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Development of a tracheoesophageal fistula (TEF) is a serious complication of treatment for esophageal or lung cancer, especially following radiation therapy. However, development of a TEF as a complication of chemotherapy or tracheal stenting after surgical debulking is quite uncommon. We herein report a rare case involving a patient with advanced adenocarcinoma invading the mediastinum who rapidly developed a TEF after placement of a tracheal stent and administration of nivolumab immunotherapy. A 55-year-old heavy ex-smoker was diagnosed with lung adenocarcinoma with mediastinal invasion. Nine months after first-line therapy (chemotherapy and radiation therapy), he underwent treatment with nivolumab (3 mg/kg) as fourth-line therapy. Two weeks after the first dose, he underwent mechanical debulking of the tumor with tracheal stenting because of the rapid development of paraesophageal lymph node swelling and severe tracheal stenosis. He received a second dose of nivolumab 2 weeks later; however, imaging studies 12 days after this second dose revealed a huge fistula between the upper trachea and esophagus through a metastatic lymph node. Neither an additional stent nor replacement of the stent was considered because of the fistula site expansion and suffocation risk. Despite further treatment, the patient died of his primary disease 2 months later. Our findings will be of great interest to the readers, especially those involved in the clinical treatment of patients with advanced lung cancer treated by immunotherapy. The knowledge of potentially devastating TEF formation in the presence of transmural tracheal metastasis/invasion will allow clinicians to provide the best possible care for their patients.

Background: Long-term patency is required during treatment for benign airway stenosis. This study investigated the effectiveness of surgical airway plasty for benign airway stenosis. Methods: Clinical courses of 20 patients, who were treated with surgical plasty for their benign airway stenosis, were retrospectively investigated. Results: Causes of stenosis were tracheobronchial tuberculosis in 12 patients, post-intubation stenosis in five patients, malacia in two patients, and others in one patient. 28 interventional pulmonology procedures and 20 surgical plasty were performed. Five patients with post-intubation stenosis and four patients with tuberculous stenosis were treated with tracheoplasty. Eight patients with tuberculous stenosis were treated with bronchoplasty, and two patients with malacia were treated with stabilization of the membranous portion. Anastomotic stenosis was observed in four patients, and one to four additional treatments were required. Performance status, Hugh–Jones classification, and ventilatory functions were improved after surgical plasty. Outcomes were fair in patients with tuberculous stenosis and malacia. However, efficacy of surgical plasty for post-intubation stenosis was not observed. Conclusion: Surgical airway plasty may be an acceptable treatment for tuberculous stenosis. Patients with malacia recover well after surgical plasty. There may be untreated patients with malacia who have the potential to benefit from surgical plasty.

Surgical reconstruction is commonly recommended for the treatment of tuberculous airway stenosis. The clinical conditions underlying tuberculous airway stenosis often involve both cicatricial stenosis and malacia. Surgical reconstruction alone may not improve the respiratory symptoms of patients with both types of airway stenosis. This study retrospectively reviewed patients who underwent surgical reconstruction for tuberculous airway stenosis to investigate the most appropriate treatment for this complicated condition.Twelve patients with tuberculous airway stenosis underwent surgical reconstruction at our institute from January 2003 to December 2013. The clinical courses of these patients were retrospectively reviewed.The 12 patients were 2 men and 10 women with a mean age of 36 years (range 17-61 years). The site of stenosis was the left main bronchus in six patients, trachea in four patients, and right main bronchus in two patients. The procedure performed was sleeve lobectomy in five patients, bronchial resection in four patients, and tracheal resection in three patients. Additional airway stenting was performed in two patients with concomitant malacia of the lower trachea. The performance status and Hugh-Jones classification improved postoperatively in all patients. The forced expiratory volume in 1 s as a percent of forced vital capacity and percent of forced expiratory volume in 1 s improved significantly.Surgical reconstruction is an acceptable treatment for tuberculous airway stenosis. Additional airway stenting may be needed in patients with symptomatic malacia.

