Search

Objectives: We introduced the critical pathway (CP) for follow-up on patients with postoperative lung cancer to the staff of the Hyogo Prefectural Awaji Medical Center and regional medical institutions in Japan, in 2010., Methods and Results: We raised awareness within our hospital and collaborating medical institutes and trained our staff on the CP before introducing it. From May 2013 through October 2023, lung cancer surgery was performed on 460 patients. Our CP was applied to 71.7% of these patients. Reasons for non-application included the high risk of recurrence due to advanced cancer stages( 39.2%) and the treatment for other types of cancer was needed in our hospital (26.2%). We reviewed the outcome of our CP., Conclusion: The high application rate was facilitated by preparatory actions, including training our hospital staff and collaborating medical institutions. An even higher application rate can be achieved by continuing to raise awareness and strengthening cooperation between concerned medical institutions that treat advanced lung cancer.

Diagnosis of aortic dissection complicating cerebral ischemic stroke is difficult. A 60-year-old patient presented at an emergency department of a hospital with a sudden development of left-sided weakness, but without chest pain. During administration of recombinant tissue plasminogen activator with diagnosis of cerebral infarction, he developed symptomatic hypotension and was transferred to our hospital. His chest computed tomography revealed Stanford type A aortic dissection. Replacement of the ascending aorta and aortic arch was successfully performed on the 4th day.

In Japan, endoscopic surgeries are covered by health insurance only when they are performed for benign diseases. Actually, endoscopic surgery is performed for the treatment of benign diseases in most cases. However, it is difficult to precisely know what types of cases are currently treated with laparoscopic procedures in Japan. The Japan Society of Gynecological and Obstetrical Surgery performed a survey to examine the frequency of the use of endoscopic surgery for the first time in Japan, and reported the results. In this article, we described the present situation and problem of gynecologic laparoscopic surgery in Japan from the results.

A nonsmoking, 52-year-old woman presented with a 4-month history of persistent dry cough. Chest X-ray film on admission showed small granular shadow in bilateral lung fields. Bronchoscopic biopsy did not yield a diagnosis. Two months later, she complained of dyspnea. Physical examination showed signs of pulmonary hypertension. Five days after the onset of dyspnea, she died of respiratory failure. An autopsy showed pulmonary embolism and swollen abdominal lymph nodes consisting of metastatic signet-ring cell carcinoma and poorly differentiated adenocarcinoma. There was also marked fibrocellular intimal proliferation and thrombus formation causing luminal stenosis in small pulmonary arterioles. Thrombi were organized by recanalization and included atypical cells. We diagnosed pulmonary tumor thrombotic microangiopathy (PTTM). In spite of various immunohistological staining procedure, we could not find out the primary lesion of this cancer. This case suggests that we should aggressively biopsy a large specimen of the lung to make a differential diagnosis of PTTM, because bronchoscopic biopsy is not enough to diagnose PTTM.

We report a case of myxoid liposarcoma developed in the right inguinal region. A 45-year-old man visited our hospital with a chief complaint of painless right inguinal mass. He was diagnosed with right direct inguinal hernia for the first time and received a hernia repair. However, the size of the inguinal mass increased gradually after the operation. Then, the tumor was re-evaluated by imaging study such as ultrasonography, computed tomography and magnetic resonance imaging. A fatty mass 4.0 cm in diameter was demonstrated and the tumor was diagnosed as a liposarcoma preoperatively. In addition to the right high orchiectomy, surrounding fatty tissue was also removed at the time of the operation. Histological examination revealed a myxoid liposarcoma and the existence of several daughter regions outside the pseudo-capsule. Right spermatic cord and testis were intact. Postoperatively, he received 54 Gy dose of radiation therapy to right inguinal region for the prevention of the local recurrence of the disease.

