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患児は9歳，男児．上気道炎で近医経過観察中，39度台の発熱が遷延し，左側胸水貯留を認めるようになり紹介された．多房性の膿胸を呈しており胸腔ドレーンを留置したが症状の改善は得られず，小開胸を用いた胸腔鏡補助下胸腔内掻爬ドレナージ術を施行した．胸腔内は胸膜の癒着が著しく，癒着の間に多房性の胸水が少量づつ貯留していた．肺は胼胝で覆われ拡張できなくなっていた．鈍的に癒着を剥離したのち，可及的に胼胝を切除した．胸腔内を充分洗浄しドレーンを留置した．小児においては，膿胸の進行が急速であること，体格上，充分な太さの胸腔ドレーンを留置できないことから，早期にドレナージ不良となることが予想され，ドレナージが効かなくなった段階ですみやかに手術療法を考慮すべきである．手術においては，小開胸を用いた，胸腔鏡補助下胸腔内掻爬ドレナージ術が有用であった．

A natural product, resveratrol (3,4,40-trihydroxy-trans-stilbene), a phytoalexin found in grapes and other food products, is known as a cancer chemopreventive agent. We studied the in vitro biological activity of this compound by examining its effect on proliferation and differentiation in myeloid leukemia cell lines (HL-60, NB4, U937,THP-1, ML-1, Kasumi-1) and fresh samples from 17 patients with acute myeloid leukemia. Resveratrol (20 microM, 4 days) alone inhibited the growth in liquid culture of each of the 6 cell lines. Resveratrol (10 microM) enhanced the expression of adhesion molecules (CD11a, CD11b, CD18, CD54) in each of the cell lines except for Kasumi-1. Moreover, resveratrol (25 microM, 4 days) induced 37% of U937 cells to produce superoxide as measured by the ability to reduce nitroblue tetrazolium (NBT). The combination of resveratrol (10 microM) and all-trans-retinoic acid (ATRA) (50 nM, 4 days) induced 95% of the NB4 cells to become NBT-positive, whereas1% and 12% of the cells became positive for NBT after a similar exposure to either resveratrol or ATRA alone, respectively. In U937 cells exposed to resveratrol (25 microM, 3 days), the binding activity of nuclear factor-kappaB (NFkappaB) protein was suppressed. Eight of 19 samples of fresh acute leukemia cells reduced NBT after exposure to resveratrol (20 microM, 4 days). Taken together, these findings show that resveratrol inhibits proliferation and induces differentiation of myeloid leukemia cells.

We report a case of perforated Meckel's diverticulum with aseptic peritonitis in a 17-day-old neonate. The baby had been brought to the hospital with fever and abdominal distention. Abdominal computed tomography showed a 5-cm abscess in the lower abdomen, and emergency laparotomy was performed for suspected perforated appendicitis. However, we found a perforated Meckel's diverticulum. No bacteria were detected in the purulent ascites from the peritoneal cavity. We speculate that the narrow lumen between the small intestine and the diverticulum, accompanied by poor self-emptying had caused acute inflammation resulting in perforation of Meckel's diverticulum. The anatomic limitations in "walling off" the perforated Meckel's diverticulum by the surrounding loops of small intestine prevented the bowel contents from spreading within the peritoneal cavity.

Large abdominal wall defects may require a prosthesis for closure. The aim of our study was to identify the best material for abdominoplasty in pediatric patients. One hundred twenty-eight Wistar KY strain male rats (3 weeks old) were used. All animals underwent celiotomy via a midline skin incision. They were divided into seven groups as follows: the animals in groups 1 through 6 underwent full-thickness abdominal wall excision 3 cm in diameter. The animals in group 1 underwent primary closure. In groups 2 through 6 the defect was closed with prosthetic material. In Group 7, a sham operation was performed. Daily weights were measured. The animals were killed after 3 and 9 weeks. Adhesion scores were assigned for each group. Vicryl mesh resulted in the fewest adhesions and had no effect on weight gain in the developing rats.

A 62-year-old man was admitted to the hospital because of a lump in the neck. After admission, cervical CT, ultrasonography, scintiscan and blood examination revealed an adenoma of the right lobe of the thyroid with slight hyperthyroidism. At operation, we found two tumors and no connection was found between the tumors and the thyroid gland. Only tumor extirpation was performed. The gross pathological specimens were 50×40 mm and 25×27 mm in size. Histological findings revealed the adenomatous goiters of the two accessory thyroid glands. After the operation thyiroid function tests were within normal limits. So-called ectopic thyroid glands are classified into two groups whether the thyroid gland is in the right place or not. This case is very rare and is worth for reporting. We think that ectopic thyroid gland with normal thyroid gland should be called accessory thyroid gland.