Purpose Malignant airway stenosis extending from the bronchial bifurcation to the lower lobar orifice was treated with airway stenting. We herein examine the effectiveness of airway stenting for extensive malignant airway stenosis. Methods Twelve patients with extensive malignant airway stenosis underwent placement of a silicone Dumon Y stent (Novatech, La Ciotat, France) at the tracheal bifurcation and a metallic Spiral Z-stent (Medico's Hirata, Osaka, Japan) at either distal side of the Y stent. We retrospectively analyzed the therapeutic efficacy of the sequential placement of these silicone and metallic stents in these 12 patients. Results The primary disease was lung cancer in eight patients, breast cancer in two patients, tracheal cancer in one patient, and thyroid cancer in one patient. The median survival period after airway stent placement was 46 days. The Hugh-Jones classification and performance status improved in nine patients after airway stenting. One patient had prolonged hemoptysis and died of respiratory tract hemorrhage 15 days after the treatment. Conclusion Because the initial disease was advanced and aggressive, the prognosis after sequential airway stent placement was significantly poor. However, because respiratory distress decreased after the treatment in most patients, this treatment may be acceptable for selected patients with extensive malignant airway stenosis.

Acute exacerbation of interstitial pneumonia (AEIP) is a leading cause of death after lung cancer resection in patients with interstitial lung disease. We retrospectively analyzed 1763 patients with non-small cell lung cancer with a clinical diagnosis of interstitial lung disease (ILD) who underwent lung cancer resection between 2000 and 2009 at 61 hospitals in Japan. AEIP occurred in 164 of 1763 (9.3%) patients with a mortality rate of 43.9% (72/164). Univariate and multivariate analyses were carried out to identify possible risk factors of fatal AEIP. We then analyzed the 164 patients who developed postoperative AEIP and identified the preoperative and postoperative risk factors. A multivariate regression analysis identified that the sex, percent vital capacity, neoadjuvant radiation, preoperative history of AEIP, preoperative use of steroids, usual interstitial pneumonia pattern on CT, and surgical procedures were independent preoperative risk factors for death due to AEIP. ILD patients with emphysema somehow showed a lower risk of fatal AEIP than those without emphysema in this study. This study revealed eight risk factors for fatal AEIP.

Pulmonary and left atrial resection is not yet an established treatment for patients with primary lung cancer involving the left atrium. We investigated the clinical course of patients with primary lung cancer involving the left atrium who were treated with pulmonary resection and partial atrial resection. From January 1996 to December 2013, 51 patients underwent extended resection for lung cancer that invaded the surrounding organs. Of these, we focused on 12 patients who underwent surgical treatment for lung cancer involving the left atrium. The clinical course of each of these patients was investigated retrospectively. The most common histological subtype was squamous cell carcinoma. Pneumonectomy was performed in nine patients, and right middle and lower lobectomy was performed in three patients. Complete resection was performed in 11 patients (92 %). Postoperative complications were observed in four patients (33 %)—prolonged air leakage in two patients, broncho-pleural fistula in one patient, and empyema in one patient. There were no surgical deaths. This study involved seven patients with pathological N0–1 disease and five patients with pathological N2 disease. The postoperative 5-year survival rate was 46 % in all patients. The 5-year survival rates in patients with pathological N0–1 disease and N2 disease were 67 and 20 %, respectively. Because treatment-related death was not observed and outcome was fair in patients with N0–1 disease, surgical resection for primary lung cancer involving the left atrium may be acceptable in selected patients. Further investigations are required to improve the outcome of surgical treatment for patients with primary lung cancer involving the left atrium.

症例は62歳女性．右乳癌術前精査中に胸部CTにて左S1＋2に28×26mm大の腫瘤陰影を認めた．気管支鏡検査を施行したところ左B1＋2と考えられる気管支が左主気管支より直接分岐する分岐異常を認め，同気管支より生検を施行し腺癌と診断した．左原発性肺癌（cT1bN0M0）と診断し左上葉切除，リンパ節郭清を施行した．術中，肺動脈の背側を左上葉に進入する索状物を認めた．上下葉間は不全分葉で上区とS6間を形成する際に前述の索状物を肺組織とともに自動縫合器にて切離したところ，索状物が左B1＋2であったことが判明した．左B1＋2が左主気管支から直接分岐し肺動脈の背側を走行する解剖学的特徴が認められた．気管支分岐異常の頻度は0.4～0.6％であり，左B1＋2分岐異常の発生頻度は全気管支分岐異常の0.02～0.2％と稀である．左B1＋2分岐異常では気管支が肺動脈の背側を走行する場合があることを念頭に置く必要がある．

