Lung Cancer in Chromate Workers--Analysis of 11 Cases

We have experienced 11 cases of lung carcinoma in workers ata chromate factory during the past 14 years. All patients weremales. The age of onset ranged from 41 to 68 years. Ten of the11 were heavy smokers. The time of exposure to chromate wasfrom 17 to 29 years and the average was 23.9 years. Seven patientshad perforation of their nasal septa. The primary sites of thecancers were from the lobar to the subsegmental bronchi. Therewere nine squamous cell carcinomas and three small cell carcinomas.Four squamous cell carcinomas were hilar type early stage cancersand two of them were found in one patient at the same time.The chromium content of the lung tissue in the seven patientstested was from 13.9 to 2,368.4 µg/g of dry tissue andwas higher than that of lung cancer or non-lung cancer caseswithout chromate exposure. There was no severe dysplasia ofthe bronchial epithelium in these 11 patients.     

Extraperitoneal laparoscopic Lich–Gregoir antireflux plasty for primary vesicoureteral reflux

Abstract We performed laparoscopic Lich–Gregoir antireflux plasty on 4 patients with primary vesicoureteral reflux. All procedures were conducted using the extraperitoneal approach. The average surgical time was 230 min. There were no complications. After surgery, voiding cysturethrograms showed no reflux in all patients.     

Evaluation of Mediastinal Abnormality by Xerotomography

Mediastinal structures of 49 patients were demonstrated by Xerotomographyand compared with the findings of ordinary film tomography.Our results suggest that Xerotomography is superior to filmtomography in demonstrating the figures of the tracheobronchialtree and blood vessels in the mediastinum. Anteroposterior Xerotomographyis recommended for demonstrating the abnormal swelling of rightand left paratracheal lymph nodes and tracheo-bronchial lymphnodes which affect the normal figures of the tracheobronchialtree and blood vessels. Right posterior oblique Xerotomographyat an angle of 55 degrees is valuable for evaluation of thepretracheal and subcarinal lymph nodes. Because the tracheobronchialwall was demonstrated clearly Xerotomography was sometimes ableto determine whether the lymph node metastases stayed withinthe lymph nodes or infiltrated into the bronchial wall.     

Somatoform pain disorder in a case of Klinefelter's syndrome with multiply operated lower back

Abstract We report a case of Klinefelter's syndrome with multiply operated low back (MOB). Psychological and/or psychosocial problems related to MOB have been of recent interest in the field of orthopedic surgery. Based on psychiatric interviews, this case was diagnosed as a somatoform pain disorder of the DSM-III-R somatoform disorders. In addition to psychological problems, the pain was partly explicable by severe osteoporosis, which was prematurely caused by endocrinological disturbances associated with Klinefelter's syndrome. Patients with this syndrome are more likely to develop severe osteoporosis. In the presenile period of Klinefelter's syndrome with severe osteoporosis, liaison psychiatrists may pay attention to somatoform disorders (e.g. somatoform pain disorder and conversion disorder) linked with the MO.     

Intra-operative secretin test for the rapid evaluation of curative operation in a case of Zollinger-Ellison syndrome

The intra-operative measurements of serum gastrin levels and an intra-operative secretin test were carried out as the rapid evaluation of curative operation in a case of Zollinger-Ellison syndrome (ZES). In this case, pre-operative investigations suggested that the tumours were located in the head of the pancreas and the duodenal wall. The surgeon planned a pan-creato-duodenectomy. Serum gastrin levels were reduced after the resection of the head of the pancreas and duodenum, and the secretin test after resection was negative. The surgeon ensured that gastrinomas were resected completely during the operation. The secretin test carried out 1 month post operatively was also negative. The patient has experienced no further complications, to date. This case suggests that intra-operative secretin test is useful for the rapid evaluation of curative operation in case of ZES.     

