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Objectives　The first population-based cancer registry (PBCR) was established in Japan in the 1950s; however, the legality of the registry was unclear, and scarcity of government funding resulted in data of poor quality. Although the collection of personal information is indispensable to checking for duplicated records and for patient follow-up, privacy protection was a main obstacle and was directly related to public opinion. The purpose of this study is to figure out the changing perspectives of newspaper reports about PBCR and to discuss qualitative changes in them.Methods　Articles with the PBCR-related keywords "cancer and registration", "cancer and statistics", "cancer and control policies" and "cancer and information" were extracted from five major newspapers and 50 local papers published during the 3rd-term Comprehensive 10-year Strategy for Cancer Control (2004-2013), the era of improved quality and standardization of cancer registries. From the 960 articles containing the keywords, 441 were finally for analysis.Results　Key social events occurred in the background while the articles on cancer registries increased. For instance, legislation passed for the Cancer Control Act in 2006 and the Cancer Registry Promotion Act in 2013, and carcinogenic health hazard incidents such as the nuclear plant accident after the Great East Japan Earthquake of 2011 contributed to increased interest in PBCR. The word "cancer registry" appeared most frequently in 2006 (68 times) followed by 2011 (60 times). Qualitative analysis of the articles showed the tide of public opinion turned against conservative privacy protection and toward the need for data.Conclusion　The interest in cancer registries increased during the observation period due to the background events that demanded the monitoring of cancer incidences and survival rates and providing precise information on cancer burden. For the general public, the benefit of PBCR is indirect. Active provision of information on PBCRs and related epidemiology information should help generate positive public opinion in Japanese society.

With the aging of the population of Japan and Westernization of the dietary life, the number of cases in which cardiovascular diseases are merged in non-cardiac surgery is increasing year by year.Many of the abdominal aortic aneurysms are asymptomatic and it is not uncommon to be discovered accidentally in preoperative examination of non-cardiac surgery.When gastrointestinal surgery involves malignant diseases of the gastrointestinal tract and abdominal aortic aneurysm, the two life prognosis-related diseases are merged, depending on the severity and urgency of the disease for each case, its treatment to determine the priority order.Abdominal aortic aneurysm occurred at the time of malignant disease surgery in 14 cases of gastrointestinal cancer patients who underwent surgery at the department during the 5 years from 2012 to 2016.T he actual condition of treatment for these cases was investigated.

A 3-month-old female with ventricular septal defect underwent definitive repair. In the operation, a venting tube was inserted through the incised patent foramen ovale. The ventricular septal defect was closed using a patch and the incised patent foramen ovale was directly closed. A transesophageal echography showed no abnormal findings in the operating room. On 1st postoperative day, the patient's heart rate and pressure of the superior vena cava increased while blood pressure decreased. A transthoracic echocardiography revealed an atrial septal hematoma. After conservative therapy, the heart rate and pressure of the superior vena cava gradually decreased while blood pressure increased. The atrial septal hematoma disappeared spontaneously. The patient was discharged on 16th postoperative day. The atrial septal hematoma appears to have a good prognosis, but sometimes can be poor resulting and death. Meticulous and constant observation is required to detect an atrial septal hematoma.

A 48-year-old man was refered to our hospital for the treatment of bicusp aortic valve and severe aortic regurgitation. He underwent Bentall procedure (SJM 25mm+HemashieldØ 28 mm composite graft). Temporary epicardial pacing lead( TPL) was placed on the right ventricle at the opetation, and was cut on his skin surface prior to discharge because of difficulty in traction removal. After 15 years from operation, follow up computered tomography and echocardiography showed migration of 2 retaining TPLs extending from vascular graft of ascending aorta to the right innominate artery. We performed Redo-median sternotomy and removed the TPLs. This is the 1st reported case of a migrated temporary pacing lead into the vascular graft of ascending aorta under noninfectious conditions.

To clarify the epidemiologic features of Mycoplasma pneumoniae, we examined 358 M. pneumoniae strains isolated between 2004 and 2013 in Yamagata, Japan. Analysis of macrolide-resistance-associated 23S ribosomal RNA (rRNA) domain V mutations revealed 6 kinds of mutants (81 A2063G, 43 A2063T, 1 A2063C, 1 A2064C, 4 C2617G and 1 C2617 mutation). There were only two mutants before 2009, but mutants A2063T and A2063G increased in 2009 and from 2010, respectively. The annual ratio of mutants varied from 20.4% to 76.4% between 2009 and 2013. Typing of the p1 gene revealed 4 types; 278 type 1, and 3 kinds of type 2 variant strains (10 type 2a, 5 type 2b and 65 type 2c). Type 1 strains accounted for between 85.2% and 100% of isolates from 2004 to 2011, whereas type 2 variant strains increased by 26.5% and 66.1% in 2012 and 2013, respectively. These results indicate that type 1 strains may have been replaced by type 2 variant strains in 2013. Furthermore, the ratio of type 1 strains with a 23S rRNA mutation was 65.1% in 2012 and 95.2% in 2013, but none of the type 2 variant strains had this mutation. In conclusion, type 1 strains with macrolide-resistant mutations appeared in 2006 and increased from 2009. In contrast, type 2 variant strains, which increased in 2012 and became predominant in 2013, showed no mutations.