The purpose of this study was to investigate the clinical characteristics of chronic hemodialysis (HD) patients with lung cancer who underwent pulmonary resection at the authors' hospital. Subjects were 24 chronic HD patients (1.1%) from among 2178 patients who underwent pulmonary resection for lung cancer at our hospital between December 1994 and March 2009. Subjects included 20 males (83.3%), and mean age was 65.9 years. Twenty-two patients underwent lobectomy, one underwent a wedge resection and one underwent a segmentectomy. Histological diagnoses included squamous cell carcinoma in 12 patients, adenocarcinoma in nine, small cell carcinoma in two and adenosquamous carcinoma in one. The distribution of pathological staging was IA in nine cases, IB in five, IIB in five, IIIA in three, and IIIB in two. There was no operative mortality, and the overall morbidity rate was 58.3%. Disease-free interval was six to 102 months with a median of 54 months, and the five-year survival rate was 43.0%. Cases of pulmonary resection for lung cancer in chronic HD patients were investigated. There were no operative deaths or deaths in hospital, but three patients had serious complications. These data indicate that surgery can be performed safely with appropriate HD and general management in the perioperative period.

Results of long-term toxicity studies of methylmercury (MeHg) in monkeys have been reported. The aim of this study was to estimate the threshold body burden, blood level and threshold daily intake (TDI) of MeHg for monkey and human. The concepts of this study stood on that body burden of MeHg would follow the accumulation theory, and that the more intake of MeHg, the earlier the neurotoxicity appeared, vice versa. The threshold blood level (TBL) of monkey was estimated to be 0.71 as Hg mg/L and the body burden was estimated to be 4.83 as Hg mg/kg. The TDI was estimated to be 0.025 as Hg mg/kg day. In human, the TBL was estimated with compensation by elimination constants of human and monkey. The blood threshold limit and TDI of human were estimated to be 0.33 as Hg mg/L and 0.0046 as Hg mg/kg day, respectively. The estimated body burden was 0.46 as Hg mg/kg.

目的．当センターにおける血液透析（HD）患者に発症した肺癌手術例を対象とし，その臨床的特徴について考察する．対象および方法．1994年12月から2007年12月までに当センターで施行された肺癌手術症例1969例のうち，慢性HD患者症例22例（1.1%）を対象とした．男性18例（81.8%）で平均年齢は65.9歳．結果．部分切除/区域切除/葉切除=1/1/20．胸腔ドレーン抜去は術後6.4±4.7日目で術後在院日数は16.5±5.1日であった．組織型は，Ad/Sq/AdSq/SCLC=7/12/1/2．病理病期はIA/IB/IIB/IIIA/IIIB=8/4/5/3/2．手術死亡および在院死亡はなかったものの術後合併症は14例（63.6%）にみられた．術後1年以内の再発を3例（16.7%）に認め，disease free intervalは6∼94ヶ月，中央値21ヶ月であり，5年間生存率は36.2%であった．結論．慢性HD患者に対する肺癌手術例を検討した．手術死亡および在院死亡は認めず，重篤な合併症は3例のみであった．周術期の適切なHD管理および全身管理で安全に手術遂行は可能であった．

症例は74歳，女性．開腹歴有り．上腹部痛を主訴に来院．受診時，腹部緊満・腹膜刺激症状軽度認めた．腹部CT，腹部超音波検査施行．術後癒着性イレウス（絞扼性）の診断にて緊急手術となる．イレウス解除術施行後，再度イレウスを発症し，再手術となった．術中所見にて初回手術時と比し高度な癒着を生じていた為，再々度のイレウスを危惧し，術中に胃瘻を造設し，減圧スプリンティングチューブを回腸末端から30cm口側の回腸まで誘導し，留置した．2回に亘るイレウス解除術を行ったにも拘らず，術後にイレウス認めたため胃瘻からガイドワイヤー下にイレウスの原因となっている狭窄部位にバルーン拡張術を行い，非観血的にイレウスを解除しえた．以上減圧スプリンティングチューブおよび拡張用バルーンカテーテルにより，過去に報告の無い，新しい方法にて治療しえた1症例を経験したので報告する．

