Thermosensitive determination of patency in lumboperitoneal shunts. Technical note

Surface cooling and thermistor recording over shunt tubing was used in 23 studies of cerebrospinal fluid shunt patency in 19 patients with lumboperitoneal shunts and normal-pressure hydrocephalus. Shunt patency was shown by downward reflection of the recording trace similar to that obtained for ventriculoperitoneal shunts. Obstruction was demonstrated by a flat-line recording or an upward deflection.     

A case of pulmonary hypertrophic osteoarthropathy associated with primary lung cancer in a young adult successfully treated with gefitinib]

The patient was a 39-year-old woman admitted with complaints of fever, clubbed fingers and arthralgia. A chest roentgenogram and chest computed tomographic scan revealed a mass in the left lower lobe. Transbronchial lung biopsy was performed, and a diagnosis of moderately differentiated adenocarcinoma was made. Physical examination confirmed finger clubbing in both hands. Bone scintigram showed marked accumulation of 99mTc-MDP in the long bones, bones of the elbows, and patellae. These findings yielded a diagnosis of pulmonary hypertrophic osteoarthropathy associated with primary lung cancer in young adult. The patient had fever and disturbance of gait of arthralgia on admission, and was treated with an oral non-steroidal anti-inflammation drug (NSAID). Advanced non small cell lung cancer (clinical stage T2 N3 M1, Stage IV) was then diagnosed. Gefitinib was administered after EGFR mutation was found in the tumor specimen. NSAID therapy alleviated the fever and arthralgia. After starting gefitinib and discontinuing the NSAID, She had kept a remission of rational symptom with cytoreductive effect. The abnormal findings of bone scintigrams subsequently disappeared and the patient's serum ICTP dropped.     

Studies of morphometric analysis and cell cycle of gastric epithelia of rat administered minimal mixed bile acids

The gastric epithelia of the rat after administrated with the minimal mixed bile acids and lysozyme for 9-weeks were studied using morphometric analysis and anti-Bromodeoxyuridine staining immunohistochemistry. Our results show that the atrophic changes and increased anti-BrdU antibody staining positive and mitotic cells of the pyloric glands area in the group administration only bile acids. Lysozyme inhibited bile acids activation on these changes of this area.     

Endoscopic approach to pulmonary diseases: Usefulness of the mediastinoscopy

The purposes of this study are to show the diagnostic values and the role of the mediastinoscopy for the respiratory diseases. From 1971 to 1998, mediastinoscopy were performed on 1664 patients admitted to our hospital with respiratory diseases. For the superior mediastinal diseases, mediastinal tumor and lymphadenopathies without cancer, two or three samples were obtained by mediastinoscopy. For lung cancer, biopsy was routinely performed at the 6 nodal stations, right and left paratracheal (#2), right and left tracheobronchial (#4), pretracheal (#3), and subcarinal (#7) lymphnodes. From 1994, we have used video-mediastinoscopy, which was combined with scope and TV-camera. Using video-mediastinoscopy, many staffs could observe the mediastinal findings on TV-monitor during mediastinal manipulation. The positive findings were observed in 17% (221/1299) for lung cancer, 100% (32/32) for sarcoidosis, 100% (2/2) for malignant lymphoma, 65% (11/17) for mediastinal tumor, 9.8% (13/132) for pulmonary tuberculosis. The positive rate according to the histological types of lung cancer were 20.5% (148/721) for adenocarcinoma, 9.4% (39/415) for squamous cell carcinoma, 31.6% (24/76) for small cell carcinoma, 21.3% (10/47) for large cell carcinoma. Complications developed in a total of 3.6%, and these were bronchial arterial damage(1.8%), recurrent nerve paralysis(0.7%), azygos vein damage (0.4%), pleural rupture(0.4%), superior vena cava damage(0.2%) and tracheal laceration(0.1%). However, there were no severe complications and operative deaths in this series. Mediastinoscopy is a minimal invasive and safety surgical procedure that is widely used as a diagnostic method for investigating the superior mediastinum, mediastinal tumor and lymphadenopathies. It is useful for obtaining histological diagnosis, as well as for staging lung cancer. Video-mediastinoscopy is more safety and educational, because many staffs could observe the findings.     