A 67-year-old woman was hospitalized with right pleural effusion on chest radiography. Chest CT showed a thickened parietal pleura and pleural effusion in the right thorax. Cytological examination of pleural effusion showed atypical plasma cells. We performed thoracoscopy with local anesthesia for diagnosis and observed an about 5 x 5 cm seized red soft tumor on the parietal pleura. Pathological and immunohistochemical examination of the pleural tumor revealed that it was marginal zone B-cell malignant lymphoma. In this case, we could not reach a diagnosis only by cytological examination of the pleural effusion. Thoracoscopy with local anesthesia was safe and useful for diagnosis of malignant lymphoma with pleural effusion. Most cases of primary pleural malignant lymphoma have a history of chronic pyothorax. This case is thought to be a very rare case of primary pleural malignant lymphoma with no history of pyothorax.

In a retrospective review of all patients who visited our hospital between January 1997 and December 2001, we identified 22 with mediastinal lymphoma or mediastina granulocytic sarcoma. They represented 24.2% of the 91 patients with mediastinal tumors. Histology revealed 6 cases of diffuse large B-cell lymphoma, 6 of lymphoblastic lymphoma, 6 of Hodgkin's disease, 2 of granulocytic sarcoma, and 1 of lymphoplasmacytic lymphoma. More than 1/3 of the tumors had highly aggressive histological pictures. Immunocytochemical analysis of cell surface markers by flow cytometry was very useful for reaching a definitive diagnosis of these tumors. In two cases, definitive diagnosis could be obtained only by flow cytometric examination of pleural or pericardial effusion. Careful attention should be paid to the relatively high incidence of hematologic malignancies in mediastinal tumors. Early and accurate diagnosis of these tumors is essential because some of these patients require immediate treatment by hematology specialists.

Current advances in the diagnostic imaging for lung cancer includes multidetector-row CT (MDCT), lung cancer screening using low-dose MDCT and fluorodeoxyglucose positron emission tomography (FDG-PET) imaging. There is no question about the clinical usefulness of MDCT, and the further development of the hardware and the software of MDCT will open new horizons for CT diagnosis. PET is not an alternative modality to CT but a supplementary one, which adds metabolic information to the morphology. Recently, experimental research on the refraction imaging of human lung specimens has been performed with synchrotron radiation. With progressive refinement, this technique may come to have some practical purpose in diagnosing lung cancer in vivo.

The combination of docetaxel (TXT), gemcitabine (GEM), and cisplatin (CDDP) produced a regression in a squamous cell carcinoma of the lung that had recurred after radiation therapy plus chemotherapy, and was resistant to the combination of carboplatin (CBDCA) with etoposide (ETP) or paclitaxel (TXL). The patient was a 62-year-old man with squamous cell lung cancer, which was first successfully treated by a combination of radiation therapy and chemotherapy, but showed local recurrence after 8 months. Although the recurrence was treated with CBDCA plus ETP and then TXL, the tumor continued to grow with symptomatic progression of airway stenosis. The tumor began to regress after the regimen of TXT, GEM and CDDP was started. This therapy achieved PR with symptomatic improvement. The combination of TXT, GEM and CDDP may be effective for recurrent non-small-cell lung carcinoma, even in patients that have failed to respond to more than one chemotherapy regimen.

A 70-year-old woman was admitted in April 1997 because a coin lesion in the left middle lung field was observed on chest roentgenograms. The lesion had slightly increased in size since 1994, when it was first pointed out. Chest computed tomography elucidated a high density area with irregular borders in the center of the shadow in S 3 a. Transbronchial biopsy revealed adenocarcinoma, and a left upper lobectomy was performed. The resected specimen demonstrated a tumor with central ossification and pleural indentation. Histologic examination determined that the the tumor was a papillary adenocarcinoma with central ossification containing marrow tissue. Primary lung cancer with central ossification is very rare, and only 6 cases have been reported to date, including this case.

