Shuichi Sasamoto

Defibrillation Effects of Intravenous Nifekalant in Patients with Out‐of‐Hospital Ventricular Fibrillation

Nifekalant (NF), a pure K+ channel blocker developed in Japan, has been reported to be effective in the treatment of life‐threatening ventricular arrhythmias. We studied its efficacy in 18 men and 4 women with out‐of‐hospital ventricular fibrillation (VF) admitted to our emergency department between August 2001 and March 2004. The number of DC shocks delivered for out‐of‐hospital VF, serum Na+ and K+, arterial blood pH, and base excess were compared in 8 patients treated with NF, 0.3 mg/kg i.v. followed by a continuous intravenous (group N) versus 14 patients treated with lidocaine, 2 mg/kg, i.v. (group C). The two groups were similar with respect to their baseline characteristics. Sinus rhythm returned in 5 of 8 patients in group N versus 2 of 14 patients in group C (P < 0.05). These seven patients were admitted to the intensive care unit, though all died within 1 month. The results of this study suggest that NF may be effective in defibrillation of out‐of‐hospital VF, though controlled studies are needed to confirm our observations.

Quantitation of c-erbB-2 Gene Amplification in Breast Cancer Tissue by Competitive PCR

Controversy exists regarding the relationship of the degree of c-erbB-2 amplification to other prognostic factors in breast cancer. To determine the degree of amplification of c-erbB-2 exactly, a sensitive and quantitative method is required. We have developed a competitive PCR method to quantitatively determine the amplification of the c-erbB-2 oncogene. Using this method, we evaluated DNA from 27 breast cancer tissue specimens and DNA from peripheral blood leukocytes from a normal individual. Regarding the relationship between the degree of c-erbB-2 amplification and clinicopathological factors, we found a greater degree of amplification of the c-erbB-2 oncogene in estrogen receptor- negative or progesterone receptor-negative specimens than in positive ones and in lymph node metastasis-positive specimens than in negative specimens, in stages II, III, and IV of disease compared with stage I disease, and in samples with positive lymphatic vessel invasion than with no lymphatic vessel invasion. Generally, these factors were seen in the group of patients who had a bad prognosis. By univariate analysis and multivariate analysis, reverse correlation was observed between amplification of c-erbB-2 and overall survival. Regarding disease-free survival, these relationships were observed only with univariate analysis in our group of patients.

A Case of Primary Lung Adenocarcinoma with a Thin-Walled Cavity.

薄壁空洞を形成した原発性肺腺癌を経験した.症例は59歳, 男性.咳嗽, 血痰, 発熱を主訴に近医受診, 胸部X線写真およびCT写真上, 右上葉に直径約6.5cm大の薄壁空洞を伴う陰影を認め当院紹介となった.精査にて原発性肺腺癌と診断, 右上葉切除術を施行した.病理診断で低分化型腺癌と診断 (P-T3NOMO), また空洞壁内には壊死組織凝血壊死像やfibrinの析出を認めた.空洞形成の原因は腫瘍内部の壊死によると考えられた.術後5カ月目に左肺野に同様の薄壁空洞が多数出現し転移と診断, その後も空洞は急速に発育し, 10カ月目に癌死した.肺癌における薄壁空洞形成は比較的稀である.自験例における空洞形成の成因は病理所見, 臨床経過などから癌細胞自体から分泌される蛋白分解酵素によるCell Autophagism説が疑われた.文献的考察を加え報告する.

Tracheal leiomyoma resected with endobronchial electrocautery snare.

Tracheobronchial leiomyoma is a rare benign tumor, which comprises about 2% of benign tumors of the lower respiratory tract. Bronchoscopic intervention is a minimally invasive treatment, but incomplete resection or recurrence has been reported. We report a case of a 76-year-old woman with a tracheal tumor of 14 mm in diameter incidentally detected on chest computed tomography. Bronchoscopic examination revealed a smooth polypoid tumor which pedunculated from the left side of the cartilaginous tracheal wall. An endobronchial electrocautery snare with flexible bronchoscope was successfully used under general anesthesia and with intubation. The resected specimen was pathologically consistent with leiomyoma. Bronchoscopic intervention can yield successful treatment of pedunculated tracheobronchial leiomyomas, although surgical resection should also be considered in cases of broad-based or iceberg-type leiomyomas because of the risk of incomplete resection or recurrence.

Adenomyoepithelioma of the breast: a case report and a review of the literature

A 74-year-old woman complained of a small nodule in the outer lower quadrant of her left breast. On physical examination, a 0.9 × 0.8 cm, round-shaped and firmly elastic nodule was palpated.Excisional biopsy was performed. Histologically, the tumor was separated into, with a bicellular pattern, containing both numerous glandular structures and numerous spindle-shaped cells.Immunohistochemical staining for EMA and cytokeratin showed strongly positive immunoreactivity for epithelial cells. Staining for α-SMA showed strongly positive immunoreactivity for myoepithelial components. Staining for keratin and S-100 protein showed weakly positive immunoreactivity for myoepithelial cells. Microscopically, the tumor was diagnosed as adenomyoepithelioma of the breast.Immunohistochemical examination is needed to distinguish epithelial cell proliferation from myoepithelial cell proliferation.Immunohistochemical examination using antibodies against EMA, α-SMA, keratin, cytokeratin and S-100 protein, is indispensable.

