An operated case of lung cancer with pleural plaques: its asbestos bodies, fiber analysis and asbestos exposure

This case was a 79-year-old man with pleural plaques, which had been pointed out in the left lung field on chest X-ray six years ago. A new shadow in the right chest appeared in 1999 and was closely examined. Cytological class IV carcinoma was detected in his lung tissue obtained by broncho-fiberscope. Lobectomy of the right upper lobe was performed, and calcified pleural plaques were found on the chest wall. The clinical diagnosis was poorly differentiated squamous cell carcinoma, T1N0M0. In World War II when he was 26 years old, he had worked as a boiler man on a battle cruiser for one year. The amount of asbestos bodies (AB) was 3,348 per gram dry lung tissue. The cores of AB and asbestos fibers were examined and showed that amosite was the most prevalent and crocidolite, tremolite and chrysotile were present in that order. After leaving the navy, he had worked as a farmer throughout his life, suggesting that he had never contacted asbestos occupationally after being a boiler man. It is strongly suggested that he had been exposed to asbestos during his work as a boiler man and that produced pleural plaques and lung cancer 50 years' later.     

An experience of stereotactic radiation therapy for primary intracranial choriocarcinoma

We report on a patient with choriocarcinoma in the pineal region who was successfully treated with stereotactic radiation therapy (SRT). The increased level of serum human chorionic gonadotropin (HCG) was lowered during chemotherapy with etoposide, cisplatin, and ifosfamide. However, HCG was not normalized and magnetic resonance images still showed an enhanced tumor mass with gadolinium.The patient underwent SRT of 40 Gy at an 80% isodose line per 10 fractions over two weeks, followed by conventional craniospinal irradiation of 32.4 Gy. The level of HCG dropped below the detection limit. The patient has been in good condition for more than four years after the completion of treatment, without any signs of recurrence. We propose SRT as a valid treatment option for malignant germ cell tumors in the pineal region.     

The Glucagon Provocative Test for the Diagnosis and Treatment of Zollinger–Ellison Syndrome

Objective Our aim was to determine whether the glucagon provocative test could be used in place of secretin test in patients with gastrinoma. Methods Three patients with gastrinoma underwent the following examinations: (1) preoperative intravenous glucagon test to enable a definitive diagnosis, (2) intra-arterial glucagon injection test to localize the tumor, and (3) intraoperative and postoperative intravenous glucagon test to confirm the completeness of the resection. Results Serum gastrin levels increased in response to intravenous glucagon in all three patients preoperatively. Computed tomography scans revealed a tumor in the lesser omentum, pancreatic head, and the pancreatic uncinate in cases 1, 2, and 3, respectively. Intra-arterial glucagon test revealed that the feeding artery for the tumor was the left gastric artery in case 1 and the superior mesenteric artery in case 3. Resection of the remnant stomach with tumor, pancreaticoduodenectomy with portal vein resection, and enucleation of the tumor were performed in cases 1, 2, and 3, respectively. Serum gastrin levels did not increase in response to intravenous glucagon intraoperatively and postoperatively in cases 1 and 3. Although intravenous glucagon caused a slight increase in serum gastrin in case 2, no recurrent tumors were evident. Conclusion These results indicate that the glucagon provocative test is a suitable alternative to testing with secretin, which is not commercially available in Japan. Case 1 in this study was published as a case report in Japanese in Jpn J Gastroenterol Surg 2007; 40:1582-1586.     

Developmental changes in phasic sleep parameters as reflections of the brain-stem maturation: polysomnographical examinations of infants, including premature neonates.

To gain understanding of brain-stem maturation during the early stages of life, we used polysomnography to examine 32 normal infants aged 33-184 conceptional weeks. Our study focused on the developmental aspects of the phasic sleep parameters, REM density and body movement, and the executive system. REM densities were highest in infants aged 36-38 conceptional weeks. The numbers of gross movements and localized movements (LMs) on chin muscle decreased with age; whereas, those of the twitch movements (TMs) on chin muscle increased. Ratios of the TMs to the total number of LMs and TMs (tentatively designated dissociation indexes because of the close relation between LMs and TMs on surface electromyograms) showed significant increases that paralleled the increase in age. We speculate that the dissociation index is a quantitative reliable sleep parameter which reflects brain-stem maturation.     

Effects of a spider toxin (JSTX) on hippocampal CA1 neurons in vitro

The effect of a toxin (JSTX) obtained from Nephila clavata (Joro spider) on the CA1 pyramidal neurons of the hippocampus was studied using slice preparations. JSTX blocked the excitatory postsynaptic potentials (EPSPs) in the pyramidal neuron evoked by Schaffer collateral stimulation but was without effect on the antidromic action potentials or on the resting conductance. Depolarization induced by ionophoretic application of glutamate was readily suppressed by JSTX but aspartate-induced depolarization was much less sensitive to the toxin. Among preferential agonists activating 3 receptor subtypes for excitatory amino acids, quisqualate responses were most effectively suppressed by JSTX. Kainate responses were similarly suppressed but in some cells higher concentration of the toxin was needed to block the responses. N-methyl-D-aspartate (NMDA) responses were the least sensitive to JSTX but they were suppressed by +/- 2-amino-5-phosphonovaleric acid (APV). Long term potentiation (LTP) once it had taken place was not completely inhibited by APV. In the presence of JSTX, however, LTP was blocked and tetanic stimuli produced only a short-lived potentiation. In Mg2+ free solution, an orthodromic stimulation evoked repetitive spike responses which were superimposed on the depolarization following the initial spike. APV suppressed the depolarization and associated spikes leaving an orthodromic response which was sensitive to JSTX. The results suggest that JSTX blocks EPSPs in CA1 pyramidal neurons which are mediated by non-NMDA type receptors.     

Effect of alpha-methyldopa administration during pregnancy on the development of a child's sleep

A male infant was born to a mother who had been suffering from primary hyperaldosteronism with the administration of alpha-methyldopa (MD) during pregnancy. His behavioral development, especially that of sleep, was studied by means of sleep-awake rhythm and polysomnography recordings (PSG) from 2 months to 2 years and 5 months of age. His daily sleep-awake rhythm showed some abnormal pattern. As to the PSG, the proportion of each sleep stage was normal and the two types of body movements (BM) showed various patterns. A paradoxical increase was seen in the twitch movement of some muscles. MD affects the catecholamine system in the CNS and human sleep. Since the sleep-awake rhythm and BM are thought to be related to the monoaminergic system in the CNS, we assume that his behavior and sleep disorders are the effects of the maternal MD administration during pregnancy.