The role of video-assisted thoracic surgery for the treatment of lung cancer: lung lobectomy by thoracoscopy versus the standard thoracotomy approach

Our objective was to evaluate the usefulness, safety, validity and benefits of video-assisted thoracoscopic surgery (VATS) for performing pulmonary lobectomy in 24 patients with clinical NO stage I primary non-small-cell lung cancer compared with 30 patients who underwent a conventional thoracotomy. There were no significant differences in the intra-operative blood loss, duration of operation, or duration of chest tube drainage between the VATS group and the standard lobectomy group, but in this VATS' experience, patients had less postoperative pain. Numbers and distributions of dissected lymph-nodes were similar in patients whether undergoing standard thoracotomy or VATS lobectomy. We can confirm that the safety and validity of VATS are virtually identical to those of the standard thoracotomy approach in the lobectomy. However, the former technique causes less discomfort to patients and requires a shorter recovery period of laboratory data and IL-6 concentrations in thoracic drainage fluid. We conclude that VATS major lung resection is technically feasible. Stringent patient selection is important and special training is needed.     

Immunosuppressive effect of cholera toxin B on allergic conjunctivitis model in the guinea Pig

Purpose: To investigate the immunosuppressive effects of mucosal immune therapy in experimental allergic conjunctivitis.Method: We used 11 white Hartrey guinea pigs divided into two groups. Six animals (treated group) received pretreatment with topical instillation of cholera toxin B (4 &mgr;g/30 ml) and ovalbumin (10 &mgr;g/30 ml). The other group of 5 animals served as control. All the animals received intra-abdominal injection of ovalbumin (100 g/mL) and aluminum hydroxide (5 mg/mL) repeated twice 2 weeks apart. Allergic conjunctivitis was induced by topical instillation of ovalbumin solution (5 mg/mL) 1 week after the above procedure. Result: Both groups developed palpebral and bulbar edema with hyperemia 30 minutes after instillation. The allergic reaction was significantly less in score in the treated than in the control group (Mann-Whitney U-test: P <.01). The clinical findings subsided after 6 hours. The treated group showed less eosinophilic infiltration in the conjunctiva and the limbus, particularly in the conjunctival epithelium, than in the control group at 6 and 24 hours.Conclusion: Pretreatment with topical cholera toxin B and antigen suppresses clinical and histological findings in experimentally induced allergic conjunctivitis.     

Susac syndrome

PURPOSE: To report the first Japanese case of the Susac syndrome characterized by microangiopathy of the brain, retina, and cochlea. METHODS: Case report. A 36-year-old Japanese man underwent extensive clinical and laboratory examination for encephalopathy, bilateral recurrent branch retinal arterial occlusion, and hearing loss. RESULTS: This case was initially diagnosed as acute disseminated encephalomyelitis. Despite exhaustive clinical and laboratory examination of the patient, no evidence of a known systemic disease was found. The bilateral recurrent branch retinal arterial occlusions were widely disseminated. Remission occurred 1 year after symptom onset. This patient demonstrated all of the clinical features associated with the Susac syndrome. CONCLUSION: Susac syndrome has been considered rare, but it is probably more common than previously thought and seems to occur in any race. This disorder usually occurs in young women, but it can affect men.     

Application of Computer Programs in the Management of Diabetic Children

Microcomputers have been used in our hospital for the past five years to summarize data from patients and to remind us to carry out routine tests. Recently, we have shown computer data on the screen to patients; this helps us to explain and discuss the monitoring of their condition with them. Unlike some other systems, general data as well as data on self-monitored blood glucose levels are recorded in our computer system. The data consist of five categories: personal profile, treatment, etiological research, indices of control and data for checking complications. The analysis and evaluation of our system are done by the modes of display, statistical calculations, early detection of complications and graphics. The system is compatible with input from a keyboard, optical character readers and interface to a glucose meter with a memory.     

Nitrite/nitrate (NOx) levels and hemodynamics during septic shock

Nitric oxide (NO) acts as a vasorelaxant. We investigated the relationship between nitrite/nitrate (NOx), which are the final metabolites of NO, and hemodynamics during septic shock. We also examined tumor necrosis factor α (TNF-α), interleukin-8 (IL-8), and endotoxin. A significant negative correlation was observed between NOx levels and pulmonary capillary wedge pressure (PCWP; r = −0.6075, P = 0.0028). A significant positive correlation was noted between NOx levels and the cardiac index (CI; r = 0.5934, P = 0.0038). A significant negative correlation was found between NOx levels and the systemic vascular resistance index (SVRI; r = −0.4354, P = 0.0485). A significant positive correlation was observed between NOx levels and the stroke volume index (SVI; r = 0.5040, P = 0.0186). A significantly close positive correlation was also observed between TNF-α levels and NOx levels (r = 0.7848, P < 0.0001). These findings suggest that NOx levels are closely associated with hemodynamics during septic shock, resulting in a vascular relaxing effect. Received: July 6, 1999 / Accepted: March 24, 2000     

Successful complete androgen blockade (CAB) therapy for prostatic cancer detected from multiple lung metastases: a case report

Prostatic cancer is rarely diagnosed by detection of lung metastases. We report a case of prostatic cancer in a 73-year-old man detected by abnormalities in chest X-ray and serum prostate specific antigen (PSA) level. He was initially admitted to our hospital due to elevation of PSA level. On the first transperineal prostatic needle biopsy, prostatic cancer was not detected and he was followed. Seven months after the first biopsy, chest X-ray revealed multiple abnormal nodules in the lung fields bilaterally and PSA level was again elevated. A second prostatic biopsy and whole-body examination were performed, and he was diagnosed with moderately differentiated prostatic adenocarcinoma with multiple lung metastases. Complete androgen blockade therapy was performed immediately. Two months after the beginning of treatment, PSA level was normalized and the multiple lung metastases had completely disappeared. There has been no evidence of recurrence or PSA relapse 24 months after detection of the prostatic cancer. This is the 26th case of prostatic cancer diagnosed in Japan following detection of multiple lung metastases.