Complication-free laryngeal surgery after irradiation failure with prostaglandin E1 administration

To examine the usefulness and efficacy of administration of prostaglandin E1 (PGE1) after laryngeal surgery in patients who were previously treated with radiotherapy, we retrospectively examined the clinical data of 12 patients who had undergone partial laryngectomy and 21 patients who had undergone total laryngectomy. Complications were observed in 5 of the 7 cases treated with partial laryngectomy without PGE1 administration, while no complications were observed in the 5 cases treated with PGE1 after operation. Also, complications, including major leakage, were observed in 6 of the 15 patients who underwent total laryngectomy without PGE1, and no complications were observed in the 6 patients who received PGE1. The hospital stay was shorter for the patients treated with PGE1 than for those not receiving such treatment. Although this study was a small, nonrandomized pilot trial, the results indicated that PGE1 administration may be useful and effective for patients who undergo laryngeal surgery after irradiation failure, in decreasing the risk of postoperative complications and increasing the quality of life of the patients.     

Bilateral vocal fold paralysis and adhesion in anterior spinal artery syndrome

The purpose of this report is to present a rare case of anterior spinal artery syndrome (ASAS) in which there proved to be a combined lesion of paralysis and adhesion. A 26-year-old woman with a history of ASAS complained of difficulty of tracheal decannulation. In 1988, she was intubated and underwent tracheotomy because of respiratory muscle weakness, and she was decannulated in 1990. In 1998, she had cesarean delivery under general anesthesia, and postdelivery dyspnea necessitated tracheotomy again. On her first visit to us, endoscopic examination revealed bilateral vocal fold immobility at the midline without an apparent web. Direct laryngoscopy under general anesthesia revealed a posterior glottic adhesion and scarring, which were treated by excision of the scar and local steroid injection. The left vocal fold gradually regained mobility, permitting decannulation 3 months after treatment. This complicated vocal fold immobility was found to be due to adhesion and partial paralysis combined.     

Enhanced endogenous thrombolysis induced by a specific factor Xa inhibitor,DX-9065a,evaluated in a rat arterial thrombolysis model in vivo

We have previously established an animal model to investigate mechanisms of arterial thrombolysis in vivo and have demonstrated that endogenous thrombolysis, mediated by thrombin-activatable fibrinolysis inhibitor, is enhanced by administration of specific thrombin inhibitors. The aim of the present study was to evaluate the effects of a synthetic and specific factor Xa inhibitor, DX-9065a, on endogenous fibrinolysis. Mural thrombi were formed in rat mesenteric arterioles by helium-neon laser irradiation in the presence of Evans blue. Thrombolysis was continuously monitored by video microscopy and was quantified using image analysis software. Oral and intravenous administration of DX-9065a enhanced endogenous thrombolysis in vivo. The mechanisms require additional investigation using other experimental systems, but nevertheless, the present results extended our previous findings and further suggested that the enhanced fibrinolysis might be due to depressed activity thrombin-activatable fibrinolysis inhibitor. The synthetic factor Xa inhibitor could provide the basis for a useful thrombolytic agent.     

Family attitude scale: measurement of criticism in the relatives of patients with schizophrenia in Japan

Expressed emotion (EE) is traditionally measured with the Camberwell Family Interview (CFI), but the CFI requires considerable time for both execution and evaluation. As an alternative, we investigated the validity of the Family Attitude Scale (FAS), a questionnaire developed for the measurement of EE. The CFI, the FAS, the General Health Questionnaire (GHQ), and the Five-Minute Speech Sample (FMSS) were administered in 57 members of the families of 41 patients with acute episodes of schizophrenia. The relative sensitivity and specificity of EE assessment with the FAS compared with the criticism component of the CFI were 100% and 88.5%, respectively. EE assessment based on criticism as assessed with the FMSS compared with the CFI had a sensitivity of 40.0% and a specificity of 90.4%. The GHQ score tended to be higher in the high-scoring FAS group than in the low-scoring FAS group. The FAS showed excellent validity for the measurement of critical aspects of family attitudes, and the FAS score reflected the state of psychological health of the families.     