Recovery of lung perfusion after sleeve resection for tuberculous bronchial stenosis.

Parenchyma-sparing main bronchial sleeve resection is a safe and effective procedure to restore impaired lung function. We present a case illustrating recovery of lung perfusion in a 24-year-old woman with dyspnea on exertion because of bronchial tuberculosis. Bronchoscopic examination revealed pin-hole stenosis of the left main bronchial orifice. 99mTc-macroaggregated albumin perfusion scanning revealed essentially absent left lung perfusion. Because of bronchomalacia in the distal portion, six rings of the left main bronchus were resected by carinoplasty. Symptoms abated and perfusion recovered to a large extent 2 months later. She became pregnant and delivered successfully 12 months postoperatively.

Infected Giant Bulla Treated by Percutaneous Drainage Followed Later by Resection: Report of a Case

A 55-year-old man was hospitalized for treatment of a giant, fluid-filled bulla in the upper lobe of the right lung. The infection was resistant to antibiotics, and the resulting drug-induced liver dysfunction prohibited us from performing emergency lobectomy. Percutaneous drainage of the bulla was done initially, using a 28-Fr chest tube, after which the symptoms of infection improved rapidly. Despite a small air leakage, which became evident on day 4 of drainage, shrinkage of the bulla was achieved, and elective bullectomy was performed after continuous drainage for 21 days. Thus, percutaneous drainage was effective in controlling the infection and minimizing the invasiveness of surgery.

Therapeutic bronchoscopy followed by lobectomy for pulmonary sarcoma.

Malignant central airway obstruction is a life-threatening presentation requiring emergency palliative procedure. In selected patients, bronchoscopic intervention could be used as a bridge to curative resection. Here we report a 54-year-old male with pulmonary sarcoma of the right upper lobe, presenting with acute respiratory failure because of endobronchial extension. Emergency coring with the rigid bronchoscope and Dumon stent insertion stabilized the patient, and subsequent lobectomy resulted in occurrence-free survival over a 71-month follow-up.

16. ICD: Defibrillation Threshold Testing & Other Issues

Purpose Electrical cardioversion for ventricular arrhythmias (VAs) contained of ventricular tachycardia (VT), ventricular fibrillation (VF) and torsades de pointes (TdP), was established to be effective for VAs. Little is known about which case should have an effect on chest thump version (TV) in patients with VAs. Method Subjects were 18 patients (Male: Female = 9:9, mean age 61±20 years old). TV was done for 28 episodes in VT, 8 episodes in VF, and 5 episodes in TdP. TV was performed after onset of symptoms within one minutes, and electrocardiogram (ECG) monitor was analyzed. Heart beats were averaged with 10 beats of VF and TdP. The time from Q wave to TV was measured from ECG monitoring in VT patients. Result TV successfully terminated VT in 12 of 28 episodes, VF in 1 of 8 episodes, and 1 of 5 episodes. TV terminated VT in the range between -20ms and +60ms. The mean cycle length of VT was 284±30ms, VF was 238±21ms, and TdP was 270±25ms, respectively. The mean cycle length of successful TV was significantly longer than that of failed TV in VT (358±57ms vs 289±59ms, p<0.01). There was no acceleration of VT in this study. Conclusion TV was available for slower VT at the timing in the range between -20ms and +60ms, and not for TdP and VF.

Efficacy of Chest Thump Version for Ventricular Arrhythmias

Purpose Electrical cardioversion for ventricular arrhythmias (VAs) contained of ventricular tachycardia (VT), ventricular fibrillation (VF) and torsades de pointes (TdP), was established to be effective for VAs. Little is known about which case should have an effect on chest thump version (TV) in patients with VAs. Method Subjects were 18 patients (Male: Female = 9:9, mean age 61±20 years old). TV was done for 28 episodes in VT, 8 episodes in VF, and 5 episodes in TdP. TV was performed after onset of symptoms within one minutes, and electrocardiogram (ECG) monitor was analyzed. Heart beats were averaged with 10 beats of VF and TdP. The time from Q wave to TV was measured from ECG monitoring in VT patients. Result TV successfully terminated VT in 12 of 28 episodes, VF in 1 of 8 episodes, and 1 of 5 episodes. TV terminated VT in the range between -20ms and +60ms. The mean cycle length of VT was 284±30ms, VF was 238±21ms, and TdP was 270±25ms, respectively. The mean cycle length of successful TV was significantly longer than that of failed TV in VT (358±57ms vs 289±59ms, p<0.01). There was no acceleration of VT in this study. Conclusion TV was available for slower VT at the timing in the range between -20ms and +60ms, and not for TdP and VF.