Late development of hydrothorax induced by a central venous catheter: Report of a case

We report herein the case of a 47-year-old woman who suffered a hydrothorax induced by a central venous catheter (CVC) which had been placed to facilitate total parenteral nutrition following a left sleeve pneumonectomy for lung cancer. The CVC was inserted into the superior vena cava (SVC) through the left subclavian vein after the operation; however, the tip inadvertently turned upward and came in contact with the lateral wall of the SVC. The patient suddenly developed dyspnea due to a right-sided hydrothorax 47 days after the insertion of the catheter. Indocyamine green administered through the catheter was thereafter found in the pleural fluid. The continuous mechanical force of the catheter tip against the SVC wall was thus considered to be the cause of this life-threatening delayed hydrothorax.     

Are the cardiovascular effects of gentamicin similar to those of calcium antagonists?

Cardiac and coronary vasodilator effects of gentamicin (GM) were investigated in isolated, blood-perfused papillary muscle, sino-atrial (SA) node and atrioventricular (AV) node preparations of dogs. GM (0.3-100 mumol) was injected intraarterially. GM produced an increase in coronary blood flow in all preparations. In paced papillary muscle preparations, GM reduced the force of contraction. In spontaneously beating papillary muscle preparations, GM decreased the rate of automaticity and the force of contraction. In SA node preparations, GM decreased the sinus rate. In AV node preparations, GM injected into the posterior septal artery (which supplies the AV node) increased AV conduction time and in large doses, produced third-degree AV block. In the same preparations, GM in large doses injected into the anterior septal artery (which supplies the His-Purkinje-ventricular system) prolonged AV conduction time (i.e., intraventricular conduction time) and reduced the amplitude of ventricular bipolar electrograms. The order of potencies of GM on the above cardiovascular variables is as follows: Coronary blood flow greater than or equal to ventricular muscle contraction greater than ventricular automaticity greater than SA nodal automaticity greater than AV nodal conduction greater than intraventricular conduction. This cardiovascular profile is different from those of organic calcium-antagonists, but rather similar to that of manganese ions, reflecting its own mechanism of action.     

An autoantibody cross-reactive to hepatitis C virus core and a host nuclear antigen.

GOR, an epitope borne by the amino acid sequence, GRRGQKAKSNPNRPL, is recognized by anti-GOR antibodies specifically found in patients with non-A, non-B hepatitis (NANBH). The epitope is not coded for by the hepatitis C virus (HCV), the presumed causative agent for NANBH, but by a single copy gene of the host. Anti-GOR antibodies, distinct from anti-HCV (c100-3) antibodies, were revealed to have dual specificities; they target both the presumed core gene product of HCV and a host component. This cross recognition is probably derived from homologous regions between the GOR epitope and a viral epitope on the core protein in HCV. It is therefore suggested that anti-GOR is an autoantibody induced by HCV infection. This may explain the autoimmune disease like aspect of NANBH pathogenesis.     

An intrathoracic vagus nerve schwannoma invading the trachea

A patient with a schwannoma of the intrathoracic vagus nerve is presented. The tumor invaded the trachea and caused dyspnea. It was successfully excised by a segmental resection of the trachea with end-to-end anastomosis. This instance of an intrathoracic vagus tumor invading the trachea is, as far as we know, the first reported in the world.     

Persistent and aggressive treatment for thymic carcinoma. Results of a single-institute experience with 25 patients

OBJECTIVES: The aim of this study is to retrospectively evaluate the role of several therapies, mainly chemotherapy, for thymic carcinoma (TC). METHODS: From July 1973 to July 2005, 25 patients (15 males and 10 females) with histologically proven TC were treated at our department. The median age of the patients was 59 years, with a range of from 30 to 78 years. According to Masaoka's staging system, there was 1 stage I patient, 3 stage II, 7 stage III, 6 stage IVa, and 8 stage IVb patients. The histological subtype was in all cases squamous cell carcinoma, nonkeratinizing type. RESULTS: There were 6 complete surgical resections, 1 incomplete resection followed by chemoradiotherapy, 6 with radiotherapy alone, 3 with radiotherapy plus chemotherapy, and 9 with chemotherapy alone as the initial treatment. Eighteen patients were administered second-line therapy. The regimen obtaining the best response rate was doublet chemotherapy consisting of carboplatin (CBDCA) and paclitaxel. The median survival time and survival rate at 5 years for the patients excluding surgical cases with stage I/II disease were 32 months and 31%, respectively. CONCLUSION: The doublet of CBDCA and paclitaxel thus appears to be a promising regimen for TC and further investigation in a multi-institutional phase II trial is, therefore, strongly called for.     

Effect of anticholesterol therapy on soluble ICAM-1 in chronic stroke patients with hyperlipidemia

OBJECTIVE: We examined the effects of drug therapy with pravastatin (P) or bezafibrate (B) and diet (D) therapy on serum lipids and soluble intercellular adhesion molecule-1 (sICAM-1) in hyperlipidemic cerebrovascular disease (CVD) patients in the chronic stage. METHODS: This study included 36 patients (28 with cerebral infarction and hyperlipidemia and eight with cerebral hemorrhage and hyperlipidemia) divided into three groups: Group P (12 patients), Group B (10 patients), and Group D (14 patients). Before and after treatment, total cholesterol (TC), low density lipoprotein cholesterol (LDL-C), triglyceride (TG), high density lipoprotein cholesterol (HDL-C) and sICAM-1 levels were measured. RESULTS: In Group P, Group B and Group D, TC levels were decreased by 30% (p < 0.005), 21% (p < 0.01), and 21% (p < 0.001), LDL-C levels were decreased by 38% (p < 0.005), 18% (not significant), and 25% (p < 0.005) and TG levels were decreased by 27% (p < 0.05), 53% (p < 0.005) and 22% (p < 0.05), respectively. sICAM-1 levels were decreased by 20% (p < 0.005) in Group P, but were not decreased in Group B or Group D. There was no correlation between deltaTC and delta sICAM-1 (r = 0.172). CONCLUSION: Administration of pravastatin significantly reduced sICAM-1 levels, independently of its decreasing effect on TC and TG in chronic CVD patients. Pravastatin may exert anti-atherosclerotic activity via two distinct mechanisms.