This study was designed to evaluate the efficacy of human growth hormone (GH) in improving the tensile strength of wounds weakened by chronic protein malnourishment and corticosteroid (CS) administration. Eighty-six female Sprague-Dawley rats, weighing 80 to 100 g, were divided into five groups. Group 1 (control) received 23.4% protein chow for 8 weeks before surgery. Groups 2, 3, 4, and 5 received nonprotein chow on alternate days for the same duration. Groups 3 and 5 received prednisolone (2 mg/kg/d intramuscularly) for 3 weeks preoperatively and for 5 days postoperatively. Groups 4 and 5 were given GH (somatotropin, 1 IU/d) for 5 days postoperatively. All the animals underwent a precise 4-cm midline celiotomy. Wound testing was performed on the sixth postoperative day, after removal of the sutures. The bursting strength (BS, mean +/- SD) for group 1 was 145 +/- 16 mm Hg. The BS for groups 4 (137 +/- 13 mm Hg) and 5 (134 +/- 7 mm Hg) were significantly stronger than those for groups 2 (115 +/- 15 mm Hg) and 3 (91 +/- 16 mm Hg). The authors conclude that postoperative systemic GH restored the wound BS in protein-malnourished animals treated with CS, to the level of the normally nourished controls.

The colon is the very rare site of metastasis of breast cancer. We emphasize that the intestine should be considered as a possible metastatic lesion of the advanced breast cancer from our experience. A 56-year-old women underwent a standard radical mastectomy for a right breast tumor on July 1990. Pathological diagnosis was infiltrating ductal breast cancer: T1n1 b m0-stage II. The patient was treated with 51 Gy local radiotherapy and chemoendocrinotherapy after surgery as an outpatient. Around February 1991, a tumor marker started to increase. Careful examination could not detect any evidence of recurrence of the breast cancer. However, multiple enlargment of para-aortic lymphnodes was found by CT, and a colon cancer was suspected by barium enema in January 1992. Right hemicolectomy was performed. Histologically, it was found that the breast cancer metastasized to the ascending colon.

Although autologous tandem hematopoietic SCT has improved the prognosis of patients with advanced high-risk neuroblastoma, the results remain unsatisfactory. In an attempt to induce the graft-versus-tumor effect, we performed autologous PBSCT followed by allogeneic cord blood transplantation in three consecutive advanced neuroblastoma cases with marked BM infiltration and high MYCN amplification. Severe acute complications did not occur in any patient and they have maintained disease-free survival for 37-60 months. This strategy appears to be feasible and effective for the treatment of extremely high-risk neuroblastoma cases.

Tamoxifen, an anti-estrogen, has been used for a long time as an adjuvant therapy in cases of estrogen receptor positive breast cancer. Tamoxifen also demonstrates some weak estrogenic activity. A small increase in serum triglycerides is commonly found after tamoxifen administration. Herein we report 3 cases of sever hypertriglyceridemia due to tamoxifen. Case 1 recovered with tamoxifen withdrawal. Tamoxifen was replaced with toremifene in case 2. The level of triglyceride decreased significantly after the change of agent. Tamoxifen was discontinued and anastrozole administration was started in the third patient. Her triglyceride levels improved. Tamoxifen-induced severe hypertriglyceridemia seen in these patients was an effect of its estrogen action. Anastrozole has been used to treat postmenopausal metastatic breast cancer, and several clinical trials in the adjuvant setting are ongoing. Anastrozole does not affect lipid metabolism. Therefore, anstrozole might be safe for patiens with abnormal triglyceride profiles during tamoxifen treatment. We recommended that a periodic serum triglyceride check is needed for patients treated with tamoxifen.

Chemotherapy is an important part of adjuvant therapy for younger patients with breast cancer, but prevention of ovarian dysfunction due to chemotherapy is important. There are some reports that pretreatment with LHRH analogue can preserve ovarian function. The present patient, who was treated in this way, delivered twins 6 years after surgery. A 33-year-old woman underwent breast conserving surgery for 1 cm carcinoma in the left A region, and pathologic findings were papillotubular carcinoma. t2n1 alpha (2/18) ER (+) PgR (+). LHRH analogue was administrated together with radiation therapy for the preserved breast. Six subsequent courses of CEF therapy were given, and then LHRH analogue was administered for 2 years and tamoxifen for 2 years and six months. Menstruation was recovered 6 months later and twins were delivered 3 years after the last administration of hormone therapy. This case should be referred in the treatment of young patients.