Morphine is the only opioid that has been found effective for the relief of dyspnea in cancer patients. However, efficacy has not been fully demonstrated for other opioids such as fentanyl. Here, we report a case of lung cancer in which the use of fentanyl was effective for the relief of dyspnea. The patient was an 88-year-old man who had cT4N2M0, cStage IIIB lung cancer with right bronchial involvement and mediastinal lymph node metastases. Although the patient complained of dyspnea, he was not given morphine due to underlying renal dysfunction. He instead received oxygen therapy, and treatment with oral steroids and oxycodone. As oral administration became more difficult with subsequent lung cancer progression, the patient underwent opioid switching from oxycodone to subcutaneous injections of fentanyl. Dyspnea was not exacerbated following the switching, and was thereafter effectively managed by increasing the fentanyl dose and using rescue medication. Fentanyl is suggested to be a possible therapeutic option for dyspnea in cases where the use of morphine is difficult.

Six 1-month-old piglets were intravenously injected with deoxynivalenol (DON) at the concentration of 1 mg/kg body weight, with three pigs each necropsied at 6 and 24 h post-injection (PI) for investigation of hepatotoxicity and immunotoxicity with special attention to apoptotic changes and cytokine mRNA expression. Histopathological examination of the DON-injected pigs revealed systemic apoptosis of lymphocytes in lymphoid tissues and hepatocytes. Apoptosis of lymphocytes and hepatocytes was confirmed by the TdT-mediated dUTP-biotin nick end-labeling (TUNEL) method and immunohistochemical staining against single-stranded DNA and cleaved caspase-3. The number of TUNEL-positive cells in the thymus and Peyer's patches of the ileum was increased at 24 h PI compared to 6 h PI, but the peak was at 6 h PI in the liver. The mRNA expression of interleukin (IL)-1beta, IL-6, IL-18, and tumor necrosis factor (TNF)-alpha in the spleen, thymus and mesenteric lymph nodes were determined by semi-quantitative RT-PCR, and elevated expression of IL-1beta mRNA at 6 h PI and a decrease of IL-18 mRNA at 24 h PI were observed in the spleen. IL-1beta and IL-6 mRNA expressions increased significantly at 6 h PI in the thymus, but TNF-alpha decreased at 6 h PI in the mesenteric lymph nodes. These results show the apoptosis of hepatocytes suggesting the hepatotoxic potential of DON, in addition to an immunotoxic effect on the modulation of proinflammatory cytokine genes in lymphoid organs with extensive apoptosis of lymphocytes induced by acute exposure to DON in pigs.
Animals ; Apoptosis/*drug effects/immunology ; Cytokines/*biosynthesis/genetics ; Gene Expression Regulation/drug effects ; Histocytochemistry/veterinary ; In Situ Nick-End Labeling/veterinary ; Liver/*drug effects/immunology ; Lymphoid Tissue/*drug effects/immunology ; RNA, Messenger/*biosynthesis/genetics/immunology ; Reverse Transcriptase Polymerase Chain Reaction/veterinary ; Specific Pathogen-Free Organisms ; Swine/*immunology ; Trichothecenes/*toxicity

We describe an unusual case of a chronic pulmonary thromboembolism with right atrial thrombus. A 56-year-old man suffering from chronic pulmonary thromboembolism for 5 years complained of increasing dyspnea. Computed tomography revealed massive emboli in bilateral pulmonary arteries and a thrombus in the right atrium. Massive tricuspid regurgitation and atrial fibrillation were also recognized. We performed pulmonary thromboendarterectomy using a Jamieson rigid long miniature sucker with a rounded tip and our original flexible sucker under deep hypothermic circulatory arrest. Right atrial thrombectomy, tricuspid annuloplasty and a Maze procedure were also performed during the cooling, recirculating, and warming period. His postoperative cause was uneventful, and he was able to return to an ordinary lifestyle without acquiring oxygen inhalation. Tricuspid annuloplasty and Maze operation during pulmonary thromboendarterectomy contributed to the maintenance of stable homodynamics during and after surgery.

A 75-year-old man was referred to our hospital with dyspnea on effort, recurrent attacks of loss of consciousness and abnormal shadow on chest X-ray film. Computed tomographic scan confirmed a 1.5×2.0cm mass with slight spiculation in the right lower lobe (S6) and revealed an ovoid right atrial mass. Transthoracic echocardiography showed that the giant mass which filled most of the right atrium had no mobility. Coronary angiography revealed clusters of new vessels which originated from the atrial branches of the circumflex coronary artery. A T1-weighted MRI scan demonstrated that the mass was isointense relative to the adjacent myocardium. We considered that performing cardiac surgery prior to pulmonary resection, as in a staged procedure, would have advantages in morbidity. We first performed removal of the right atrial tumor which was a 6.8×5.5×4.5cm shiny mass attached to the interatrial septum. Histological examination of the mass confirmed the diagnosis of cardiac myxoma. Three months later, right S⁶ segmentectomy was carried out using thoracoscopy and the tumor was finally diagnosed as squamous cell carcinoma. We have followed the patient for about 10 months after the first operation and there is no evidence of tumor recurrence and no more syncopic attacks.