Mesenchymal stem cells (MSCs) are important clinical applications in treating immune disorders due to their multipotency, immunosuppressive properties by production of cytokines. However, the majority of studies rely on an in vitro cell expansion phase, and the properties of MSCs in vivo are still unknown, because there is no specific marker for MSCs. The purpose of this review is to provide an update on our knowledge of MSCs isolation and their immunosuppressive properties, focusing on bone marrow-derived MSCs.

A 59-year-old man was admitted for evaluation of short of breath and bilateral leg edema that had progressively worsened over 3 months. Chest computed tomography revealed marked pericardial thickening. Cardiac echocardiography revealed right heart volume load and diastolic dysfunction. Cardiac catheterization revealed a dip-and-plateau pattern of the pressure curve of right ventricule (RV)without any coronary disease. On a diagnosis of heart failure due to pericardial constriction, he underwent pericardiectomy under cardiopulmonary bypass. Multiple longitudinal and transverse incisions like a waffle were made in the thickened epicardium and improved the hemodynamics. The symptoms improved after surgery. As serum level of immunoglobulin G(IgG)4 was elevated and IgG4-positive plasma cells were recognized in the resected pericardium, diagnosis of constrictive pericarditis of hyper-IgG4 disease was made.

Aim: The purpose of this study was to examine the effects of a Tai Chi Yuttari-exercise based care prevention program aimed at frail elderly people on new care-need certification and mortality., Methods: Participants were elderly individuals (≥65 years of age) who lived in Kitakata City and who had experienced a fall in the past year but were not receiving support or long-term care. Those who agreed to participate in the exercise program were the intervention group (n=34), and those who did not participate were the control group (n=84). The intervention program was carried out once a week for a total of 15 times during the period spanning December 5, 2006 to March 22, 2007. In the intervention group we measured and analyzed changes in physical functions and administered a questionnaire before and after the intervention. We confirmed any deaths and determined whether certification for long-term care had been issued to the participants, in March 2010., Results: New care-need certification was issued to 2 participants (6.3%) in the intervention group and 19 (24.1%) in the control group. Logistic regression analysis revealed that participants in the intervention group tended to require less new certification than those in the control group (p=0.098). There was no significant difference in the number of deaths between the intervention (2 participants; 5.9%) and control (5 participants; 6.0%) groups. We observed significant changes between pre- and post-intervention on several variables, including motor fitness scale, maximum walking speed over 10 meters, functional reach test, ability to stand after a long period of sitting, and maximum one step width., Conclusion: The Tai Chi Yuttari-exercise based intervention program for frail elderly people reduced the need for new care-need certification and was useful as a care prevention program.

We presented the case of a 46-year-old man with no medical or family history but with a history of smoking 3 packs of cigarettes per day for the past 25 years. He was admitted to our hospital due to hemoptysis. Chest computed tomography revealed a tumor of right upper lung and interstitial pneumonia in the surrounding lung parenchyma. He was operated upon and diagnosed with stage IIB pleomorphic carcinoma of the lung with invasion of the chest wall. He underwent three courses of postoperative carboplatin (CBDCA) (area under the curve 5 on day 1, every 3 weeks and paclitaxel(PTX) (200 mg/m(2); day 1, every 3 weeks) combination chemotherapy. No recurrence was observed for a period of 760 days after the operation. According to previous reports, lung pleomorphic carcinoma is aggressive and has a poor prognosis. Further, the significance of chemotherapy in the management of this disease has not been established. Postoperative combination chemotherapy of CBDCA and PTX may result in a good prognosis for this disease.

We have treated 14 advanced and metastatic colorectal cancers with irinotecan (CPT-11) plus fluorouracil (5-FU) and l-leucovorin (l-LV) combination chemotherapy. The 14 patients consisted of 8 males and 6 females with a mean age of 65 years. We diagnosed adenocarcinoma of the colon in 10 patients and of the rectum in 4 patients. Four patients had liver metastases, five had lung metastases, and one had both, while one had lung and lymph node metastases, two had lymph node metastases and one had a local recurrence. The chemotherapy consisted of CPT-11 100 mg/m(2) div, as a 150-minute infusion, simultaneously l-LV 10 mg/m(2) div, as a 30-minute infusion, followed by 5-FU 500 mg/m(2) iv, as a bolus injection. This treatment was administered weekly for 2 weeks followed by a 2-week rest period and repeated every 4 weeks. All patients received this regimen as first-line chemotherapy. All patients were evaluated for efficacy 1 CR, 2 PR, 9 SD, and 2 PD. The overall response rate was 21.4% with a median time to progression of 8.1 months and a median survival time of 18.6 months. Grade 3 nausea, diarrhea and the suppression of white blood cells were seen in 3 patients, respectively. All other adverse reactions were mild (grade 1 or 2). Except for one patient,residual patients were able to receive the systemic chemotherapy on schedule. CPT-11/5-FU/l-LV combination chemotherapy appears to be effective first-line chemotherapy for advanced and metastatic colorectal cancer.

