Staging System of Thymoma

Introduction:Thirty years have gone by since the Masaoka staging system of thymoma was proposed in 1981. Although the Masaoka staging system has been accepted by many surgeons and pathologists, some proposals of revision and improvements have been suggested. At this time, I reinvestigated the Masaoka staging system based on the recent follow-up study of the thymomas resected at Nagoya City University.Methods:Using the follow-up results of 211 thymomas in Nagoya, I analyzed the following aspects: (1) evaluation of the Masaoka staging system as a prognostic factor in the Nagoya series and (2) critical assessment of the proposals of revision to the Masaoka staging system.Results:(1) Univariate analysis showed that Masaoka stages were significantly prognostic for overall survival (p < 0.0001). (2) The difference of survivals between stage I and II was not significant, but progression-free survival of stage I was 100% for up to 20 years, whereas one tumor death case in stage II was found. (3) Differences of survival between the cases with and without great vessel invasion in stage III were not significant. (4) Prognosis of N+ tumors was yet better defined.Conclusion:(1) The Masaoka staging system remains a valuable prognostic factor. (2) Combination of stage I with II and separation of stage III into subgroups are not recommended. (3) At the moment, it is better to include N+ tumors in stage IVb

Esophageal tracheobronchoplasty for diseases of the central airway

AbstractThree infants with congenital tracheal stenosis and three adults with various diseases of the central airway underwent esophageal tracheobronchoplasty to repair long-segment stenoses and defects. The primary operative goal was enlargement of the stenosis ( n = 4), repair of the defect ( n = 1), or both ( n = 1). Cardiopulmonary support was required in two cases. All three infants were operated on for generalized congenital tracheal stenoses. There was one postoperative death on the fifth day. Another infant died of pneumonia 3 months after operation. Tracheal patency was excellent in two infants. One infant is well without symptoms 6 years after the operation, although balloon dilation was required three times during the first postoperative year. In the three adult patients, the primary diseases were congenital tracheal stenosis, iatrogenic injury associated with relapsing polychondritis, and malignant mediastinal tumor involving the trachea. All lesions involved both the trachea and main stem bronchi. Postoperative airway patency was excellent in all three adults, although expandable metallic stents had to be inserted in one patient. Postoperative pulmonary function was improved, particularly forced expiratory volume in 1 second and peak expiratory flow rate. Although the postoperative mortality rate was still high, especially among the infants, and prolonged postoperative ventilatory support was required for five of the six patients, long-term patency and postoperative pulmonary functional improvement are encouraging. (J Thorac Cardiovasc Surg 1996;112:124-9

Migration, early axonogenesis, and Reelin-dependent layer-forming behavior of early/posterior-born Purkinje cells in the developing mouse lateral cerebellum

<p>Abstract</p> <p>Background</p> <p>Cerebellar corticogenesis begins with the assembly of Purkinje cells into the Purkinje plate (PP) by embryonic day 14.5 (E14.5) in mice. Although the dependence of PP formation on the secreted protein Reelin is well known and a prevailing model suggests that Purkinje cells migrate along the 'radial glial' fibers connecting the ventricular and pial surfaces, it is not clear how Purkinje cells behave in response to Reelin to initiate the PP. Furthermore, it is not known what nascent Purkinje cells look like <it>in vivo</it>. When and how Purkinje cells start axonogenesis must also be elucidated.</p> <p>Results</p> <p>We show that Purkinje cells generated on E10.5 in the posterior periventricular region of the lateral cerebellum migrate tangentially, after only transiently migrating radially, towards the anterior, exhibiting an elongated morphology consistent with axonogenesis at E12.5. After their somata reach the outer/dorsal region by E13.5, they change 'posture' by E14.5 through remodeling of non-axon (dendrite-like) processes and a switchback-like mode of somal movement towards a superficial Reelin-rich zone, while their axon-like fibers remain relatively deep, which demarcates the somata-packed portion as a plate. In <it>reeler </it>cerebella, the early born posterior lateral Purkinje cells are initially normal during migration with anteriorly extended axon-like fibers until E13.5, but then fail to form the PP due to lack of the posture-change step.</p> <p>Conclusions</p> <p>Previously unknown behaviors are revealed for a subset of Purkinje cells born early in the posteior lateral cerebellum: tangential migration; early axonogenesis; and Reelin-dependent reorientation initiating PP formation. This study provides a solid basis for further elucidation of Reelin's function and the mechanisms underlying the cerebellar corticogenesis, and will contribute to the understanding of how polarization of individual cells drives overall brain morphogenesis.</p

Epidemiology of Infectious Hepatitis 1st. Chapter Epidemiologic Observations for Infectious Hepatitis in Akaiwa District (No. 1)

Since August 1951 to Feb. 1953, there was a great epidemic of serious infectious hepatitis over the area including Toyota, Onoda, Kama villages in Akaiwa County, as well as Kumayama village in wake County; observing its state, the following results were obtained. 1. Death toll has amounted to 13, out of 93 patients: its mortality rate, 13.98%; in number of the patients, Kama at the top, next, Toyoda, Onoda and Kumayama village, in literal order. 2. The epidemic took the direction, from the south extending to the north in a slow march, taking a hamlet as unit, showed a lack of specific seasonal occurence. 3. As to age, it has ranged roughly from 10 to 60, amid which 21-30 figured out as top years; below 10, only 4 cases; above 70, 5 cases. As to sex, almost similar in number. 4. As to profession, principally, farming people; as one can suppose from its locality. In making investigations into the cause of disease. certain consideration must be taken on the great responsibility imposed on farmers' wives. 5. The infection for this disease was classified as village infection or familiary infection; among 22 cases (23.4% of total patients) of familary infection, there were 4 families, each yielding even 3 sickened members; 5 families whose two members taken infection; in total, amnunted to 9 families. Among these tribal infection, report has been submitted about 1 family whose infection tract was clearly traced, as well as a family in which, if man did not expose certain inapparent infections, all cases have proved utterly whimsical. 6. The incubation period for this disease may probably be estimated to be about 24-27 days, if it may be supposed from these infectious state, and would be considered perorale infection