Synchronous four primary lung adenocarcinoma associated with multiple atypical adenomatous hyperplasia

A 69-year-old woman with synchronous bilateral 4 primary lung adenocarcinoma accompanied by multiple atypical adenomatous hyperplasia (AAH) is described. The patient was found to have bilateral multiple tumors during a preoperative chest CT evaluation which was performed for the previously-diagnosed adenocarcinoma of the right middle lobe. Since intraoperative diagnosis of the left nodular lesion was adenocarcinoma and judged to be a pulmonary metastasis, a lobectomy of the right middle lobe only was performed. Postoperative pathological diagnosis including immunohistochemical findings demonstrated that the bilateral lesions were synchronous multiple primary adenocarcinoma, independent of each other and associated with multiple AAH. This case suggests the possibility of the AAH-adenocarcinoma sequence in the development of lung cancer. In addition, the strategy of treatment for synchronous multiple adenocarcinoma should be considered.     

Increased intensity of lung infiltrates at the side of lung cancer in patients with lung cancer associated with pulmonary fibrosis

A patient with a small-sized pulmonary adenocarcinoma was successfully treated by percutaneous high dose rate interstitial brachytherapy alone. The patient, who had an adenocarcinoma with 12-mm diameter in the lingular lobe of left lung, was judged to be inoperable because of poor pulmonary function due to emphysema and extensive pleural adhesion. The tumor was punctured with a 21-gauge fine applicator needle followed by the introduction of an iridium 192 (192Ir) radioactive source through the applicator needle using a remote afterloader. The tumor was irradiated for 225.1 s in one fraction. The tumor was in the inside of the iso-dose line of 40 Gy. The delivered doses calculated at nine reference points, which were 12.5 mm distant from the center of the tumor, distributed between 19.225 and 32.169 Gy, with a mean of 24.8 Gy. No apparent side effect including pneumothorax and hemoptysis was observed. The tumor shrank and showed no increment of the size for about 2 years.     

Antiarrhythmic and cardiohemodynamic effects of a novel Ca(2+) channel blocker, AH-1058, assessed in canine arrhythmia models

The antiarrhythmic profile and cardiohemodynamic effect of a novel Ca(2+) channel blocker, 4-(5H-Dibenzo[a, d]cyclohepten-5-ylidene)-1-[(E)-3-(3-methoxy-2-nitro)phenyl-2-p ropeny l]piperidine hydrochloride (AH-1058), were analyzed using the epinephrine-, digitalis- and two-stage coronary ligation-induced canine ventricular arrhythmia models. Intravenous administration of AH-1058 (100 microg/kg) effectively suppressed each of the ventricular arrhythmias accompanied by weak hypotensive effects. The results contrast well with those of a typical Ca(2+) channel blocker, verapamil, which suppresses only the epinephrine-induced ventricular arrhythmia with severe hypotension. These results indicate that AH-1058 may possess a more selective inhibitory action on Ca(2+) channels in the heart than on those in the vessels. Furthermore, the antiarrhythmic actions of AH-1058 were slower in onset and longer-lasting, than those in our previous studies using other antiarrhythmic drugs, including Na(+) and Ca(2+) channel blockers. The antiarrhythmic effects of AH-1058 did not correlate with its plasma concentrations when administered either intravenously or orally. These results suggest that AH-1058 can become a long-acting Ca(2+) channel blocker with unique antiarrhythmic properties, and that AH-1058 may be used in certain pathological processes, for which selective inhibition of the cardiac Ca(2+) channels is essential.     

Palliative treatment of inoperable tumors of the efferent bile ducts

Our method of percutaneous transhepatic cholangiodrainage (PTCD) and radiotherapy shows better results and prognosis in patients with inoperable tumors of the liver, biliary system and pancreas. PTCD was performed in patients with progressive obstructive jaundice due to inoperable tumors to decompress the hepatobiliary system and to reduce jaundice. This was combined with radiotherapy which was performed pre- and postoperatively and without operation. Aim of radiotherapy was to reduce the tumor and also to explore the possibility of radical operation. Radiotherapy was carried out in most patients with Linear accelerator (Linac), and in some with Betatron or Telecobalt 60. In a few cases was chosen: 1) two phase radiotherapy 2) and/or a combination of ray therapies. Inoperable tumors, which can not be excised, should be treated intraoperatively with radiation therapy. Only after a radiation with 3000-4000 rad linac, tumors showed shrinkage in size and at the same microscopic degenerative changes in tumor cells were observed.     