Tracheobronchial injury is a relatively rare but often fatal condition due to the injury from the neck to the chest. Different clinical features depend on the site of injury. We experienced 5 cases of tracheobronchial injury; cervical trachea in 2, thoracic trachea in 1, tracheal carina in 1, left main bronchus in 1. Three cases were caused by blunt trauma by traffic accident and 2 cases were due to penetrating injury (stab wound and gunshot wound). Thoracotomy with primary repair for 3 (simple repair, bronchoplasty, pneumonectomy) and cervicotomy for 2 (end-to-end anastomosis) were performed. One patient with severe associated injury died of multiple organ failure after surgery. Accurate diagnosis and the appropriate treatment in the early stage is essential in the treatment of tracheobronchial injury.

A 75-year-old male of adenocarcinoma in non-small cell lung cancer (NSCLC) was diagnosed to be p-staged IIIA by a preoperative mediastinoscopy. After the induction chemotherapy of cisplatin (80 mg/m2, day 1, 4 weeks, 2 cycles) plus docetaxel hydrate (60 mg/m2, day 1, 4 weeks, 2 cycles), we performed lobectomy and lymph nodes dissection. The postoperative pathological results showed no metastasis of the resected lymph nodes. The postoperative stage has been down to be pN0 IA from pN2 IIIA. After the adjuvant therapy of docetaxel hydrate (60 mg/m2, day 1, 4 weeks, 2 cycles), the postoperative serum carcinoembryonic antigen level has been normalized without a recurrence for more than 2 years. A pathological staging with a mediastinoscopic diagnosis for the suspected clinical IIIA-staged NSCLC should bring us a good assessment of the induction therapy.

A 68-year-old male was found an abnormal shadow on chest X-ray and was diagnosed as thymoma by computed tomography (CT)-guided needle biopsy. As the tumor invaded the aortic arch, left main pulmonary artery and the lung, thymectomy combined resection of the surrounding tissues was performed for the complete resection. The aortic arch was replaced with cardiovascular graft under cardiopulmonary bypass, with the aid of selective cerebral perfusion. The left pneumonectomy was performed because the tumor invaded to the left main pulmonary artery and to the lung parenchyma. Masaoka stage III and histologic type B2 were diagnosed according to the World Health Organization classification. The patient has been well without recurrence or metastasis after the surgery for 2 years. A complete resection of the thymoma invaded to great vessels should be performed to expect for the good curability and prognosis.

A small lesion showing ground-glass opacity (GGO) by preoperative computed tomography (CT) is sometimes difficult to detect after lobectomy when it locates in the central part of the lobe. In order to facilitate to identify the lesion for marking pathological specimen, we developed a new method using CT. After surgery, the resected pulmonary lobe was expanded with airflow through the bronchial stump and the target lesion was examined with CT. The laser beam of the CT on the surface of the lung is used as a guiding line for cutting. Through the application of this method for 2 clinical cases, it was found to be possible to exactly identify the GGO lesion from the surface of the resected lung enabling to visualize a fresh surface of the lesion like a CT image with minimal destruction of the structure.

Unlabelled: Pure red cell aplasia (PRCA) and myasthenia gravis (MG) are respectively combined with thymoma, however, these 3 complications are extremely rare coexisted as a clinical triad. A 73-year-old female with mediastinal tumor found in 2000 was pointed out anemia in June 2002. As PRCA was diagnosed by the bone marrow examination, blood transfusion had been performed. By a chest computed tomography (CT), a thymoma in size of 7 x 5 cm in diameter was recognized in the anterior mediastinum. The serum level of anti-acetylcholine receptor antibody was elevated to be 35 nmol/l. MG was simultaneously diagnosed with a decreased power of neck muscle. The extended thymectomy was performed in August 2002, and pathological diagnosis disclosed a 'type AB' by World Health Organization (WHO) classification. After the operation, the decreased power of neck muscle had been improved, however, PRCA had not been remitted in the early-postoperative term. Blood transfusion had been required (2-4 units/1-2 weeks) for the postoperative 7 months' term. A cyclosporin (250 mg/day) as an adjuvant therapy was administered in April 2003. One month later, the patient's serum level of Hb had been over 10 g/dl without blood transfusion. The patient has been followed up with reducing the dose of cyclosporin., Conclusions: Surgery for a thymoma combined with PRCA and MG was effective for MG but not for PRCA in an early-postoperative term, however, a multimodality therapy with immunosuppressant as a postoperative adjuvant should bring a favorable outcome to patient's clinical data, and the postoperative long-observation must be critical in this case.

