A successfully treated case of thoracic meningocele with von Recklinghausen's disease]

Intrathoracic meningocele is an uncommon disease. Only 95 cases in the foreign literature and 13 cases in Japanese literature have been reported since Phol Meningocele occurs most frequently in the sacral and lumbar spinal regions. In this present paper, an 18-year-old female with intrathoracic meningocele associated with neurofibromatosis is described. The patient was admitted to our Surgical Clinic with a complaint of constrictive pain in the upper chest. The meningocele was diagnosed preoperatively and resected surgically by left thoracotomy. The patient has been followed up to for six years without any evidences of local recurrence. However, she recently complains of headache and weakened eyesight because of pituitary tumor, the operative indication of which is now discussed.     

Chick Embryo Assay as Chemosensitivity Test for Malignant Glioma

To predict the efficacy of anticancer drugs such as ACNU [l-(4-amino-2-methyl-5-pyrimidinyl)-methyl-3-(2-chloroethyl)-3-nitrosourea hydrochloride] and MCNU [l-(2-chloroethyl)-3-(methyl-α-D-glucopyranos-6-yl)-l-nitrosourea] in the treatment of malignant gliomas, the usefulness of the chick embryo assay as a Chemosensitivity test was studied. Fifty-seven surgical specimens including benign tumors were examined by this method. All tumor specimens tested could be grafted on the chorioallantoic membrane of chick embryo; the evaluable ratio was 100%. Twenty-one patients with previously untreated malignant glioma could be evaluated to test the predictability of the clinical effects, judged by computed tomography. There were 7 (78%) instances in which the assay response corresponded to a clinical partial response (true-positive). There were 2 (22%) false-positives for the assay, 0 (0%) false-negative and 12 (100%) true-negatives. The over-all predictive accuracy was 90% (19/21). Thus, a high-degree of positive association exists between the chick embryo assay and the clinical outcome. This in vivo assay system for malignant glioma is advantageous for Chemosensitivity tests because of its convenience, rapidity, and inexpensiveness.     

Tachyphylaxis to capsaicin-induced cough and its reversal by indomethacin,in patients with the sinobronchial syndrome

Cough reflex testing with capsaicin has been used to study the pathophysiology of the cough reflex and the antitussive effects of various drugs. Although the reproducibility of capsaicin-induced cough has been well established in normal subjects, it is not known if prior challenge with capsaicin reduces the subsequent cough response to inhaled capsaicin in patients with the sinobronchial syndrome, a condition characterized by chronic upper and lower airway inflammation. Measurement of the capsaicin cough threshold, defined as the lowest concentration of capsaicin eliciting five or more coughs, was repeated four times at intervals of 15, 30 and 60 min in eleven patients with the SBS and ten normal subjects. The cough thresholds at 15, 30 and 60 min were greater than the initial value in patients with the SBS but not in normal subjects. In addition, we examined the effect of 4 days treatment with indomethacin (100 mg/day) on the cough thresholds measured twice at an interval of 15 min in eight patients with the SBS. Indomehacin increased the initial cough threshold and reduced the increment in the post-15 min cough threshold from the initial value compared with placebo, thus reducing the tachyphylaxis. These results indicate that chronic airway inflammation may be responsible for the decreased response (tachyphylaxis) to repeated inhalation of capsaicin, and suggest that cyclooxygenase products released by the airway inflammation may be involved in tachyphylaxis, cough receptor sensitivity to inhaled capsaicin, or both, in patients with the SBS.     

Experimental Model for Predicting Metastatic Ability of Tumors Using Chick Embryo

At present, there is no established diagnostic method by whichthe metastatic ability of an idividual human cancer can be accuratelypredicted. We used chicken chorioallantoic membrane (CAM) topredict the metastatic ability of three B16 murine melanomavariant lines and also of human giant-cell carcinoma of thelung. Tumor cells were deposited on the CAM of eggs 10 daysafter fertilization. On day 7 after the tumor inoculation, theembryos were killed, and the lungs removed, minced and implantedon the CAM of other 10-day-old embryos. On day 7 after thisinoculation, the tumors on the CAM were inspected under a surgicalmicroscope, and were also checked histologically. The resultsaccurately reflected the differing metastatic abilities of theB16 melanoma variant lines. Metastases were observed in thelungs of the embryo bearing human giant-cell carcinoma of thelung on the CAM. Using CAM seems to be a suitable way of predictingthe malignancy of tumors with metastatic ability.