration of airbronchogram or airbronchiologram in nodular lesions can make the CT diagnosis of small peripheral bronchogenic carcinomas, especially adenocarcinomas.     

One stage repair for an oesophageal fistula after pneumonectomy using an omental pedicle flap.

A 67 year old man developed an oesophageal fistula after a pneumonectomy that was complicated by an empyema. An omental pedicle flap was brought through the diaphragm to repair the fistula and to fill the empyema space. The outcome was successful.     

Effects of the subcutaneous administration of enkephalins on tail-flick response and righting reflex of developing rats.

The s.c. administration of [Met5]-enkephalin to 10-day-old rats pretreated with the mixture of 3 peptidase inhibitors, amastatin, captopril and phosphoramidon, produced the inhibition of tail-flick response and loss of righting reflex. When infant rats were pretreated with the mixture of any combination of two peptidase inhibitors, however, the change in both the response and the reflex were not produced at all by enkephalin injection, indicating that 3 kinds of enzymes, amastatin-sensitive aminopeptidase(s), captopril-sensitive peptidyl dipeptidase A and phosphoramidon-sensitive endopeptidase 24.11, played an important role in the inactivation of enkephalin after its systemic administration. Additionally, the fact that the two enkephalin-induced effects were more effectively antagonized by naloxone, a relatively selective mu-opioid antagonist, than by naltrindole, a specific delta-antagonist, or by nor-binaltorphimine, a specific kappa-antagonist, showed that these two effects were produced by the interaction of enkephalin with mu receptors. Moreover the involvement of mu receptors in the production of these two effects was shown by the fact that the s.c. administration of [D-Ala2,N-Me-Phe4,Gly5-ol]-enkephalin, a selective mu agonist, also produced these two effects which were more effectively antagonized by naloxone than by naltrindole or nor-binaltorphimine. Since the magnitude of the two effects induced by enkephalins in 15-day-old rats was significantly lower than that in 10-day-old rats, and the two enkephalin-induced effects were not produced at all in 20-day-old rats, a maturation-induced decrease in the permeability of the blood-brain barrier against opioid peptides was indicated.     

Necrotizing bronchial aspergillosis in a patient receiving neoadjuvant chemotherapy for non-small cell lung carcinoma.

We describe a case of necrotizing bronchial aspergillosis which developed after lobectomy following neoadjuvant chemotherapy in a 73-year-old woman with non-small cell lung cancer. The lesion was visualized and biopsied through FBS, which played a useful role for early diagnosis of this disease. Itraconazole therapy was effective and safe.     

Cardiomyopathy Characterized by Abnormal Accumulation of Desmin-type Intermediate Filaments in Cardiac Muscle Fibers: A Case Report and Review of the Literature

A 42 year old Japanese male, who had been suffering from congestive heart failure and electrocardiographic abnormalities (A V block, intraventricular conduction disturbance, ventricular tachycardia), died after a clinical course of 2 years and 1 month. Macroscopic investigation revealed dilation of the left ventricle and thickening of the right ventricular wall. The unique finding in this case was a circumferential fibrous scar in the median circular layer and outer oblique layer of the left ventricular wall. Biopsy and autopsy materials revealed diffuse loss of myofibrils in the central zone of cardiac muscle fibers, and replacement with aniline blue positive homogeneous material (17–35% of the area of one muscle fiber). Electron microscopy revealed abnormal accumulation of fine filamentous material (7.5–25 nm in diameter), which was immunohisto-chemically proved to be desmin type intermediate filament. Moreover, sarcoplasmic reticulum like material was detected in the degenerated area. At autopsy, degeneration was detected all over the heart. The ventricular muscle fibers were more severely affected than the atrial muscle fibers. The conduction system was also affected, in some parts more severely than the surrounding ordinary muscle fibers. The pathogenesis of this disorder remains to be clarified. Acta Pathol Jpn 39: 266–273, 1989.     

AN AUTOPSY CASE OF DIFFUSE MYELOMATOSIS ASSOCIATED WITH SYSTEMIC KAPPA LIGHT CHAIN DEPOSITION DISEASE (LCDD) A Patho-anatomical, Immunohistochemical and Immunobiochemical Study

A case of systemic light chain deposition disease in a 48-year-old man is presented. Clinically, the patient showed the signs of multiple organ (liver, heart and kidney) failure, but multiple myeloma was not diagnosed. Autopsy revealed generalized deposition of hyaline, a Congo red-negative substance, especially in the arterial walls of various organs. In the bone marrow, myelomatous proliferations of plasma cells positive for kappa light chain were recognized. The deposited substance was ultrastructurally different from amyloid fibrils, and was identified as kappa light chain by immunohistochemistry. A liver tissue extract was immunobiochemically examined and the deposited substance was confirmed to consist of kappa light chain, its molecular weight being approximately 14,000 to 17,000 Da.     

Immunological similarity of NCA (non-specific cross-reacting antigen) in feces with alpha 1-acid glycoprotein

We have recently suggested that carcinoembryonic antigen (CEA) may contain alpha 1-acid glycoprotein (AG) antigenic determinant. In the present work we examined a protein with CEA-like activity in the feces of healthy subjects (NCA) for immunological cross-reactivity with AG. When the perchloric acid extract of feces was fractionated on a Sephadex G-200, two fractions (large and small molecular weight) were obtained. The large molecular weight fraction had higher CEA activity than the small one. The perchloric acid (PCA) extract of feces was subjected to affinity chromatography using anti-CEA bound to Sepharose, and the bound protein was labelled with 125I, and then fractionated on a Sephadex G-200 column. Two radioactive peaks, Peak 1 corresponding to an approximate Mr of 180 000 and Peak 2, corresponding to an approximate Mr of 60 000 were found. Both peaks showed immunoreactivity with either anti-CEA or anti-AG. This experiment suggests the presence of two kinds of CEA-reactive proteins in feces: one which may be a big protein with immunological similarity to AG and a second which appears to be a hydrolysed fragment of this protein.     

Surgical adjuvant chemotherapy with mitomycin C and cyclophosphamide in Japanese patients with breast cancer

A controlled trial of surgical adjuvant chemotherapy for breast cancer was carried out using 551 Japanese patients. Single or combined treatment with mitomycin C (0.2 mg/kg i.v. three times within five days postoperatively) and cyclophosphamide (100 mg postoperatively daily for four months or longer) was used after radical surgery. In patients of the chemotherapy group with one to three lymph nodes involved in the axilla, the five-year cancer-free survival rate was 84.8% compared with 57.3% in the control group (P < 0.05), and the five-year cumulative recurrence in distant sites was 5.1% compared with 31.1% in the control (P < 0.05). The effectiveness of chemotherapy was much less marked in patients without nodal metastasis and with four or more nodes involved. Histologically, scirrhous cancer was the type that responded most favorably to chemotherapy, even in patients without axillary involvement. Premenopausal patients benefited more than postmenopausal patients from chemotherapy. A combination of mitomycin C and cyclophosphamide was more effective than their use singly. The present chemotherapy regimen was effective primarily in moderately advanced stages of breast cancer with decreased incidence of distant metastasis.