The disclosed 5-year survival rate for lung cancer in the Internet website represents a various difference by each institution. The better inferiority of the survival has been listed in a table to compare with other institutions and has been reported in magazines and media with a lack of an enough inspection, i.e., with a sufficient considering of a risk adjustment such as patient's background, operative policy, postoperative adjuvant therapy, and statistical background. We report our outcome of the surgical treatment for primary lung cancer. Of 875 patients treated for lung cancer in our department for 23 years between January 1980 and December 2002, 115 patients containing of 42 cases in 1997 and of 48 ones in 1992 and of 25 ones in 1987 were selected and the accumulated survival analysis was treated by Kaplan-Meier method. Eighty males and 35 females were between 15 and 80-year-old (average 63.2 +/- 11.4). The pathological classification was adenocarcinoma (n=69), squamous cell carcinoma (n=32), and others (n=14). The operative procedures were pneumonectomy (n=14), bilobectomy (n=12), lobectomy (n=85), and wedge resection (n=4). The survival time was from 29 days to 182 months (median survival time was 1471+/- 1180 days, the averaged time was 49 months). The 5-year survival rate was 41.4 +/- 9.1% (n=25) in 1987, 35.6 +/- 6.2% (n=48) in 1992, and 56.0 +/- 7.0% (n=42) in 1987, respectively (log-rank test, p = 0.2555). The 10-year survival rate was 24.1 +/- 7.9% in 1987 and 8.5 +/- 3.6% in 1992, respectively. The 5-year survival rate was as follows: IA 81.0 +/- 8.6% (n=20), IB 73.7 +/- 10.1% (n=19), IIA 57.1 +/- 18.7% (n=7), IIB 55.6 +/- 16.6% (n=9), IIIA 28.6 +/- 7.6% (n=35), IIIB 15.4 +/- 10.0% (n=13), IV 16.7 +/- 10.8% (n=12), respectively. The 5-year survival rate was as follows: male 42.8 +/- 5.3% (n=80), female 63.2 +/- 7.3% (n=35), respectively (p = 0.0147). In regard to the histological classification, the 5-year survival rate was as follows: adenocarcinoma 47.2 +/- 5.9% (n=69), squamous cell carcinoma 50.8 +/- 8.9% (n=32), respectively (p = 0.9012). As a rule of the disclosure on the internet website, we report our survival data by accompanying with minimum parameters such as, patient's background, pathological types, gender, pathological stages, and mean survival rate with standard error. When we compare the 5-year survival rate with other institutes, in considering of a risk adjustment, we would carefully have to estimate the determined survival rate with a standard error.

Type I neurofibromatosis (NF-I), also referred to as von Recklinghausen's disease, is an autosomal dominant disease characterized by neurofibromas and abnormal cutaneous pigmentation (café-au-lait spot). We studied retrospectively the 8 cases operated in our hospital between January 1979 to December 2002, which were complicated with von Recklinghausen's disease and a thoracic surgical disease. The patients were 6 males and 2 females and the age from 16 to 70 (the averaged age was 36 +/- 22). The thoracic diseases were consist of mediastinal tumors (n = 7) and esophageal cancer (n = 1). The operative procedures were tumorectomy (n = 6), subtotal esophagectomy (n = 1), and pericardial cystectomy (n = 1). The mediastinal tumors were neurofibroma (n = 3), malignant schawannoma (n = 1), ganglioneurinoma (n = 2), and pericardial cyst (n = 1). Malignant neoplasms were recognized in 2 cases (25%). The postoperative survival was 10 months for malignant schwannoma, and 8 months for esophageal cancer, and the others were alive. For 1 case of neurofibromas, there was observed to be the reoperated one after the postoperative recurrence. von Recklinghausen's disease are apt to be complicated with thoracic surgical neoplasms, it should be required a careful and systemic exploration especially for malignant neoplasms.

