Metastatic Bone Tumors: Diagnosis and Treatment

Seventy-four cases of metastatic bone tumors were reviewed inorder to study the actual problems concerning their diagnosisand treatment. Sixty-five of the 74 tumors were carcinoma metastasesand the remaining nine were other malignancies. Diagnosis: In our study, as has often been reported elsewhere,there was a high incidence of metastasis of lung and breastcancer (27% and 9%, respectively). In all patients in this series,the existence of bone metastasis itself was shown by plain radiogramsat the time of their admission. In 51 patients, primary siteswere identified by clinical records and/or various clinicalexaminations. Autopsy revealed additional seven primary sites. Treatment: Limb surgery which directly intends a resection ofthe metastatic lesion generally provided good palliation and,on occasion, relatively long survival. Of the seven patientswhose bone lesions were enthusiastically resected, three survivedfor 15, 27 and 36 months postoperatively and one has survivedup to the present (18 months). On the other hand, laminectomy and other procedures of vertebralsurgery which do not directly intend a resection did not givegood results in either quad vitam vol functionem. Twenty of21 patients died within a relatively short time (1 to 13 months,average 3.6 months) without any functional recovery.     

Histoclinical Long-standing Follow-up Study of Hyperplastic Polyps of the Stomach

In a series of 2,013 gastric polyps in 1,201 patients, morphological and histopathological studies have been performed. Ninety-three hyperplastic polyps in 56 patients have been followed-up endoscopically and histopathologically for five to 12 years. The incidence of detection of gastric polyps has increased: 1.4% in 1967 to 8.7% in 1979 year by year. Thirty patients (54%) among the 56 showed changes in number, size or shape of polyps during follow-up. Twenty patients (37%) revealed numerical changes (increase in 16 patients, reversion in three patients and vanishing in two patients).
Twenty-eight polyps (30%) showed morphological changes, six of them showed continuous enlargement, 18 lesions repeated enlargement, stationary or reduction stages, three lesions were reversed and two polyps disappeared.
Histopathologically, three lesions showed transformation from the hyperplastic type to adenoma while demonstrating morphological enlargement. Two of these showed increase in cellular atypia, from the hyperplastic type through adenoma with severe atypia and finally to carcinoma in the polypectomy specimens. From this study, it was concluded that although hyperplastic polyps show changes in size, shape or number with passage of time, malignant changes occur in only a few cases.     

High Efficacy of Disopyramide in the Management of Ventricular Fibrillation Storms in a Patient with Brugada Syndrome

The patient was a 57‐year‐old man with Brugada syndrome, who had been implanted with a implantable cardioverter defibrillator (ICD). The frequency of ventricular fibrillation (VF) started to increase about 4 years after ICD implantation, occurring, at worst, six times in one night. Immediately after starting oral administration of disopyramide, VF stopped occurring. He then discontinued taking disopyramide, but immediately after the discontinuation VF started occurring again, so he restarted taking disopyramide. Thereafter, VF completely stopped occurring. Findings observed in our case suggest that disopyramide could be added in our arsenal of medications for treating arrhythmic storms in patient with Brugada syndrome. (PACE 2010; 33:e53–e56)     

Beneficial Effects of Cervical Spinal Cord Stimulation (cSCS) on Patients with Impaired Consciousness: A Preliminary Report

Electrical stimulation of the spinal cord can be used for treatment of intractabie pain and spasticity. Based on our experimental findings cervical spinal cord stimulation (cSCS) was performed on eight patients with severe brain dysfunction due to traffic accidents, pronounced vasospasm caused by subarachnoid hemorrhage or surgery of huge cerebral tumors (chordoma). After a 1 to 2 month period of stimulation, two patients became conscious and began to speak. It remains unclear whether cSCS induced the restoration of consciousness and improved neurological deficits. Although the successful results might be due to chance, cSCS might have stimulated brain function. This preliminary report shows such excellent results that further studies are warranted.     

The Health Insurance System in Japan

The steadily increasing cost of medical care associated with advancing medical technology as well as the rapid progression of generalized aging of the society has become a major socioeconomical issue confronting most developed countries. Although Japan is no exception in this regard, and a drastic modification of the health care system is now being discussed, it is also clear that its postwar health insurance system has played a major role for the Japanese achieving the longest life expectancy in the world (over 82 years for female and 76 years for male) in the past decade. It is thus my understanding that the invitation for this brief review reflects the need for reference information regarding the current debate in the North American continent.     

Melorheostosis of the Toe: A Case Report

A case of melorheostosis in a 57-year-old Japanese woman is presented. This case is noteworthy because of its unusual radiographic features and local findings and its unusually long follow-up period of more than 29 years. Melorheostosis progresses very slowly over a long period of time, and can show bizarre features, simulating malignant tumor.     

Source of plasma adrenomedullin in a patient with pheochromocytoma receiving hemodialysis

Abstract  A 45-year-old man on long-term hemodialysis (HD) was incidentally discovered to have a pheochromocytoma and underwent successful resection. This patient was normotensive, and had no symptoms suggesting pheochromocytoma. The plasma concentrations of total adrenomedullin (AM-T) and mature AM (AM-m) were higher than those in normal controls. To elucidate the source of AM, we measured plasma AM levels by immunoradiometric assay before and 3 weeks after surgery in addition to plasma adrenaline, noradrenaline and dopamine. AM expression was also assessed by immunoblot and immunohistochemical analyses on normal adrenal and tumor tissues. After surgery, elevated plasma adrenaline levels returned to the normal range; however, the levels of AM-T and AM-m remained almost the same as the preoperative values. Furthermore, although AM was expressed in both normal adrenal and tumor tissues, the AM expression level was less in tumor. In this case, it was suggested that elevation in plasma AM level might be a factor associated with normotensive blood pressure; however, adrenal pheochromocytoma was not a major source of circulating AM. To our knowledge, this is the first case of pheochromocytoma in patient with HD associated with AM in the literature.