当センターにおける悪性気道狭窄に対する硬性気管支鏡下ステント留置症例をretrospectiveに検討した．2003年1月から2007年5月までに施行された硬性鏡下治療症例73例のうち悪性疾患による気道病変に対して硬性気管支鏡下ステント留置が施行された55例を対象とした．狭窄の様式は，粘膜浸潤型24例，壁外型24例，混合型7例．ステントの種類は，Dumon 12例，Dumon Y型（Y）21例，EMS 17例，Y＋EMS 5例．ステント留置により，呼吸状態の改善は全例で認められ呼吸状態の悪化は認めなかった．PSは46例（86.8％）で改善した．術後人工呼吸管理を要したもの10例，肉芽形成4例，ステントの移動2例であり，術後2日以内に2例が死亡した．ステント挿入後のMSTは2.5ヵ月，平均生存期間は4.9±5.2ヵ月であった．悪性気道狭窄に対する硬性気管支鏡下ステント留置は患者のADLの改善および呼吸困難の改善に有用であったが，術前全身状態不良が多く，術後管理には注意を要する．

A 61-year-old man with right lung cancer underwent right lower lobectomy. He suffered from postoperative broncho-pleural fistula, which was treated with thoracic drainage. After disappearance of air leakage, a drainage tube was removed. Forty days later, severe back pain, cough and fever were observed. Chest computed tomography showed enlarged thoracic cavity around the bronchial stump. Bronchoscopical examination revealed complete dehiscence of the bronchial stump. Because thoracic cavity was localized and located dorsal to the bronchial stump, a fenestration surgery was difficult. We placed a nasal airway from the dorsal to directly thoracic cavity, followed by disappearance of the symptoms. Thoracic cavity around the bronchial stump was gradually decreased and a nasal airway was successfully removed. Because a nasal airway was soft enough to keep supine position, we chose it as a drainage tube. Thoracic drainage using nasal airway may be a suitable therapeutic approach for localized small thoracic cavity.

The pharmacokinetics of carbamazepine (CBZ), one of the useful analgesic adjunctive agents for palliative care, and its major active metabolite, CBZ-10,11-epoxide (CBZ-E), were investigated after the intrarectal and intracolostomal administration of CBZ to rabbits with rectal-resection or colostoma-construction. In rectal-resected rabbits, the bioavailability of CBZ and the plasma level of CBZ-E after rectal administration were significantly lower than those in normal rabbits, and furthermore these values after intracolostomal administration to colostoma-constructed rabbits tended to be lower than those in rectal-resected ones. This decreased bioavailability of CBZ was thought to be not due to an increased first-pass effect, but to the lower CBZ absorption ability in the upper rectum and colon, since absorption profile of CBZ was not affected by first-pass metabolism. When the dose was increased based upon the difference in the absolute bioavailability values in the rectal-resected and colostoma-constructed rabbits, the decreased plasma levels of CBZ were restored to the control levels incompletely, and the elimination of CBZ and CBZ-E was retarded. These findings suggest that owing to the similarity of their pharmacokinetics in rabbit and man, the increment of dosages of CBZ should be avoided, when CBZ suppositories are administered to rectal-resected or colostoma-constructed patients.

発性肺癌手術症例87例を, A群: 手術単独の75例, B群: 術前放射線化学療法 (45Gy) 後の4例, C群: 放射線化学療法 (60Gy) 後2ヵ月～5年経過後の手術症例8例の3群に分け, 術前放射線化学療法が気管支粘膜血流および気管支断端治癒に及ぼす影響を検討した.気管支粘膜血流はレーザードップラー血流計を用い, 術前, 術中, 術後 (8～10病日) に測定した.C群では周術期を通じ血流は著しく傷害されており, 気管支断端の治癒も不良であった.8例中1例には気管支断端痩を認めた.しかしA群およびB群では血流は十分に保たれ, 気管支断端の治癒も良好であった.以上より, 術前の放射線化学療法は, 慢性期には気管支粘膜血流を傷害し気管支断端治癒不良の因子となりうる.しかし現在行われている術前放射線化学療法の設定ではこれらに及ぼす影響は少ないことが示唆された.