Unlabelled: In Japan, relatively little attention has been paid to atypical depression, which is defined as the presence of mood reactivity and two of four associated features: hyperphagia, hypersomnia, leaden paralysis, rejection sensitivity. The present study was undertaken to obtain detailed clinical information from patients with a diagnosis of atypical depression. We assessed clinical characteristics of each atypical feature, comorbidity of other psychiatric disorders, presence of a stressful life event, and underlying psychological stress in 39 psychiatric outpatients. We also examined the relationship of interpersonal sensitivity to each atypical feature., Results and Discussion: Mean age of onset was 22 +/- 6, 74% were female, 20 patients (51%) had comorbid social phobia. Thirty (77%) had hyperphagia and 25 of these were women. Twenty (74%) had hypersomnia. Only seven patients reported daytime sleepiness and others (13) reported difficulty in staying awake due to lack of energy. Nineteen (49%) had leaden paralysis. Thirty-two patients (82%) had rejection sensitivity and this symptom correlated with scores of FNE (fears of negative evaluation), LSAS (Liebowits social anxiety scale) and Brief social phobia scale (BSPA). Seven patients reported disappointment in love as a stressful life event preceding the depressive episode. In patients with comorbid social phobia, loss of confidence due to hypersensitivity to rejection or criticism seemed to be the most important factor as a chronic psychologica stress. Seven patients met criteria for bipolar disorder and five out of seven had comorbid generalized social phobia. The clinical and theoretical implications of these findings were discussed.

Mucormycosis is an extremely rare case of pulmonary mycosis, its prognosis is very poor, and known as an opportunistic infection among immunocompromised hosts accompanied with other primary chronic disease. We report here a case of bilateral lower lobectomies carried out by two-stage operation for pulmonary mucormycosis combined with diabetes mellitus (type I) and severe resistance to an antimycobiotics under biblicographical considerations. A 36-year-old female was diagnosed as a diabetes mellitus (type I), and has been administrated with an insulin injection in 1989 at the age of 22-year-old. The patient was suffered a dry cough in June and the bilateral abnormal shadows were pointed out by the chest X-ray film in November, 2002. By transbronchial lung biopsy, Mucor fungus was confirmed in grannulomatous lung specimen. Intravenous injection of amphotericin B could not be continued due to the unavoidable side-effects from this agent. As the lung mass shadow was enlarged increasing and strongly suggested an abscess, formation in its focus, and then the left lower lobectomy was performed as the first step of surgical treatment and the right lower lobectomy was done on the postoperative forty-fourth day as the second step. The postoperative prognosis was considerably uneventful. After bilateral lower lobectomies, the patient could try a walk and go upstairs with a moderate dyspnea. A possible surgical resection should be conducted for the pulmonary mucormycosis, when the medicinal therapy showed an uneffectiveness and/or an infectious lesion was shown as restricted lesion.

Unlabelled: We report a case of thymothymectomy for the thymoma with pure red cell aplasia (PRCA). A 31-year-old male with a general fatigue had a severe anemia (hemoglobin 3.1 g/dl) since November 1997. By the bone marrow examination, PRCA was diagnosed and treated with blood transfusion and immunosuppressive drug (cyclosporin: CYA) administration but anemia had not been improved. The chest computed tomography displayed a 3 cm in a diameter of thymoma located in the anterior mediastinum. The extended thymothymectomy had been performed in February 1998, pathological detection disclosed Masaoka classification stage I, type AB was diagnosed due to the World Health Organization (WHO) classification. PRCA had not obtained an immediate remission during the postoperative-early term, while, adjuvant therapy (CYA 300 mg/day) has been continued and it brought a complete remission of PRCA in August 2001 (after the postoperative 3 years and 6 months later)., Conclusions: Even though only thymothymectomy for thymoma with PRCA showed no effectiveness for the postoperative-early remission of PRCA, however, the combination of thymectomy and the postoperative adjuvant therapy (CYA) should bring a better outcome, and the continuous follow-up would be required for a long postoperative term.

Predictivity of mediastinal lymph nodes metastasis of 201Tl SPECT were examined before operation in 113 patients with non-small cell lung cancer (69 adenocarcinoma, 31 squamous cell carcinoma, 10 large cell carcinoma, 2 bronchiolo-alveolar carcinoma, 1 neuroendocrine cell carcinoma). Patients were classified into two groups, with or without lymph nodes metastasis according to the pathological diagnosis. We calculated parameters of 201Tl SPECT early ratio, delayed ratio, retention index (RI) and maximal diameters. In addition, we calculated optimal cut-off value of RI to estimate the mediastinal lymph nodes metastasis. Mediastinal lymph nodes metastasis was confirmed pathologically in 62 patients. ER and DR did not show any statistical significance between two groups. Maximal diameters of primary tumor were also comparable between two groups. RI was significantly higher in mediastinal lymph node metastasis positive group compared to that in mediastinal lymph node metastasis negative group. The sensitivity (Sen), specificity (Spe), positive predictive value (PPV), negative predictive value (NPV) and accuracy (Acc) of 201Tl SPECT were 82.2%, 82.3%, 85.0%, 79.2% and 82.3%. These parameters were similar of higher than 72.6%, 82.4%, 83.3%, 71.2% and 77.0% of chest CT. The RI of 201Tl SPECT was useful tool for predicting lymph nodes metastasis in non-small cell lung cancer. The optimum cut-off value of RI in the prediction of mediastinal lymph nodes metastasis was 35%. We should take into account of upstaging in cases with higher RI (>35%).