Increased expression of mRNAs for microtubule disassembly molecules during nerve regeneration

The mRNA expression of the microtubule disassembly molecules (SCG10, stathmin, SCLIP and RB3) in response to nerve injury was examined using a rat hypoglossal nerve injury model. After nerve injury prominent increase in mRNA expression of SCG10, stathmin and RB3 was observed, while only slight increase in SCLIP mRNA was observed in injured motor neurons. The increase in SCG10 and RB3 mRNA expression was quicker than that of stathmin and SCLIP. All the elevated signals decreased gradually to control levels by 4 weeks after nerve injury.     

Effect of Mass Screening for Breast Cancer from the Aspect of Psychosocial Assessment of the Quality of Life

To assess the quality of life (QOL) in patients with breast cancer receiving mass screening, a collaborative matched case-control study was conducted in nine hospitals throughout Japan. A total of 122 patients detected by mass screening (study group) and 226 patients found in out-patient clinics (control group) were assessed psychosocially on the basis of questionnaire information. The incidence of patients with early stage breast cancer was significantly higher in the study group than in the control group ( P <0.05). Chest wall pain was observed in 35.2% of the study group and in 46.5% of the control group ( P <0.05). Although control patients were more optimistic than study group patients, disturbed daily life and anxiety about recurrence were a little more frequent in the former group than in the latter. In particular, shoulder stiffness was frequently seen in the control group ( P <0.05). Early detection and information do not create anxiety in mass screening patients ( P <0.01). We should recommend mass screening to patients to detect early stage breast cancer and provide better QOL.     

Neoadjuvant Chemotherapy with Etoposide, Leucovorin, 5-Fluorouracil and Cisplatin for Advanced Esophageal Squamous Cell Carcinoma

Eighteen patients with invasive periadventitial tissue (T4)or distant lymph node metastatic (M1,LYM) squamous cell carcinomawere entered into a pilot study of neoadjuvant chemotherapywith etoposide (50 mg/m²/day, days 1–5), leucovorin (30mg/body/day, days 2–5), 5-fluorouracil (5-FU; 400 mg/m²/day,days 2–5) and cisplatin (100 mg/m²–day, day 1) (ELFP).The overall response rate was 56%. The response rates in theT4 tumor and M1, LYM patients were 56 and 50%, respectively.Radical esophagectomies were performed on six of 17 patientswho had completely recovered from the chemotherapy, a resectabilityof 35%. Histologically, the primary tumor was moderately toslightly effective, and the lymph nodes markedly to moderatelyeffective. Histologic responses in the lymph nodes were differentfrom those in the primary tumors and in each node. There werefour chemo-surgically related deaths. Median survival timesin responding and non-responding patients were nine and threemonths, respectively. In conclusion, neoadjuvant chemotherapywith ELFP appears to be effective against esophageal squamouscell cancer with periadventitial tissue invasion or distantlymph node metastasis. Chemo-surgically related deaths werehowever, 22%, showing neoadjuvant chemotherapy to necessitateextremely careful attention to the medical and surgical managementof patients.     

Spontaneous intracerebral hematomas expanding during the early stages of hemorrhage without rebleeding. Report of three cases

Expansion of intracerebral hematoma usually occurs in the chronic phase because of repeated bleeding from pre-existing vascular anomalies or exudation of blood from capillaries of the capsule. In contrast, spontaneous intracerebral hematoma expanding during the acute phase of hemorrhage without rebleeding is seldom seen. Three such cases are reported, along with magnetic resonance (MR) and computerized tomography (CT) follow-up studies. The follow-up MR images and CT scans demonstrated no evidence of rebleeding, but revealed gradual expansion of a fluid component of the hematoma, beginning in the acute phase. Volume alterations posthemorrhage are carefully documented. There was a characteristic phenomenon of layering, with the red blood cell component of the clot settling by gravity and the serum separating as well as seen in a test tube, depending on whether a preservative was used. Examination of blood samples indicated a possible correlation between expansion of the hematoma and the activities of both the fibrinolytic system and coagulation factors.