There are few reports of resected cases of second primary lung cancer in post-treatment survivors of small-cell lung cancer. Here, we report a surgical case of a 62-year-old female with second primary lung adenocarcinoma after chemoradiotherapy against small-cell lung cancer. She had been treated for small-cell lung cancer 2 years earlier, and achieved complete response after the treatment. A new nodular lesion was detected at a different segment in the right lower lobe. We performed a right lower lobectomy accompanied with systemic mediastinal nodal dissection. Histopathological findings revealed that the new nodular lesion was a second primary lung adenocarcinoma. No metastatic tumor was seen in the dissected lymph node; the initial tumor had disappeared completely. The postoperative course was uneventful, and she was discharged on day 10 after the operation. Ten months after the operation, she was free of recurrent tumor.

Objective: We investigated the relationship between bronchial mucosal blood flow around the area of lung resection and the state of healing of the bronchial stump in patients after chemotherapy with or without radiation therapy. Methods: Ninety patients with primary lung cancer were divided into the following 3 groups: group A, 72 patients who had no preoperative therapy; group B, 10 patients who had chemotherapy; and group C, 8 patients who had chemoradiation (60 Gy) therapy. Bronchial mucosal blood flow was measured preoperatively, intraoperatively, and postoperatively (days 8-10) with a laser Doppler flowmeter. Results: In groups A and B bronchial mucosal blood flow was preserved sufficiently around the surgical site, and the healing of the bronchial stump was satisfactory. On the contrary, preoperative blood flow in group C was 70% of the preoperative value in group A and decreased further intraoperatively. Healing of the bronchial stump was poor, and a bronchopleural fistula occurred in one patient of group C. Conclusion: Preoperative chemoradiation therapy may adversely affect bronchial mucosal blood flow and healing of the bronchial stump, although lymphadenectomy and preoperative chemotherapy had little effect. It is recommended that the bronchial stump should be covered with pedicled viable tissue after chemoradiation therapy for prophylaxis against bronchial complications. (J Thorac Cardiovasc Surg 2000;119:939-45)

The total dust concentration and the particle size distribution were determined around die sites of demolition associated with the Great Hanshin-Awaji Earthquake, which occurred on January 17, 1995. The total dust concentrations ranged from 0.20 to 0.23 mg/m(3), being about 1.2 to 2.2 times that in die non-demolition area, and intermediate particles (2.1-11.0μm) made up a large proportion of the dust. The dust concentrations were not influenced by the weather on the day preceding measurement around the sites of demolition of concrete buildings, whereas the values decreased to about half around die sites of demolition of wooden buildings, nearly the same concentration in the control areas, when it had rained on the previous day. The dust concentrations increased compared with that in an average year but to The degree of die upper limit of die environmental standard (1 hr-value0.20 mg/m(3)) . The dust due to the smoke of Mt. Sakurajima in the surrounding areas accounted for a higher proportion of large particles (11.0m) than in the earthquake-devastated area. The concentration of respirable dust (;7.07m) in a worker engaged in demolition was 4.0 mg/m(3), being twice the recommended concentration (2 mg/m(3)) of the Japan Society for Occupational Health. It was thus considered that workers should use a respiratory protective device.

肺癌切除後の他臓器重複癌症例について臨床的検討を行った.完全切除206例中28例 (13.6%) に重複癌を認め, 術後経過観察中に発見した重複癌は9例 (4.3%) であった.発見契機をみるとCEA値の上昇が4例, 症状発見3例, CT発見が2例であった.全例消化器系臓器の癌であり, 胃癌, 大腸癌がそれぞれ3例と多かった.症状発見例・CT発見例では診断は迅速であったが, CEA値上昇例では肺癌再発検索が先行し確診までの期間が長くかかった.同観察期間中の肺癌再発は71例 (34.5%) で, このうち12例がCEA値上昇で発見されたが, 両者間に術前CEA値の差は認めなかった.以上より肺癌切除後にCEA値上昇を見た場合, 他臓器原発の癌発生も考慮した肺癌再発の検索を行うべきと考えられた.

Neuroblastoma is rare in adults. We encountered this tumor in an asymptomatic 21-year-old man with a 10-year history of a mass-like shadow in chest radiography. Diagnosis was confirmed after resection, and 60 Gy radiation therapy was started. One year later, the patient has no clinical or radiological evidence of recurrence.