It is difficult to determine what kind of appropriate operations should be applied for which phase of chronic empyema would be administered, especially for a surgical management. We report that the postoperative outcomes of the treatment should be recommended for chronic empyema with the aid of omental flap transposition. Seven cases of chronic empyema (the averaged age was 66.1 +/- 7.5, 6 males and 1 female) in our hospital were operated during from June 1993 to January 2001. The disease-carrying time was 3 to 16 months and the inflammation findings at the admission were positive in all cases. The cause of chronic empyema was pneumonia (n = 3), plombage for tuberculosis (n = 2), and postlobectomy empyema (n = 2). As the first-stage of treatment for empyema cavity, intrathoracic tube drainage and lavage were performed for all cases. The operative procedures were described as below; one-stage operation with both thoracostomy and omental flap transposition was performed after the first-stage treatment (n = 2), simple thoracostomy (n = 1), and two-stage operation with thoracotomy and omental flap transposition (n = 4). Three of the 4 cases with two-stage operation could be completely treated for 1 month interval. However, the rest one case had not been able to be radically cured, which empyema had been extensively turned for the worse for one month after the two-stage operation. Thoracostomy had been redone, and it took 8 months to be cured. All cases could be finally recovered and discharged. On the priority of treatment for chronic empyema, at first, both thoracic tube drainage and thoracostomy should be performed as a first-stage operation, and if they could not be effective, after the combined inflammation was settled down, then the omental flap transposition should be considered as a two-stage operation.

Viral isolation is the conventional method for influenza virus diagnosis but it is less useful for immediate patient management. RT-PCR is the sensitive and rapid assay for the detection of respiratory viruses. Single step and multiplex RT-PCR is able to detect several viruses simultaneously in a single reaction. Real time PCR(TaqMan method) is able to detect the amplicon directly by release of a fluorescent reporter of the probe during the amplification reactions. This procedure can save time since it eliminates post-PCR processing steps. These RT-PCR methods should be useful for the accurate and rapid diagnosis of influenza virus infection, especially severe cases such as pneumonia and encephalopathy.

Background: The measurement of infusion fluid temperature is important for patients' thermoregulatory management. However, we usually estimate the temperature by touching and feeling the surface of the infusion bag. Accordingly, there is increasing demand for more quantitative method to measure infusion fluid temperature., Methods: In the operating room we evaluated the accuracy and precision of the infrared thermometer (Genius) for the measurement of infusion fluid temperature compared with the thermistor., Results: The fluid temperature measured by Genius is accurate with sufficient precision compared with that measured by thermistor., Conclusions: The temperature measurement of infusion fluid by infrared thermometer is clinically helpful and useful for patients' safety.

We assessed the clinical features in twenty-three cases diagnosed as paragonimiasis westermani from April 1988 to May 2000 in our clinic at Miyazaki Medical College Hospital. Twenty-one patients had eaten wild boar or crab meat. Their symptoms included productive cough, chest pain and hemosputum. The findings of radiography and computed tomography (CT) were nodules, masses, infiltrative shadows and pleural effusion. The percentages of eosinophils in the peripheral blood were elevated in 16 of 23 patients, and the serum IgE values were elevated in 12 of 18 patients. Serologic tests, which are very helpful for diagnostic purposes were performed on the blood sera of all patients, and on the pleural effusions of five patients. It is often difficult to diagnose paragonimiasis westermani in patients in whom eosinophilia or increased serum IgE is not present. However, paragonimiasis westermani should also be considered as a possible diagnosis when abnormal shadows are found in chest radiographs and chest CT.

We compared the differential diagnostic capabilities of 201Tl-SPECT and biopsy methods and serum tumor marker in 125 patients with solitary pulmonary lesions composed of 87 lung cancer and 38 benign lesions. The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and accuracy of 201Tl-SPECT were 76%, 95%, 97%, 63%, and 82%, respectively. These parameters are similar in biopsy methods. Although sensitivity improved to be 85% by the combination with tumor marker methods, both specificity and accuracy deteriorated to be 55% and 76%. Using combination method with 201Tl-SPECT and biopsy, sensitivity, NPV and accuracy improved to be 84%, 70% and 85%. Based on its high PPV value, 201Tl-SPECT could be useful when biopsy method could not prove lung cancer or in case whose biopsy is considered to be invasive. Because of the lower NPV value owing to false negative cases in some adenocarcinoma, negative 201Tl-SPECT case should be followed up carefully.