Clinical significance of serum hyaluronic acid as a fibrosis marker in chronic hepatitis C patients treated with interferon-α: Histological evaluation by a modified histological activity index scoring system

Abstract The aim of the present study was to investigate the histological changes effected by interferon (IFN) treatment and to evaluate the clinical significance of serum hyaluronic acid (HA) as a marker of fibrosis. Forty-nine patients with chronic hepatitis C treated with IFN-α were divided into three groups according to the existence of viraemia: sustained complete responders (CR), complete responders with relapse (PR) and non-responders (NR). Needle biopsy sections of the liver taken before and at the end of IFN treatment were assessed according to the modified histological activitindex (HAI) scoring system. Serum fibrosis markers, including HA, were measured at needle biopsies. Biopsies of CR at the end of treatment showed a significant improvement in fibrosis and necroinflammatory scores. More significant correlation was observed between fibrosis scores and serum levels of HA before IFN treatment (r= 0.607, P < 0.0001) than those between fibrosis scores, on the one hand, and pepride of type III procollagen (PIIIP; r= 0.531, P= 0.0004) or type IV collagen 7S domain (type IV-C; r= 0.241, P= 0.1062) on the other. Moreover, serum HA levels fell significantly in patients in whom fibrosis improved (P= 0.011). This is the first paper describing the advantages of the modified HAI scoring system over others in estimating the effect of IFN-α; the results also indicate that serum HA can be useful in monitoring liver fibrosis in chronic hepatitis C patients treated with IFN-α.     

A Clinico-Pathological Study of Surgical Treatment for Small Cell Carcinoma of the Lung

Thirty-seven patients with histologically confirmed small cellcarcinoma (SCLC), who underwent surgical resection at the NationalCancer Center Hospital between 1963 and 1983, were reviewed.They were divided into two groups, 25 patients who were operatedon between 1963 to 1979 and 12 who were operated on between1980 and 1983. When these two groups were compared, a significantdifference in 5-year survival was found (8% vs 50%). An accumulationof various factors including adjuvant chemotherapy was consideredto contribute to the improvement in survival. After carefullyanalyzing these factors, we have come to the conclusion thatadjuvant chemotherapy was the most important factor among them.An additional six patients with SCLC, who were operated on in1984 and 1985, were also studied. They were either those whowere given an adequate dose of combination chemotherapy beforesurgical resection or those whose local carcinoma which recurredafter complete response was achieved by chemotherapy and/orchest radiation was surgically removed. In two cases, a tumor-likemass which was clearly visible on X-ray film- and in the surgeon'shand at the time of thoracotomy revealed a histo pathological"cure." In another two cases, tissue diagnosis of SCLC whichwas obtained without thoracotomy before chemotherapy and/orradiation was started was reported as NSCLC after the resectedspecimen was histo-pathologically examined. In both of them,the cancer tissue was made up of NSCLC of small cell type. Adiscrepancy between clinical TNM after treatment and pathologicalTNM was noted in two cases. Microinvasion and micrometastases,which were the reasons for the discrepancy, are considered tobe a core of eventual recur rence following induction of completeresponse.     

Endoscopic Diagnosis of Colorectal Villous Adenoma

Villous adenoma or adenoma with a predominant villous componentshowed a characteristic finding on macroscopic or endoscopicobservation. The fundamental elements which constitute thisfinding were reddish sulcus and whitish ramified relief similarto the villous pattern normally seen on the mucosa of the smallbowel. We called this feature "V (villous) pattern." A comparativestudy of the endoscopy and pathology of 70 polypoid lesionsof the large intestine was conducted, with the following results:The frequency of the V pattern in the endoscopic picture increasedin proportion to the population of the villous component inhistological picture of the polypoid lesions. However, evenin small polyps the V pattern could be observed when the lesionhad a villous component. Careful and close endoscopic observationmay allow the diagnosis of villous component (which means ahigh frequency of malignancy) of the colorectal polyp even withoutbiopsy. Dr. Makino's present address: Av. Ceará, 335, Belém—Pará,Brasil.