A successful treatment of coronary arteriovenous fistula with intraoperative echocardiogram and Symbas procedure is presented. The patient, a 2-year-old male, had been suffering from concealed congestive heart failure from his birth. The cardiac catheterization and angiogram revealed coronary arteriovenous fistula from LAD to right ventricle with large coronary aneurysm. In the operation, no fistula vessels were noted on the cardiac surface. Then, the intraoperative echocardiography was performed, and the fistula pour into right ventricle with aneurysm was found in the myocardium. The fistula was closed with Symbas procedure, and excellent closure could be checked with the intraoperative echocardiogram, too. After this operation, he got well under anticoagulant treatment with "ticlopidine".

Conventional isoenzyme and enzyme values in serum usually are normal during the first few hours of acute myocardial infarction (AMI). Thus definitive diagnosis may be delayed. Measurement of serum creatine kinase (CK) isoform has begun to attract attention. In this study, we measured CK isoform with an immunoinhibition method in the first available samples from patients with AMI and from healthy subjects. In the 394 healthy subjects, the mean ratio of MM3 to MM1 of CK isoform was 0.494 +/- 0.1495 (SD). The upper limit of the reference values for this ratio was considered to be 0.793 (mean + 2 SD). In 40 of 48 patients, this ratio in the first available samples from patients with AMI was greater than 0.793. In 15 of 20 patients whose total CK activity was less than 260 IU/l, this ratio was greater than 0.793, while CK-MB activity measured with the immunoinhibition method was well within the reference range in all of these patients. Our results show that in the first available samples from patients with AMI, measurement of the ratio of MM3 to MM1 of CK isoform has the highest diagnostic efficiency. Thus, measurement of CK isoform with the immunoinhibition method can be applied for early diagnosis of AMI.

The frequency of patients requiring non-cardiac surgery complicates ischemic heart disease (IHD) is increasing, however, there have been few reports of combined coronary revascularization and abdominal surgery. In this paper, we describe three patients with IHD and cholecystolithiasis in whom simultaneous coronary artery bypass grafting (CABG) and cholecystectomy was successfully performed. Initially, CABG was performed employing standard extracorporeal circulation through median sternotomy. After closure of chest, cholecystectomy was carried out through right pararectal laparotomy. Their postoperative course was uneventful. Relief of angina and freedom from epigastralgia were obtained in all patients. Combined CABG and cholecystectomy is beneficial for the selected patients.

The basic and clinical studies of cefotiam (CTM) in pediatric infections were carried out, and the following results were obtained: 1. The antibacterial activity of CTM against S. aureus was equal or slightly less than that of cefazolin (CEZ). Those of CTM against E. coli and K. pneumoniae were eight times more active than those of CEZ. 2. CTM 20 mg/kg was administered wither by 30 minutes or 1 hour intravenous drip infusion. The peak serum levels were obtained at the end of each drip infusion, with the mean peak levels being 44.8 and 41.4 mcg/ml respectively. The serum levels at 1.5 and 2 hours after drip infusion were 2.8 and 2.2 mcg/ml respectively, and at 3.5 and 4 hours after drip and 4 hours after drip infusion were 0.3 and 0.7 mcg/ml respectively. The half lives were 0.62 and 1.15 hours, respectively. The mean urinary excretion over 6 hours were 52.8% in ;the 30 minutes drip infusion group and 42.6% in the 1 hour drip infusion group. 3. Clinical efficacy was evaluated in sixteen cases suffering from tonsillitis (4 cases), pneumonia (4), bronchitis (2), cervical lymphadenitis (2), purulent meningitis (2), suppurative arthritis (1) and suspected sepsis (1). Good and excellent responses were obtained in 15 of 16 cases (93.8%). Bacteriological response in the form of eradication was noted in 4 of 6 cases. Side effect observed was rash in 1 case, and laboratory abnormalities were elevation of BUN in 1 case and elevation of GPT in 2 cases.