Various tumors metastasize to the lung, and they are often detected as multiple nodules. We report on two cases of such multiple lung metastases combined with primary lung cancer: a myxoid liposarcoma in the right thigh and a colon cancer. In each case, a pulmonary metastasectomy revealed that one of the tumors was primary lung cancer. Regardless of recent advances in computed tomography for detecting small pulmonary nodules and ground-glass opacity components, which indicate possible primary lung cancer, the preoperative differential diagnosis for either metastatic or primary lung cancers is usually difficult because they are too small to obtain enough tissue for diagnosis, except by surgery. When nodules are removed and diagnosed as lung metastasis combined with primary lung cancer, additional treatment should be considered depending on the prognosis of each disease.

We report an uncommon clinical case of extrathoracic protrusion of a chronic expanding hematoma in the chest, mimicking a soft tissue sarcoma. A 77-year-old Japanese man was successfully treated by chest wall resection and partial decortication of the lung. The postoperative pathology examination confirmed a diagnosis of a granular cell reaction. Details of the clinical and radiographic features are presented.

Itai-itai (or ouch-ouch) disease is a syndrome accompanied by bone mineral disorders, and which may be related to oral cadmium exposure. Itai-itai predominantly affects postmenopausal women with a history of multiple childbirths. Recently, it has been reported that polymorphisms of the estrogen receptor alpha (ERalpha) gene are associated with postmenopausal reduction of bone mineral density in Japanese women. However, estrogen receptors have never been studied in itai-itai disease. In this study, we examined the genotypic distributions of PvuII and XbaI restriction fragment length polymorphisms (RFLPs) of the ERalpha gene in patients with itai-itai disease and compared them with those of control subjects. The RFLPs are represented here as Pp (PvuII) and Xx (XbaI); the capital and small letters signify the absence and presence of restriction sites, respectively. The genotypic distributions of the patient group were: PP, 14.8%; Pp, 55.6%; pp, 29.6%; XX, 7.4%; Xx, 29.6%; and xx, 63.0%. These distributions were similar to those observed for the control groups, hence no pattern of genotypic distribution was observed that could be related to itai-itai disease. We conclude that RFLPs of the ERalpha gene may not be associated with itai-itai disease.

We report herein an uncommon clinical case of pulmonary artery aneurysm in Behcet's syndrome, for which only a few reports have been published in the literature to date. A 68-year-old Japanese male, who was referred for recurrent fever of unknown origin, anemia and pulmonary nodular opacities, was treated by right lower lobectomy followed by postoperative oral administration of colchicine and corticosteroid. Postoperative pathological examination confirmed a diagnosis of pulmonary artery aneurysm accompanied by vasculitis and thrombi. Clinical and radiographic feature are presented herein.

The aim of this study was to analyze gaseous organic chemicals (GOCs) of high traffic (Nishinomiya City: 979,987 vehicles/day) and low traffic areas (Miki City: 29,338 vehicles/day) by gas chromatography-mass spectrometry (GC-MS) and to evaluate general environment exposure by PAHs in GOCs. After air sampling using an OMNIPORE membrane filter (0.45 microm) and Porapak-QS, sorbents were extracted with solvent (dichloromethane: acetone (4:1 v/v), and analysis was carried out by GC-MS. Oxidative derivatives of diethylbenzene, such as diacethylbenzene and ethylacetophenone, were detected in GOCs. PAHs and phthalates in GOCs were measured. Pyrene, benz[a]anthracene, benzo[a]pyrene and benzo[ghi]perylene level were significantly higher in high traffic areas. The geometric mean of pyrene was 0.76 ng/m3 for low traffic areas and 1.96 ng/m3 for high traffic areas; benz[a]anthracene was found at 0.72 ng/m3 and 1.80 ng/m3 in low and high traffic areas, respectively; benzo[a]pyrene was found at 0.87 ng/m3 and 3.60 ng/m3 in low and high traffic areas, respectively and benzo[ghi]perylene was found at 0.57 ng/m3 and 3.04 ng/m3 in low and high traffic areas, respectively. The bis(2-ethylhexyl) phthalate (DEHP) level was the highest in the detected GOCs. The geometric mean of the DEHP levels in high traffic and low traffic areas were 484.85 and 387.26 ng/m3, respectively. Adult and child DEHP exposure levels were 145.32 and 300.33 ng/kg/day, respectively, in high traffic areas. In low traffic areas, adult and child DEHP exposure levels were 116.18 and 240.10 ng/kg/day, respectively.