Case Report: Determination of Primary Foci of Metastatic Tumors by p53 Mutational Analysis in Intraesophageal Multiple Carcinomas

It is well known that squamous carcinomasfrequently develop multifocally, either synchronously ormetachronously, in the upper aerodigestive tract (1).Such phenomena were first reported by Slaughter et al in 1953, and they were named fieldcancerization (2). Using recent molecular biologytechniques, these multiple carcinomas have been revealedto arise from independent origins (3). Esophagealcarcinomas have been reported to frequently metastasize tothe lymph nodes even at the early stage of tumorextension (4). Furthermore, simultaneous multifocalcancer development is not rare in the esophagus (5). In cases of intraesophageal multiple carcinomaswith lymph node metastases, the primary focus of themetastatic tumors cannot be identified by conventionalhistologic examination. Here we report a case of intraesophageal multiple carcinomas in whichthe attributed foci of lymph nodal metastases could beclearly identified by analyzing the p53 gene mutationalstatus used as a clonal marker.     

Anti‐high mobility group box 1 monoclonal antibody ameliorates experimental autoimmune encephalomyelitis

High mobility group box 1 (HMGB1) is an established inflammatory mediator when released from cells. Recent studies have implicated extracellular HMGB1 in the pathogenesis of various autoimmune diseases. The objective of this study was to determine whether HMGB1 could be a therapeutic target for experimental autoimmune encephalomyelitis (EAE). In this study, an anti‐HMGB1 monoclonal antibody was injected intraperitoneally into a mouse model of EAE. We also measured serum cytokines levels in EAE and anti‐HMGB1 monoclonal antibody‐treated EAE. As a result, intraperitoneal injection of an anti‐HMGB1 monoclonal antibody ameliorated the clinical and pathological severity of EAE and attenuated interleukin‐17 up‐regulation in serum. In conclusion, HMGB1 is involved in EAE pathogenesis and could trigger inflammation in the central nervous system. The novel aspect of this study is the demonstration that anti‐HMGB1 ameliorates EAE. HMGB1 may be a novel therapeutic strategy for multiple sclerosis.     

Quantitative evaluation of the diagnostic thinking process in medical students

OBJECTIVE: To explore the diagnostic thinking process of medical students. SUBJECTS AND METHODS: Two hundred twenty-four medical students were presented with 3 clinical scenarios corresponding to high, low, and intermediate pre-test probability of coronary artery disease. Estimates of test characteristics of the exercise stress test, and pre-test and post-test probability for each scenario were elicited from the students (intuitive estimates) and from the literature (reference estimates). Post-test probabilities were calculated using Bayes' theorem based upon the intuitive estimates (Bayesian estimates of post-test probability) and upon the reference estimates (reference estimates of post-test probability). The differences between the reference estimates and the intuitive estimates, and between Bayesian estimates and the intuitive estimates were used for assessing knowledge of test characteristics, and ability of estimating pre-test and post-test probability of disease. RESULTS: Medical students could not rule out disease in low or intermediate pre-test probability settings, mainly because of poor pre-test estimates of disease probability. They were also easily confused by test results that differed from their anticipated results, probably because of their inaptitude in applying Bayes' theorem to real clinical situations. These diagnostic thinking patterns account for medical students or novice physicians repeating unnecessary examinations. CONCLUSIONS: Medical students' diagnostic ability may be enhanced by the following educational strategies: 1) emphasizing the importance of ruling out disease in clinical practice, 2) training in the estimation of pre-test disease probability based upon history and physical examination, and 3) incorporation of the Bayesian probabilistic thinking and its application to real clinical situations.