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A woman in her 70s visited our hospital to undergo endoscopy. Esophagogastroduodenoscopy showed a white submucosal tumor-like lesion in the upper esophagus. Analysis of a biopsy specimen revealed that the tumor was a basaloid squamous cell carcinoma. A superficial squamous cell carcinoma was also revealed near the basaloid squamous cell carcinoma before endoscopic submucosal dissection. Curative en bloc resection was successfully performed. Histopathological examination revealed that the basaloid and superficial squamous cell carcinomas had invaded the lamina propria (pT1a-LPM) and epithelium (pT1a-EP), respectively. In addition, the basaloid squamous cell carcinoma had two different components in terms of malignancy and differentiation. Here we report a rare case of esophageal basaloid squamous cell carcinoma resected by endoscopic submucosal dissection.

Phenylbenzoimidazol sulfonic acid (PBS) is a kind of sunscreens in cosmetics and is nominated as the restricted ingredients in cosmetics in Japanese Pharmaceutical Affairs Act. So the analytical method for PBS was investigated by HPLC. 1.0 g of the lotions with 1.0% PBS was exactly weighed, put into a 50-mL volumetric flask. Water was added to make exactly 50 mL and this mixture was used as the sample solution. On the other hand, 1.0 g of the creams with 1.0% PBS was exactly weighed, put into a beaker. After adding 1 mL of tetrahydrofuran and dissolving the cream, that mixture was transferred to a 50-mL volumetric flask. And then the beaker was rinsed with 1 mL of tetrahydrofuran and the rinsed solution was put together into the volumetric flask. After adding water to the volumetric flask to make exactly 50 mL, this mixture was used as the sample solution. If necessary, the mixture was filtrated with a membrane filter (0.45 microm). 5.0 mL of the sample solution was pipetted and put into a 200-mL volumetric flask. After adding water to make exactly 200 mL, 20 microL of this solution was analyzed by HPLC using the ODS column (CAPCELL PAK C18 column, 4.6 mm i.d. x 250 mm), the mixture of 40 mmol/L acetic buffer (pH 3.4) and acetonitrile (3:1) with 0.8 mmol/L dodecyltrimethyl ammonium bromide and the detection wavelength of 305 nm. The working curve from 0.5 to 20.0 microg/mL showed a linear line between the concentrations of PBS and the peak areas. There was no interference of peak of PBS from the lotion and cream.

Sodium benzoate is a kind of preservatives in cosmetics and is nominated as the restricted ingredients in cosmetics in Japanese Pharmaceutical Affairs Act. So the analytical method for sodium benzoate was investigated by HPLC. After adding 5 ml of tetrahydrofuran to 0.05 g of the lotions or creams with 0.1 or 1.0% sodium benzoate and dissolving them, that mixture was made up to 50 ml with methanol. If necessary, the mixture was filtrated with a membrane filter (0.45 microm). The testing solution of 20 micro1 was analyzed by HPLC using the ODS column (CAPCELL PAK C18 column, 4.6 x 250 mm), the mixture of 50 mmol/l phosphate buffer (pH5.5) and acetonitrile (7:3) and the detection wavelength of 227 nm. The working curve from 1.0 to 12.0 microg/ml showed a linear line between the concentrations of sodium benzoate and the peak area. There was no interference of peak of sodium benzoate from the lotion and cream.

A 48-year-old male patient was admitted to our institution with left hypochondralgia. Preoperative serum CEA was 504 ng/ml. Under a radiological diagnosis of simultaneous double cancer of the pancreas and lung, resection was performed. Pathological study revealed primary pancreatic cancer with lung metastasis. After the operation, serum CEA fell to 55 ng/ml. Seventeen months later, bowel obstruction occurred and serum CEA was 140 ng/ml. One course of systemic chemotherapy, using the combination of CDDP, 5-FU and Leucovorin, was successful. After another three months, however, the same clinical symptoms occurred. With no response to the prior chemotherapy regimen, surgery was undertaken and a mass at the mesentery was removed. Fifty-nine months have passed since the initial operation and the patient is free of disease, though his serum CEA is around 50 ng/ml. In conclusion, there are cases of pancreatic cancer in which tumor dormancy can be achieved by postoperative 5-FU based chemotherapy.

2-(2'-hydroxy-5'-methylphenyl)-benzotriazole (HMB) is nominated as the restricted ingredients in cosmetics in Japanese Pharmaceutical Affairs Act. So the analytical method for HMB was investigated by HPLC. After dissolving HMB in cream or oil with tetrahydrofuran and making the constant volume with methanol, the test solution was prepared. Twenty micro-liter of the test solution was determined by HPLC by using CAPCELL PAK C18 column, the mixture of methanol and water (17:3) as mobile phase, the detection wavelength at 306 nm. The concentrations of 10 to 80 micrograms/ml HMB gave the linear relationship between the concentrations and the peak areas. In creams and oil 0.1% and 1% HMB were sufficiently determined by the established method.

