Tomoharu Kuda

DNA Ploidy patterns of tumors diagnosed as metachronous or recurrent lung cancer

The relationship between the first tumor and the second tumor resected in 8 patients with non-small cell lung cancer was analyzed using deoxyribonucleic acid (DNA) flow cytometry. Of the 8 patients, 6 were clinically diagnosed as having metachronous lung cancers and 2, local recurrent tumors. The mean interval between operations in patients with metachronous lung cancers was 62 months (range, 15 to 128 months). Both tumors showed the same histology in 4 patients and a different histology in 2. In the 2 patients with local recurrent tumors, the interval between operations was 9 months and 39 months. In the analysis of DNA flow cytometry of the first and second tumors in the same patient, the tumors were defined as independent of each other when one tumor showed diploidy and the other, aneuploidy, or when each DNA index of abnormal clones between two aneuploid tumors was different. When both tumors showed diploidy or when at least one DNA index of abnormal clones between two aneuploid tumors was identical, the tumors were defined to be related to each other. According to these criteria, in 5 (83%) of the 6 patients clinically diagnosed as having metachronous lung cancers, the second tumor was classified as independent of the first tumor. On the other hand, in the 2 patients clinically diagnosed as having recurrent tumors, the second tumor was judged to be related to the first tumor. These data suggest that DNA flow cytometric analysis of tumors may be of value in the diagnosis of metachronous lung cancers.

Long-Term Survivors in Resected and Nonresected Small Cell Lung Cancer

Long-term survival (greater than or equal to 3 years) was evaluated in 164 patients with small cell lung cancer (SCLC). Thirty-seven patients underwent surgical resection, and 127 did not. All but one resected patient received combination chemotherapy. Of the 20 (12%) long-term survivors, 13 (35%) were resected, and 7 (6%) were not. Eleven of these resected patients had pathologically confirmed stage I disease. All of the 7 nonresected patients achieved complete remission by treatment, 6 of these having presented with limited disease. In addition, all patients received thoracic irradiation combined with chemotherapy. Two of the 20 patients who survived beyond 3 years developed a second malignancy 11.3 and 12 years, respectively, after initial treatment for SCLC. In conclusion, surgical resection for stage I, and probably stage II SCLC followed by chemotherapy may be an appropriate therapeutic approach. For advanced limited disease, thoracic irradiation, in addition to chemotherapy, seems to improve long-term survival.

Evaluation of inflammatory-response-induced thoracoscopic surgical stress

OBJECTIVE Due to the paucity of reports evaluating stress induced by thoracoscopic surgery with minithoracotomy, we assessed this stress based on the inflammatory response to surgery. METHODS Differences in pre- and postoperative peripheral white blood cell (WBC) count, serum C-reactive protein (CRP), and serum interleukin-6 (IL-6) were evaluated, defined as dW, dCRP, and dIL-6. Thoracoscopic partial lung resection cases were divided into 2 groups by access route: Group A patients in which surgery was concluded via several small access ports. and Group B patients going surgery via small access ports plus minithoracotomy. We also compared dW in standard lobectomy with exploratory thoracotomy (thoracotomy without lobectomy) cases. RESULTS No significant difference was seen in dW, dCRP, or dIL-6 between groups. dW in response to exploratory thoracotomy was lower than that in standard lobectomy (p = 0.06). CONCLUSIONS Surgical stress induced by thoracoscopic partial lung resection does not increase significantly when minithoracotomy is added. Postoperative inflammatory response may, however, be influenced by the extent of surgical trauma.

Promotion of Departmental Cooperative Activities Supporting the System of Legionella Infection Control in the Hospital

In our hospital, Legionella monitoring in the shower water of bathrooms is conducted every year. Legionella was detected in only one of the sink taps of the ˆfth ‰oor psychiatric ward bathroom in 2010, but Legionella was also detected in several showers and sink taps of the fourth ‰oor obstetrics and gynecology ward, Maternity and Perinatal Care Center, and NICU in 2011. Furthermore, L. pneumophila serogroup 1 was detected in several components of the water system equipment except for bathrooms. Hoses were exchanged and water drained to eradicate Legionella, and rechecking was negative in all locations except the sink of the interview room in the Maternity and Perinatal Care Center. According to interviews with nurses, water drainage was not fully performed. We considered the departmental cooperative activities supporting the system of Legionella infection control in the hospital, and the arrangement and use of water system equipment at this time. We thought that the risk of Legionella becomes high with low frequency in use of water system equipment, because the infection center was on the fourth ‰oor that is the bottom of the arrangement of water system equipment, and infection spread mostly from water system equipment with low frequency use in that location. The arrangement of a water supply system must be carefully examined, and the frequency of use of water system equipment monitored as part of measures against Legionella. For this reason, prompt cooperation between the infection control committee, responsible staŠ, and the equipment division, and information exchange are essential. We propose a guidance plan to ensure cooperation and exchange of information. Key wordsLegionella, infection control, supporting system structure

Evaluation of Infection Control Education for Medical Students Using Simulations

The signiˆcance of clinical practice for medical students is continuing to increase in conformity with international standards, but the clinical practice of infection control is less well developed. The present study evaluated infection control education using simulations involving 94 medical students. A survey was conducted to evaluate the knowledge of standard precautions and cleaning, disinfection and sterilization techniques before and after practice in the surgical operation center. Before the practice, 91 of the students were aware of the standard precautions, but 68 considered that the intentions were unfamiliar. After the practice, 97 of the students understood the standard precautions, and 95 believed that they could practice the standard precautions. The students displayed a signiˆcant increase in knowledge about cleaning, disinfection and sterilization after the practice. Standard precautions are not included in the learning purpose of the objective structured clinical examination, so addition should be considered. The present results indicate that education using simulation is eŠective for the understanding of standard precautions, as well as for cleaning, disinfection and sterilization techniques. The standard precautions are diverse and present di‹culty in clinical practice, so continuous education should be provided throughout the training from medical student to physician. Key wordsmedical student, infection control education, standard precautions, simulations, objective structured clinical examination

Thoracoscopic surgery for diagnosis of interstitial pneumonia special reference to medicoeconomical effect

We compared thoracoscopic surgery (TS) and open thoracotomy for the diagnosis of interstitial pneumonia. Intraoperative blood loss and duration of postoperative chest drainage were significantly less with TS than with thoracotomy. The length of postoperative hospital stay and social insurance costs with TS was significantly less than with thoracotomy. These results show that TS for the diagnosis of interstitial pneumonia is superior to open thoracotomy in terms of surgical stress and cost.

Malignant fibrous histiocytoma of the lung and mediastinum.

悪性線維性組織球腫malignant fibroushis tiocytoma (MFH) は, 四肢軟部組織;後腹膜に好発するが, 肺原発及び縦隔原発MFHは非常に稀である. 今回, 44歳女性の右肺腫瘍, 39歳男性の左前縦隔腫瘍を切除し, 組織学的所見と臨床所見より, それぞれ肺原発及び縦隔原発MFHと診断した. 肺原発及び縦隔原発MFHの本邦報告例とともに考察を加える.