The number of cases of visceral larva migrans caused by the pig ascarid, Ascaris suum has recently been increasing. We have encountered two cases of visceral larva migrans due to A. suum with a nodular shadow on the chest radiograph and eosinophilia in the peripheral blood. Patient 1 was a 26-year-old man who had been admitted to our hospital for an elective minor operation. His chest radiology and chest computed tomography revealed a nodule in the left lung field. Peripheral blood eosinophil counts and serum IgE values were elevated. Radiological abnormality disappeared without treatment. Patient 2 was a 57-year-old man who had been admitted to our hospital because of a migratory nodule on chest radiography and eosinophilia in the peripheral blood. The diagnosis of visceral larva migrans caused by A. suum was made because the serum of both patients was positive for an antibody against A. suum. Patient 1 and patient 2 were accustomed to eating the raw flesh of wild boar and deer, and of chicken and turkey, respectively. Treatment with albentazole was effective in these patients.

Unlabelled: During extracorporeal cardiopulmonary bypass (ECB), the activated coagulation and fibrinogenolysis system causes bleeding and postoperative multiple organ failures. We studied the effect of an anti-bleeding agent, nafamostat mesilate (NM) during the surgery of thoracic ascending aorta to decrease a side effect of bleeding. From March 1980 to January 1998, for thoracic ascending aorta operations in our department (true aneurysm, 16-, psudoaneurysm, 2-, and dissection, 11 cases, in 29 cases, respectively), age from 16 to 79 (mean 62.9 +/- 9.5 year of age), we classified the objects in two groups, NM group (intraoperative infusion with NM of 60 mg/hr and with heparin 300 IU/kg) and C group (only with heparin treated, 500 IU/kg). We investigated the preoperative factors (age and aneurysmal diameter), the intraoperative factors (ACT, hematcrit, platelet, aorta clamping time, operative time, ECB time, bleeding volume, and blood transfusion), and the postoperative factors (bleeding and blood transfusion) after the administration of NM., Results: There was no significance for the protection effect of NM infusion on the preoperative and the postoperative factors. However, intraoperative bleeding and blood transfusion volume in NM group were significantly lesser than those in group C., Conclusions: It might be useful for NM infusion during the surgery of thoracic ascending aorta due to the decrease of volume of intraoperative bleeding and blood transfusion amount with the remarkable anti-bleeding effect.

RT-PCR is the sensitive and rapid diagnostic method of influenza virus infection. Using appropriate primers, RT-PCR is capable of detecting and typing or subtyping of influenza A and B viruses simultaneously from a clinical specimen. Compared with virus culture in MDCK cells, Little or no increase has been observed in detection rate of influenza viruses in respiratory tract-derived specimens. The procedure is valuable, however, in dealing with specimens containing predominantly inactivated virus(as a result of prolonged storage) as well as those that may contain very few infectious viruses(e.g. cerebrospinal fluid and blood). Even in these cases, however, it is preferable that RT-PCR is made in combination with other traditional, diagnostic methods.

Metastatic tumors from variable organs are seen in pulmonary tissue because of its unique anatomical situation. In this article, current diagnosis and treatment for metastatic lung tumor are reviewed and discussed including recent topics. Control of metastatic lung tumor by chemotherapy and hormonal treatment has been improved. Furthermore, active applying of Video Assisted Thoracoscopic Surgery induces a change of surgical indication for metastatic lung tumor. Metastatic tumors express oncogene and tumor suppressor gene as well as primary lung cancer. However, the relationship between oncogene/tumor suppressor gene and lung metastatic phenomenon is still unclear. Molecular biological study may indicate new treatment strategy against metastatic pulmonary tumor. Prospective controlled studies for each type of primary tumor are needed to evaluate the true efficacy of pulmonary metastectomy.

Complications of infective aneurysm are not rare in patients with infective endocarditis. An optimal timing of heart operation after brain surgery for hemorrhage is controversial. We reported a 19-year-old woman with ventricular septal defect (type II), mitral regurgitation and ruptured cerebral aneurysm with infective endocarditis. Cerebral aneurysm had been ruptured during infective endocarditis treatment. Resection of the aneurysm was performed next day. Vessel spasm occurred, resulting in cerebral infarction 7 days after the operation. Conservative therapy was continued for infective endocarditis until heart failure appeared. Heart operation was successfully performed 41 days after brain surgery without cerebral complication. This report indicates that heart operation might be avoided at the early postoperative stage of brain surgery for cerebral aneurysm with hemorrhage.

Constant Denaturing Gel Electrophoresis (CDGE) was used as an analytical method of the genetic markers. Even a single base change in a fragment amplified by PCR was detected exactly by CDGE. The computational simulation of CDGE gave the calculation whether a single base change in a fragment amplified by PCR could be detected by CDGE or not. In this report, genotyping of three blood groups, MN, Duffy and Kidd, and Gc system is described. The regions reflecting allelic differences of each system were amplified from genomic DNAs. The concentration of denaturants (urea and formamide) in CDGE gels was decided with the computational simulation as follows: 15% for MN, 27% for Duffy, 24% for Kidd, 30% for Gc. CDGE was run in TBE buffer at 60 degrees C, 100 V constant voltage. PCR amplified fragments with 1-3 base changes were separated clearly in each gel. By staining the gels with ethidium bromide, the genotype of each system was determined. The genotyping of system by CDGE can avoid mistakes in the conventional method, which requires complicated and multiple troublesome operations. Analysis of PCR amplified fragments by CDGE will make a beneficial contribution to medico-legal practice.