122. Die percutane transhepatische Cholangio-Drainage zur Therapie des extrahepatischen cholestatischen Ikterus

Zusammenfassung 70 Patienten wurden wegen eines Verschlußikterus mit pereutaner transhepatischer Cholangio-Drainage (PTD) behandelt. Bei 55 Patienten wurden PTDen oder Palliativbehandlungen mit PTD wegen eines inoperablen Gallenwegscarcinoms durchgeführt. Diese 55 Patienten überlebten durchschnittlich 17 Wochen. Bei anderen Patienten wurde nach temporärer Entlastung kurativ operiert. Durch die PTD wird einerseits das OP-Risiko vermindert, andererseits wird dadurch bei inoperablen Gallenwegscarcinomen der palliative Eingriff ermöglicht.     

Quantitative trait loci on chromosomes 10 and 11 influencing mandible size of SMXA RI mouse strains

Predicting the mandible size before the termination of growth of the maxillofacial bones is essential in pedodontics as well as for the predictions needed for genetic analysis. Here, Quantitative Trait Locus (QTL) analysis was used to detect the chromosomal regions responsible for the mandible length between the menton and gonion in an SMXA recombinant inbred strain of mice. Around the region 60 cM from the centromere in chromosome 10, the logarithm of the odds score showed a higher than suggestive level. Around the regions 13 cM and 16 cM in chromosome 11, two significant QTLs were detected. Analysis of genotypes from loci corresponding to those QTLs revealed a large mandible when the region between the markers Hba and D11Mit163 and D10Mit70 and D10Mit136 indicated the genotype from the A/J and SM/J alleles, respectively. These results suggest that the major gene(s) responsible for mandible length are located in these regions.     

Endoscopic treatment of a choledochocele in a 2-year-old child

Choledochocele is an extremely rare congenital lesion of the biliary tree causing abdominal pain, pancreatitis, and obstructive cholestasis. Traditionally the therapy for this malformation has been surgery. Recently endoscopic therapy has been utilized alternatively for the treatment of choledocele in adults. We report the case of a 2-year-old girl with a choledochocele who was treated by endoscopic sphincterotomy and placement of a biliary stent. The prosthesis was removed after 4 months. After a follow-up of 20 months the patient remains free of symptoms. Our experience suggests that endoscopic treatment of congenital biliary disease can be performed accurately. Further studies will be necessary to confirm the value of stent implantation in congenital bile duct stenosis. Received: 7 June 1995/Accepted: 22 January 1996     

Prolonged inhibition of vascular contraction and calcium influx by the novel 1,4-dihydropyridine calcium antagonist cinaldipine (FRC-8653)

We examined the effects of FRC-8653, a novel dihydropyridine calcium antagonist, on the contraction of an arterial preparation and the calcium influx into vascular smooth muscle cells to clarify the long-lasting hypotensive activity of this drug. Inhibition by FRC-8653 persisted for more than 7 hr after its removal, whereas nifedipine and nicardipine exhibited shorter durations of suppressive activity. These results suggest that prolonged inhibition of calcium influx through L-channels contributes to the long-lasting vasodilative and antihypertensive activity of FRC-8653.     

Management of chronic pancreatitis with pancreas cyst by endoscopic pancreatic prosthesis

Summary Cases of chronic pancreatitis accompanied by stenosis or dilation of the pancreatic duct were treated by endoscopic placement of an endoprosthesis and drainage. The purpose of the treatment was the alleviation of pain, restoration of extrapancreatic secretion and retardation of the progression of inflammation. The procedure was performed successfully in 9 of 13 patients, using an endoscopically placed pigtail prosthesis in the pancreatic duct. The successfully treated patients consisted of 9 cases of chronic pancreatitis, 2 cases being pancreas divisum. After disappearance of the symptoms and abnormal endoscopic findings, the drainage tubes were removed after a period of 5–12 months. No serious complications were encountered. Following the procedure, an improvement in appetite and increase of 2–13 kg in body weight was recognized. This method yielded satisfactory results in the treatment of chronic pancreatitis.