The authors have carried out the laboratory and clinical studies of cefadroxil (CDX). The results were as follows; The sensitivity was measured by plate dilution method on 27 strains of S. aureus and E. coli, 26 strains of K. pneumoniae isolated from patients. The distribution of sensitivity of S. aureus was 3.13-12.5 microgram/ml and the peak of distribution was 3.13 microgram/ml and 6.25 microgram/ml, of E. coli was 6.25 microgram/ml by 10(8) cells/ml. And the distribution of sensitivity of K. pneumoniae was 6.25-25 microgram/ml and its peak was 6.25 microgram/ml by 10(8) cells/ml. CDX were given orally at dose of 10 mg/kg to 3 children. The serum levels of CDX were 10.5 +/- 1.78 microgram/ml, 15.8 +/- 3.25 microgram/ml, 12.0 +/- 0.41 microgram/ml and 3.9 +/- 0.9 microgram/ml at 0.5, 1, 2, 4 hours after administration respectively, and was 2.3 +/- 0.48 microgram/ml at 6 hours. The urinary excretion rate was 55.6% up to 8 hours after administration. CDX were administered to 39 cases of pediatric infectious disease (26 cases with tonsillitis, 5 cases with enterocolitis, 3 cases with UTI, 2 cases with impetigo, each one case with bronchitis, cervical lymphadenitis and epididymitis). And CDX were given 25.0-65.2 mg/kg daily. Clinical results obtained were above good in all cases. No side effects were observed in any cases, except for one case, with diarrhea, 6 cases with the elevation of serum transaminase and 1 case with eosinophilia.

The authors have carried out the laboratory and clinical studies of cefuroxime (CXM). The results were as follows: The sensitivity was measured by plate dilution method on 26 strains of S. aureus, 22 strains of E. coli and 24 strains of K. pneumoniae isolated from patients. The distribution of sensitivity of S. aureus was 0.78 approximately 3.13 micrograms/ml and the peak of distribution was 1.56 micrograms/ml. The distribution of sensitivity of E. coli was 1.56 approximately 50 micrograms/ml and the peak was 6.25 micrograms/ml. The growth of 79.2% K. pneumoniae was inhibited in concentration of less than 3.13 micrograms/ml. CXM was given intravenously for 30 minutes at a single dose of 20 mg/kg to 3 children. The serum mean levels of CXM were 99.0 +/- 10.6 micrograms/ml at 30 minutes, 18.0 +/- 10.7 micrograms/ml at 1 hour, 7.0 +/- 2.0, 2.2 +/- 0.6, 0.79 +/- 0.2 microgram/ml at 2, 4 and 6 hours after drip infusion for 30 minutes, respectively. Mean half life was 48 minutes. The mean urinary recovery rate was 96.2% up to 8 hours after administration. CXM was effective in 9 of 10 cases of bacterial infections. No side effect was observed except for 1 case with elevation of serum transaminase.

Peak blood level of cephalexin was obtained at 4 hours after the administration of S-6437 as opposed to 2 hours after regular cephalexin. Peak blood level with regular cephalexin was higher than that with S-6437. Blood levels with S-6437, however, stayed for longer period than those with regular cephalexin. Mean urinary recovery within 12 hours after the administration of S-6437 after meal and during meal were 57.1 and 69.3%, respectively. S-6437 was studied in 23 pediatric patients, 7 with acute tonsillitis, 15 with acute cystitis and 1 with cellulitis. They were orally given 400 to 1,200 mg/day of S-6437 in two divided doses at 30 minutes after meal for 4 approximately 12 days. Of the 23 patients, 18 responded to the drug but 5 did not respond. As for side effects, eruption and diarrhea were observed in 1 and 2 patients, respectively. No other side effects were found.