A 75-year-old woman presented with chest pain on exertion. Cardiac catheterization revealed double vessel coronary artery disease. Echocardiographic examination showed the presence of an abnormal mass in the interatrial septum without any flow velocity signal within the mass. She was scheduled for elective coronary artery bypass grafting. The lesion appeared as a homogeneous mass on CT scan, with an attenuation coefficient of -122 Hounsfield units, suggestive of lipoma. A T1-weighted MRI scan demonstrated that the signal intensity of the interatrial mass corresponded to that of fatty tissue. On surgery with cardiopulmonary bypass a large mass was found to involve the right atrial wall, the interatrial sulcus and the interatrial septum. The mass could not be resected completely, because it adhered strongly to the septal myocardium. On histological examination, the tumor was composed of mature fatty tissues, was not encapsulated and was diagnosed as infiltrating lipoma. The postoperative course was uneventful. CT, MR imaging and color Doppler ultrasonography were very useful in making a tissue-specific diagnosis.

The purpose of this study was to investigate characteristics of past injuries of female university soccer players in comparison with injuries in male university soccer players.
We investigated past injuries of female players (n=32) and male players (n=24) . A past injury was defined as any injury sustained during soccer that required admission to a team doctor, medical attention or absence from practices or games for more than seven days.
The most frequent injury was Joint Injuries in both female and male players. High occurrence of overuse injuries of lower leg was most apparent in the female players. The 32 female players had experienced 144 injuries, or 4.5 injuries per player, and the 24 male players had suffered 85 injuries, or 3.5 injuries per player. The numbers of injuries per player of female players were 1.3 times higher than the male players. Also, the incidence of injury was 0.64 (injury/player/year) in female players, and 0.27 (injury/player/year) in male players. The incidence of injury of female players was significantly larger than that of male players.
We conclude that the prevention and care of overuse injuries in lower leg is very important for female succor players.

The purpose of this study was to investigate the relationship between low back pain (LBP) any physical characteristics in university wrestlers. We especially focused on radiological abnormalitie (RA) in their lumbar regions.
Physical characteristics and isokinetic trunk muscle strength of the 55 male university wrestlers were measured. MRI was used to evaluate the cross-sectional areas of trunk muscles between lumbar spine 3 and 4 (L3/4) . Evaluations of LBP were based on the diagnose of orthopedic surgeons and the questionnaire test. According to this evaluation, we assigned all wrestlers into two groups as the LOP group and the no LOP group. Furthermore, four groups were defined by having RA based on X-ray and MRI diagnose.
We obtained the following results. In comparison between the LOP group and the no LOP group, the trunk muscle extension flexion strength ratio of the LOP was significantly lower than that of the no LOP group. In addition, the LOP without RA group showed significant low strength of their trunk extensors in comparison with the no LOP without RA group.
We considered that the relative low strength of trunk extensors should have some effect on LBP in university wrestlers.

Intravenous leiomyomatosis (IVL) is defined as the extension into the venous channels of histologically benign smooth muscle tumors originating either from a uterine myoma or from the walls of a uterine vessel. We report a case of IVL extending to the right atrium and right ventricle through the right internal iliac vein and the inferior vena cava. The patient was a 43-year-old woman. The tumor was extirpated by simultaneous median sternotomy and laparotomy with the use of cardiopulmonary bypass. It was necessary to use cardiopulmonary bypass in order to open the right atrium. However, it proved difficult to insert the venous cannulae into the inferior vena cava due to the presence of the tumors. In order to perform the cannulation, a trans-right atrial excision of this tumor was necessary. Nevertheless, hemodynamic deterioration tended to occur during the procedure because of unexpected bleeding. We believe that to safely carry out this operation, it would be better to ensure circulatory arrest before trans-right atrial excision of the tumor. We have been continuing preventive antiestrogen therapy because recurrence would be very likely if any tumorous tissue remained after surgery. Fortunately, no intravenous infiltration of the tumor has been detected by either pelvic computed tomography or ultrasonography during the 26-month follow-up period. Surgical excision of the tumors and postoperative medication are now believed to have been effective.

The patient was a 52-year-old man with a history of antiphospholipid syndrome (APS), renal dysfunction and myasthenia gravis (MG). On May 2, 1998, he had sudden chest pain while sleeping. Enhanced computed tomography revealed acute aortic dissection (DeBakey type I). We performed emergency graft replacement of the ascending aorta and the aortic arch under extracorporeal circulation. Because of perioperative anuria, we used peritoneal dialysis (PD) just after the operation. Two days after the operation, we performed re-intubation nine hours after the extubation of the tracheal tube, and performed re-extubation three days later. For a while, his postoperative course was uneventful, but because of gradual worsening of APS, we administered more prednisolone, but 74 days after the operation, he died of multiple organ failure caused by an opportunistic infection, sepsis, and disseminated intravascular coagulation. This was very rare case of acute aortic dissection with MG and APS. After administration of more glucocorticoids, it is important to be wary of opportunistic infections.

The patient was a 63-year-old man with a history of multiple mononeuritis with hypergammaglobulinemia since 1980. The symptoms gradually worsened, and he had been bed-ridden since 1992. On February 28, 1997, he had sudden dyspnea after defecation. Echocardiography demonstrated a large thrombus in the right atrium and the right ventricle. Enhanced chest computed tomography revealed thrombi in the bilateral pulmonary arteries. The patient was considered to have acute pulmonary thromboembolism, and an emergency operation was indicated. Thrombectomy was performed under extracorporeal circulation through a median sternotomy. No thrombi were found in the right atrium or the right ventricle, and thrombi in the bilateral pulmonary arteries were removed completely. Four days after the operation, a Greenfield filter was implanted in the vena cava inferior because venography detected a thrombus in the right common iliac vein. The postoperative course was uneventful. No pulmonary rethromboembolisms were noticed after the operation. The long duration of being bed-ridden seemed to be the chief cause of thrombosis in the deep veins, and hyperviscosity due to hypergammaglobulinemia may have caused hyperthrombogenicity.