We report an uncommon clinical case of multiple, diffuse pulmonary arteriovenous fistulas that occurred during childhood. A 15-year-old Japanese girl with multiple pulmonary arteriovenous fistulas presented with moderate hypoxemia and was treated by left lower lobectomy for complete resection of the arteriovenous fistulas. Clinical and radiographic features are presented.

Objective To review diagnostic procedures, therapeutic modalities, and follow-up methods in patients with suspected lung tumors. Methods We retrospectively examined 70 patients who underwent a complete medical checkup because they had been positive for sputum cytology and had presented no chest X-ray findings for the 10-year period between 1994 and 2004. To make a diagnosis, we conducted the first complete medical checkup that included chest X-ray, sputum cytology, chest computed tomography (CT), and bronchoscopy. In the case that no diagnosis could be made, we repeated the chest X-ray and sputum cytology every 3 to 6 months and additionally conducted chest CT and bronchoscopy according to abnormal findings. Results Among 70 patients, there were 36 and 13 who were diagnosed during the first complete medical checkup and follow-up, respectively, 13 who remained undiagnosed, and eight for whom follow-up was discontinued. Among the 49 diagnosed patients, 40, 8, and 1 patient had lung cancer, upper respiratory tract carcinoma (URTC), and esophageal carcinoma (EC), respectively. Among the 40 patients with lung cancer, 34 had a stage 0 or I tumor and 15 were radically treatable by photodynamic therapy and endobronchial irradiation. Nine among 11 patients whose lung cancer was detected during follow-up had a stage 0 or IA tumor. Conclusion Not only lung cancer but also URTC and EC were successfully detected in patients who were positive for sputum cytology and presented negative chest X-ray. Radical treatment was possible in 38 (76%) of 50 diagnosed patients, thus indicating the importance of follow-up through these procedures.

The experimental details for the synthesis of human renin inhibitors are described. In order to aviod metabolic degradation of the Phe-His (P3-P2) amide bond in transition-state analogs, structurally modified acyl residues (P4-P3) were incorporated into the inhibitors. Compound 1a, which contained 2-(1-naphthylmethyl)-3-(N-phenethylcarbamoyl)propionyl residue (P4-P3) with a retro-inverso amide bond, L-histidine, and norstatine isoamylamide residue (P1-P1') as a transition-state mimic, had potent human renin inhibitory activity, and it lowered blood pressure when administered orally to common marmosets.

Particulate air pollution is a serious problem all over the world, and the development of a method to evaluate the health effects of ambient particles is necessary. In this study, cells cultured in vitro were exposed to particles sampled at the side of a main road, and their protein expression levels were examined.Ambient particles were collected at the side of a main road using a high-volume air sampler. Some of the collected particles (crude particles) were treated with an organic solvent to remove chemical components, and the resulting residues were used as residual particles. Cells from the mouse alveolar epithelial cell line LA-4 were inoculated into tissue-culture dishes at 1.4×10(4)/cm(2), exposed to each type of particle or artificial carbon particles (Printex 90) that were dispersed using an ultrasonic homogenizer by mixing in the medium twice at 24 and 48 hours, and incubated for up to 72 hours after the start of inoculation. After exposure, the number of cells and intracellular dehydrogenase activity were measured. Proteins extracted from the cells were subjected to two-dimensional gel electrophoresis with isoelectric focusing at pHs 4-7 using a 10% acrylamide gel, and their expression levels were analyzed after fluorescent staining.The intracellular dehydrogenase activity of the cells significantly decreased as a result of exposure to the residual (0.70-fold) and crude (0.84-fold) particles compared with that of the control, but it showed no change as a result of exposure to Printex 90. The protein expression levels in the cells exposed to the particles increased or decreased similarly, but different expression levels were also observed. There were differences in the effects observed between the cells exposed to the artificial carbon particles and those exposed to particles collected from ambient air.This study indicates that protein expression levels in cells change in response to exposure to particles collected from ambient air. To evaluate the effects of particles on health, it is considered necessary to use particles collected from ambient air.