The authors have carried out the laboratory and clinical studies of cefroxadine (CXD), and obtained the following results. The antibacterial activities of CXD were measured by plate dilution method on 26 clinical isolates of S. aureus, E. coli and K. pneumoniae. CXD inhibited the growth of all strains of S. aureus at concentrations less than 6.25 microgram/ml, the peak of activity distribution was obtained at 3.13 microgram/ml with an inoculum size of 10(6) cells/ml. And the p eak sensitivity distribution of E. coli was obtained at 6.25 microgram/ml. The growth of all strains of K. pneumoniae was inhibited at concentrations of less than 25 microgram/ml. Phagocytosis was determined by QUIE'S method. In the presence of CXD, phagocytosis of human PMNs was not enhanced to E. coli and K. pneumoniae. For pharmacokinetic study, CXD was given orally at a single dose of 10 mg/kg to 3 children before and after meals. The serum levels of CXD on fasting were 14.2 microgram/ml, 11.0 microgram/ml, 4.0 microgram/ml and 0.57 microgram/ml at 0.5, 1, 2. 4 hours after administration respectively, and the level at 6 hours was not detectable. Half-life was 0.65 hours. The serum levels of CXD after meals were 3.9 microgram/ml, 5.3 microgram/ml, 5.3 microgram/ml, 2.4 microgram/ml and 0.42 microgram/ml at 0.5, 1, 2, 4, 6 hours after administration respectively, but at 8 hours it was not detectable. Half-life was 0.95 hours. The 8-hour urinary excretion rates on fasting and non fasting were 89.4%, 89.0% respectively. CXD was given to 31 cases with tonsillitis, 4 with bronchitis, 1 with impetigo, 3 with cervical lymphadenitis, 7 with U.T.I, totalling 46. A daily dose of CXD 400 approximately 1,500 mg was given for 4 approximately 14 days. Clinical results obtained were good and excellent responses in 43/46 (93.5%) cases. No side effects were observed except for 1 case with elevation of GOT, 2 cases with elevation of GOT and GPT and 1 case with eosinophilia.

The authors have carried out the laboratory and clinical studies of cefoperazone (CPZ). The results were as follows: The sensitivity was estimated by plate dilution method on 26 strains of S. aureus, E. coli and K. pneumoniae, 25 strains of P. aeruginosa, 14 strains of Salmonella sp. and 9 strains of GM resistant P. aeruginosa isolated from patients. The distribution of sensitivity of S. aureus was 1.56 approximately 25 mcg/ml and the peak of distribution was 3.13 mcg/ml. The growth of 96.2% of E. coli was inhibited at concentration of less than 12.5 mcg/ml. The growth of 50.0% of K. pneumoniae was inhibited at concentration of less than 6.25 mcg/ml. The peak of distribution of P. aeruginosa was 12.5 approximately 25 mcg/ml (GM sensitive) and 12.5 mcg/ml (GM resistant). CPZ was given by drip infusion for 30 minutes at a single dose of 25 mg/kg to 2 children, and by drip infusion for 60 minutes at a single dose of 46.9 mg/kg to a child. The serum mean level of CPZ was 127.5 +/- 8.5 mcg/ml at 30 minutes, 30.5 +/- 7.5 mcg/ml at 1 hour, 23.5 +/- 3.5 mcg/ml at 2 hours, 10.5 +/- 1.5 mcg/ml at 4 hours and 6.8 +/- 2.4 mcg/ml at 6 hours after administration at a single dose of 25 mg/kg, respectively. The serum level was 102.0 mcg/ml at 1 hour, 32 mcg/ml at 2 hours, 14.5 mcg/ml at 5 hours and 12.5 mcg/ml at 7 hours after administration at a single dose of 46.9 mg/kg. Half-life time was 92 minutes. The mean urinary excretion rate was 32.0 +/- 7.3% in the drip infusion for 30 minutes up to 8 hours after administration. CPZ was effective in 6 of 8 cases with pediatric bacterial infections. No side effects were observed except for 1 case with elevation of GOT.