Therapeutic efficacy and the treatment days for cure of imipenem/cilastatin sodium (IPM/CS) in treatment of pulmonary infections were prospectively determined in comparison with those of beta-lactams other than carbapenems mainly ceftazidime (CAZ) or sulbactam/cefoperazone (SBT/CPZ). The overall response rate was 84.9% (62/73) in the IPM/CS group and 74.7% (56/75) in the beta-lactam group, the difference not being significant. In the subjects having underlying respiratory diseases, the response rate was 91.1% (41/45) and 73.9% (34/46) in the IPM/CS and beta-lactam groups, respectively. In patients with infections secondary to chronic respiratory disease, the rate was 91.2% (31/34) in the former group and 66.7% (24/36) in the latter group, respectively. The differences were significant for both stratified analyses. The treatment days for cure judged by the attending physician were 12.9 +/- 0.6 days in the IPM/CS group, and 14.5 +/- 0.7 days in the beta-lactam group. The difference was not, however, significant. In patients with mild to moderate infections, the treatment days for cure was 12.0 +/- 0.6 days (n = 64) in the IPM/CS group and 14.3 +/- 0.7 days (n = 70) in the beta-lactam group. In patients with underlying respiratory disease, the treatment days for cure were 11.8 +/- 0.7 days (n = 45) and 14.7 +/- 0.9 days (n = 46) in the IPM/CS and beta-lactam groups, respectively. In patients with infections secondary to chronic respiratory disease, the days were 11.1 +/- 0.7 days (n = 34) and 14.7 +/- 1.1 days (n = 36), respectively. Thus, IPM/CS therapy significantly reduced the number of treatment days until cure. There was, however, no significant difference between the two therapy groups in treatment of the patients with severe infections, those without underlying respiratory disease, or those with pneumonia and/or lung abscess. The treatment days for cure were also assessed by the members of review committee taking into consideration of body temperature, leukocyte count, and C-reactive protein. As the result, it was 6.9 +/- 0.5 days in the IPM/ CS and 10.3 +/- 0.7 days in the beta-lactam groups; respectively, and the difference was significant. Time (days) until cure was also compared between the two groups using survival time analysis, confirming a more rapid response in the IPM/CS group. Although IPM/CS therapy was associated with a shorter response time as assessed by both the attending physicians and the review committee, there were considerable differences between the results of these judgements. Thus, the duration of treatment with injectable antibiotics requires reevaluation in the future. No significant differences were observed between the groups with respect to parameters indicating side effects and laboratory abnormalities. There were no severe symptoms or laboratory findings, and symptoms and changes in laboratory values, if any resolved during the course of therapy or after the withdrawal of treatment. In conclusion, IPM/CS seems to be very useful as first-line therapy for respiratory tract infections and for shortening the duration of treatment.

Various CNS side effects have been reported since interferon (IFN) was introduced for the treatment of chronic active hepatitis C (CAHC) patients. Most reports of EEG changes after IFN therapy were inspective, and there is no report of quantitative EEG analysis. In this study, changes in quantitative EEG and biogenic amines after IFN therapy were studied to enable identification of CNS side effects early in CAHC patients. Before and 7 days after IFN therapy, EEG records and plasma and urinary amines were examined in 36 CAHC patients (46.9 +/- 12.3 years, 29 men and 7 women) who were hospitalized for the IFN therapy. After IFN therapy, no notable change in biogenic amines was recognized. On EEG, 13 patients (39.4%) showed increased slow wave activities and 2 patients (6.1%) showed paroxysmal discharges after IFN therapy. On quantitative EEG, the patients showed significantly increased absolute power in slow alpha, theta and delta bands and decreased absolute power in fast beta band (paired-T test). After IFN therapy, 4 of 36 patients developed psychiatric disorders; 2 patients developed depressive symptoms and 2 other patients developed manic states. One depressive patient and one manic patient had 6 Hz spike and slow waves before IFN therapy. On quantitative EEG, the other manic patient had shown significantly increased absolute power in slow alpha and decreased power in fast alpha and beta bands, and the other depressive patient had shown significantly increased absolute power in fast theta band and decreased power in fast beta band before the development of the psychiatric disorders. These results suggest that the changes of quantitative EEG, between before and 7 days after IFN therapy, can be useful in assessing the risk for the development of psychiatric symptoms induced by IFN therapy. It also suggests that patients with slight EEG abnormality such as a 6 Hz spike and slow waves before IFN therapy need careful observation.