Objective: Combined esophago-airway stenosis and/or esophago-airway fistula due to malignancy bodes a dismal prognosis. We describe our work with double stents for combined esophago-airway lesions.Methods: Between February 1994 and July 2000, we treated 11 patients using double stents—the Dumon stent for the airway and the covered Ultraflex for the esophagus. Double stenting was necessitated by combined esophago-airway stenosis in 8 patients and fistulas in 3, of these, 6 had lung cancer and 5 esophageal cancer.Results: In all but 1 ventilator-dependent patient, dyspnea and dysphagia were significantly reduced and fistula was successfully closed after double stenting. This palliation effectively continued more than 1 month in 5 patients, more than 2 months in 3, and more than 3 months in 2. Mean survival was 64 days (range: 9 to 148 days). Life-threatening complications developed in 5 (45%)—massive bleeding in 3 and uncontrollable esophago-airway fistula in 2. All 5 had received prior radiation.Conclusion: Although patients who received radiation frequently had life-threatening complications after double stenting, this procedure improved the quality of life in patients with esophago-airway stenosis or fistulas due to lung or esophageal cancer.

To investigate the effects of exposure to styrene vapor on pregnancy, mice proved to be pregnant were exposed to 0, 2, 20 and 100 ppm styrene continuously for 24 hours during the period from day 0 to day 15 of gestation. A special small exposure chamber which can accurately maintain a constant low concentration of styrene vapor was made and used in the experiment. 1) In the 100 ppm group, hyperkinesis was presented in the chamber during the exposure period and inhibition of body weight gain was found (p < 0.01). No deaths occurred in any of the groups. 2) At necropsy of dams, no significant difference was found between the styrene exposed groups and the control group in any of the fertility indices, number of implantations, number of live fetuses, percentage of resorptions, or in the percentage of dead fetuses. The 100 ppm group showed lower fetal and placental weights (p < 0.01). 3) Gross necropsy of dams in the 100 ppm group showed significantly decreased adipose tissue. The liver, kidney and spleen weights were also low (p < 0.01). 4) When exposed to 100 ppm, which corresponds to 5 times the permissible concentration, i.e., 20 ppm, for 24 hours, non-pregnant dams showed no abnormality, while pregnant dams showed inhibition of body weight gain and significantly lower fetal and placental weights and maternal organ weights. Therefore, careful consideration should be given to exposure of women of childbearing age to styrene.

We present a case of malignant solitary fibrous tumor of the pleura in an asymptomatic 75-year-old man. A needle biopsy specimen revealed a solitary fibrous tumor of the pleura with suspected. The tumor was resected and the final diagnosis was a malignant solitary fibrous tumor. At one-and-a-half years later, the patient has no clinical or radiological evidence of recurrence. The propriety of a needle biopsy for preoperative diagnosis is discussed.

The surface fatigue failures of the traction drive rollers are different to that of gears and bearings because of the high traction force, skew and small slip ratio. In this research, fatigue tests of traction rollers were performed in different slip ratios and skew angles. The effects of running conditions on the fatigue lives of traction drive rollers are clarified and explained based on the surface crack growth and wear situations. Although a higher slip ratio will make a lower fatigue life, the fatigue strength will increase inversley under the skew conditions, because of the differences in mechanical and tribological condition for surface crack growth and the severe surface wear, which diminishes the surface crack length. For evaluation of the effects of such as slip ratio and skew on the fatigue strength of traction rollers, a new method is put forward in which the relationship between the surface temperature index and fatigue life is used instead of S-N curve.

The interaction of the methylmercury cation with sulfur compounds in aqueous solution at physiological pH was studied by laser Raman spectroscopy. Metal binding is shown to occur preferentially at the sulfhydryl group of sulfur compounds. Raman frequencies of S-Hg stretching of the one-to-one methylmercury-sulfhydryl or sulfur-containing complexes were observed at approximately 330 cm-1. There was no frequency shift when ligands were exchanged. However, the relative intensity (I S-Hg/I C-Hg) was different. The relative intensities of MeHg-thioglycerol, MeHg-cysteine and MeHg-2-mercaptobenzothiazole were 0.18, 0.43 and 0.62, respectively. Methyl-mercury shifted from combination states of lager relative intensity to ones of smaller relative intensity. These results may cast light on the distribution and excretion mechanisms of methylmercury in the human body.