The authors have carried out the laboratory and clinical studies of ceftizoxime (CZX), and obtained the following results. 1. The antibacterial activities of CZX were measured by plate dilution method against clinical isolates of S. aureus, E. coli, K. pneumoniae and P. aeruginosa. CZX inhibited the growth of S. aureus at concentrations less than 12.5 micrograms/ml, and the peak of sensitivity distribution was obtained at 3.13 micrograms/ml with an inoculum size of 10(6) cells/ml. And the peak sensitivity distribution of E. coli and K. pneumoniae were obtained at less than 0.1 microgram/ml and that of P. aeruginosa was obtained at 6.25 micrograms/ml. 2. Phagocytosis was determined by Quie's method. Phagocytosis of E. coli and K. pneumoniae by human polymorphonuclear neutrophil was more enhanced in the presence of 1 MIC and 1/2 MIC of CZX than of CEZ at 4 and 6 hours after incubation. 3. As for pharmacokinetic study, CZX was given by intravenous injection and drip infusion for 1 hour at a single dose of 10 mg/kg and 30 mg/kg. After intravenous injection of 10 mg/kg and 30 mg/kg of CZX, the mean peak serum levels were 19.1 +/- 3.4 micrograms/ml and 69.1 micrograms/ml at 30 minutes, and half-life times were 1.20 hours and 1.35 hours, respectively. After 1 hour drip infusion of 10 mg/kg and 30 mg/kg of CZX, the mean peak serum levels were 28.8 +/- 3.6 micrograms/ml and 60.9 +/- 5.9 micrograms/ml at the end of infusion, and half-life times were 1.40 hours and 1.77 hours, respectively. The mean urinary excretion rates were between 75.3% and 101% up to 6 hours after intravenous injection and drip infusion. 4. CZX was given to 4 cases with tonsillitis, 3 with pneumonia, 1 with enteritis, 4 with U.T.I., totaling 21 cases. A daily dose of CZX between 350 mg and 2,000 mg was given for 3 to 5 days. Clinical results obtained were good in all cases. No side effects and abnormal laboratory findings were observed.

The authors have carried out the pharmacokinetics and clinical studies of CS-1170. The results were as follows; CS-1170 was given by drip infusion for 1 hour dose of 20 mg per kg body weight to 3 children. The maximum blood level was reached at one hour after drip infusion. This blood levels were 38 micrograms/ml, 68 micrograms/ml and 86 micrograms/ml, respectively, (mean 64 micrograms/ml), and level at 2 hours, 11.5 micrograms/ml, 9.4 micrograms/ml, 16 micrograms/ml respectively, (mean 12.3 micrograms/ml), the blood level at 6 hours was not determined. The urinary excretion rates were 94.8 approximately 96.8% up to 6 hours after drip infusion dose of 20 mg per kg body weight. CS-1170 was effective in 7 of 8 cases with pediatric bacterial infections. An ineffective case was a pneumonia due to Serratia marcescens. No side effect was observed except for 2 cases with diarrhea and one case with elevation of GOT and GPT.

The authors have carried out the laboratory and clinical studies of cefamandole (CMD). The results are as follows: The sensitivity was measured by plate dilution method on 26 strains of Staphylococcus aureus, Escherichia coli, Klebsiella pneumoniae and 14 strains of Salmonella typhimurium isolated from patients. The distribution of sensitivity of S. aureus was 0.39 approximately 3.13 micrograms/ml and the peak of distribution was 1.56 micrograms/ml. The distribution of sensitivity of E. coli was 0.78 approximately greater than 100 micrograms/ml, and K. pneumoniae, 1.56 approximately greater than 100 micrograms/ml. The distribution of sensitivity of Salmonella typhimurium was 6.25 approximately greater than 100 micrograms/ml and its peak was 6.25 micrograms/ml. CMD were given intravenously for 30 and 60 minutes at a single dose of 25 mg/kg body weight to 6 children. The serum mean levels of CMD were 105.3 micrograms/ml at 30 minutes, 15.1 micrograms/ml at 1.5 hours, 1.6 micrograms/ml at 2.5 hours after drip infusion for 30 minutes, respectively, and 34.7, 5.2, 0.6 micrograms/ml at 1, 2, 3 hours after drip infusion for 60 minutes, respectively. And the serum level at 4 hours after administration was not detected. The mean urinary excretion rates were 73.3% in the drip infusion for 30 minutes and 60.7% in its for 60 minutes, up to 8 hours after administration. Half life was 26 minutes. CMD was effective in 18 of 21 cases of bacterial infections. No side effects were observed except for 2 cases with elevation of serum transaminase.