Between 1980 and 1995, 10 patients underwent thoracotomy for pulmonary aspergillosis. In six patients, hemoptysis and bloody sputum were the chief complaints. The other complaints were nonspecific. Six patients had a history of pulmonary tuberculosis, and two of those patients underwent upper lobectomy. Aspergillosis had developed in the residual space. A fungus ball was observed on the preoperative chest X-ray and CT scan films in seven patients. Lobectomy was done in three patients, segmentectomy in two, and partial pulmonary resection in four. The patients with lesions that had grown in the residual space underwent curettage with muscle plombage. Three patients underwent thoracoplasty. An additional operation was done in two patients because of poor residual lung expansion. No patient had recurrence. We conclude that surgical treatment should be based on symptoms and on pathological findings.

Traumatic diaphragmatic hernia requires urgent surgical treatment. A 51-year-old female was injured in a speeding car. She had dyspnea, and resistance on the abdominal wall on physical examination. Intra-thoracic and abdominal visceral injury was suspected. A chest roentogenogram and CT scan revealed an obvious diaphragmatic herniation on the left which necessitated emergency operation. On the right semi-lateral position, left thoracoabdominal spiral incision was made through the 7th intercostal space. Good exposure of the chest and abdomen was easily obtained. Herniated organs and the abdominal cavity were thoroughly examined with ease. The diaphragm was repaired directly. She had an uneventful postoperative recovery, and was discharged in 17 days. Thoracoabdominal spiral incision offered an excellent operative exposure for the patient with a possible combined thoracic and abdominal visceral injury.

Expression of major histocompatibility complex of lung cancer was examined to study the malignant potential of the tumor using immunochemical staining (anti-HLA class I monoclonal antibody; w6/32). Nuclear DNA contents and the labeling index of proliferating cell nuclear antigen (PCNA) were measured as well. Forty three advanced (p-stage IIIa) lung cancers resected by lobectomy (33 cases), pneumonectomy (9 cases), and segmentectomy (1 case) entered the study. Mediastinal lymph node dissection was performed in every case during the operation. Of the 43 cases, expression of HLA class I was positive in 17 and negative in 26. The patients with positive HLA expression showed significantly better prognosis than those with negative HLA expression in terms of 5 year survival (p < 0.01). The patients with aneuploid pattern and positive HLA class I expression had the best prognosis on the survival curve (p < 0.01). When the PCNA positive rate was high, the prognosis was poor. And the patients with negative PCNA and positive HLA class I expression had significantly better prognosis than the others (p < 0.01). These findings suggest that the expression of HLA class I on the tumor cells is an important prognostic factor in the patients with NSCLC.

Four patients underwent resection of mediastinal malignant tumors with invasion to the superior vena cava. Two patients had invasive thymoma, one seminoma, and one metastatic mediastinal lymph nodes of unknown origin. Prior to resection of the tumor, an ePTFE graft was anastomosed between the innominate vein and the right atrium to maintain the venous drainage from the brain and the upper extremities. In two patients, the superior vena cava was reconstructed by patch angioplasty after the tumor with a part of the vena cava was safely resected. One patient died of acute respiratory failure, but the other three are alive and well without any evidence of graft obstruction. This safe and useful method in order to prevent cerebral congestion during and after resection of the tumor.

Hepatic cells receive dual blood supply of the arterial and portal systems, but hepatoma has been thought to be supplied completely by hepatic artery. However, transcatheter hepatic artery embolization (TAE) has not been able to damage hepatoma entirely. For the study on the relationship between hepatoma and portal vein, I gave intraportal infusions of bromodeoxyuridine. (BrdU), an analogue of thymidine, to 10 patients with hepatoma at the time of surgery, and counted BrdU-positive nuclei immunohistochemically using the anti-BrdU monoclonal antibody. The labeling index, or percentage of BrdU-labelled cells, was 2.0 +/- 1.1% (mean +/- SD) in the cases without TAE and 11.9 +/- 4.2% in the other after TAE. On the other hand, examining the specimens with Microfil injected into the portal branch showed the distribution of portal branches in the hepatoma by radiograph or microscope. It is concluded that hepatoma does not receive arterial blood supply alone but the portal vein participates in vascular distribution of hepatoma, and the participation gets larger after TAE. It is suggested that this finding could be of great importance in planing treatment of patients with hepatoma.

A clinical investigation was made on the concurrent use of amikacin (AMK) and cefoxitin (CFX) against complicated infections with hematological disorders. The results obtained were summarized as follows: Eleven patients were treated with AMK and CFX. Clinical responses were excellent in 2 (18%), good in 4 (36%), fair in 1 (9%), and poor in 4 (36%), with an efficacy rate of 64%. No significant side effects requiring cessation of the treatment were observed.