Diagnostic ability of contrast-enhanced computed tomography formetastatic cervical nodes in head and neck squamous cell carcinomas : significance of additional coronal reconstruction images

Purpose: To evaluate the significance of additional coronal reconstruction images in the diagnostic ability of contrastenhanced computed tomography (CECT) for metastatic cervical nodes in patients with head and neck squamous cell carcinomas (HNSCC). Material and methods: We retrospectively assessed 97 metastatic and 141 reactive histologically proven cervical nodes of 38 patients with HNSCC, who underwent CECT before neck dissection. Observer #1, an expert radiologist in head and neck imaging, and observer #2, a general radiologist, reviewed all CECT images. The observers first assessed the presence of nodal metastasis using axial CECT alone (A-CECT). Three days later, they reassessed its presence using combined axial and coronal CECT (A&C-CECT). Results: The sensitivity of A-CECT vs. A&C-CECT was 73.2% vs. 75.3% for observer #1 (p = 0.73) and 69.1% vs. 69.1% for observer #2 (p = 1.00), respectively. The specificity of A-CECT versus A&C-CECT was 92.2% vs. 97.2% for observer #1 (p < 0.05) and 92.9% vs. 95.7% for observer #2 (p = 0.22), respectively. The accuracy of A-CECT versus A&C-CECT was 84.5% vs. 88.2% for observer #1 (p < 0.05) and 83.2% vs. 85.3% for observer #2 (p = 0.30), respectively. The area under the curve (AUC) of A-CECT vs. A&C-CECT was 0.86 vs. 0.91 for observer #1 (p < 0.05) and 0.85 vs. 0.85 for observer #2 (p = 0.80), respectively. Conclusions: The specificity, accuracy, and AUC increased with the use of coronal images during the assessment by the expert radiologist. The appropriate use of coronal images allowed proper configuration recognition and improved diagnostic ability

Effects of Rolipram and Cilostamide on Renal Functions and Cyclic AMP Release in Anesthetized Dogs 1

ABSTRACT The present study was undertaken to examine whether phosphodiesterases III and IV regulate renal cAMP level and whether inhibition of these enzymes influences renal functions in anesthetized dogs. The intrarenal arterial infusion of rolipram (0.1, 0.3, and 1 g/kg/min), a selective phosphodiesterase IV inhibitor, increased renal blood flow, glomerular filtration rate, urine flow rate, and urinary Na ϩ excretion with elevating arterial and renal venous plasma cAMP concentrations and urinary cAMP excretion. However, cilostamide (0.1, 0.3, and 1 g/kg/min), a selective phosphodiesterase III inhibitor, did not affect the values of these parameters. Indomethacin (3 mg/kg i.v. bolus and 1 mg/kg/min i.v. infusion), a cyclooxygenase inhibitor, reduced the basal arterial and renal venous plasma cAMP concentrations and blunted the rolipram-induced elevation of cAMP concentrations and urinary cAMP excretion. The effects of rolipram on renal hemodynamics and urine formation were attenuated in the presence of indomethacin. These results suggest that in the dog kidney in vivo, 1) phosphodiesterase IV, but not phosphodiesterase III, participates in degradation of cAMP and 2) the inhibition of phosphodiesterase IV enhances glomerular filtration and urinary Na ϩ excretion, the responses of which depend in part on indomethacin-susceptible (prostaglandin-mediated, probably) control of basal cAMP level

胸部外科手術後のPeak cough flow とMaximum phonation time の関係

研究論文Original Articles　手術後の肺活量（VC）が咳嗽力（PCF）に影響を及ぼすことは明らかだが，最大発声持続時間（MPT）で評価される声門閉鎖機能低下がPCF に及ぼす影響は明らかとなっていない．本研究では呼吸器外科手術後の患者28 例においてMPT とPCF の関係を明らかにすることを目的とし，手術後1 日目〜5 日目にPCF，MPT，VC を測定した．手術後5 日目までPCF およびMPT は，手術前と比較し有意に低下した（p <0.05）． またPCF とMPT の回復率には手術後1 日目のみに相関関係を認めた（r= 0.53，p <0.05）．PCF とVC の回復率は手術後1 日目〜5 日目まで相関を認めた（r = 0.41-0.27，p <0.05）．手術後の声門閉鎖機能低下が咳嗽力に及ぼす影響は，人工呼吸器離脱後１日目までで，その後はVC の影響を強く受けると考えられた．　The vital capacity（ VC） after thoracic surgery affects peak cough flow（ PCF）.　However, the influence of glottic closure deterioration evaluated by maximum phonation time （MPT） on PCF is not clear. We clarified the relationship between coughing and vocal cord function in 28 patients after thoracic surgery. We measured the PCF, MPT, and VC on postoperative days 1 to 5. On postoperative day 1, the mean PCF decreased to 58.0% and the mean MPT decreased to 62.5%. The mean PCFs and MPTs on postoperative days 1 to 5 were significantly lower than the preoperative PCF and MPT, respectively （p < 0.05）. There was a positive correlation between the rates of change in the PCF and MPT only on postoperative day 1 （r = 0.53, p < 0.05）. There was also a positive correlation between the rates of change in the PCF and VC on postoperative days 1 to 5 （r = 0.41–0.27, p < 0.05）. Cough intensity was affected by the vocal cord function on postoperative day 1. However, after postoperative day 2, the cough intensity was not influenced by the vocal cord function. Declining glottal closure function（ vocal cord function） immediately after surgery affects the cough intensity and vocal function. The influence of reduction in glottic closure function after surgery on coughing decline was observed up to 1 day after the withdrawal of ventilatory support. After the secondpostoperative day, the PCF was strongly influenced by the VC

A new approach to left sleeve pneumonectomy: complete VATS left pneumonectomy followed by right thoracotomy for carinal resection and reconstruction

Abstract Background Left sleeve pneumonectomy is a challenging operation that requires individualized approaches. Here, we present a new minimally invasive combined thoracoscopic approach. Case presentation A 61-year-old woman was diagnosed with tracheobronchial adenoid cystic carcinoma. The tumor originated from the left main stem bronchus, and tumor with carinal involvement was observed. We judged that complete resection would be possible via left sleeve pneumonectomy. However, because tumor involvement with the esophagus and descending aorta was suspected, evaluation of resectability in advance was necessary. After confirmation via examination thoracoscopy of no involvement with the surrounding organs, complete VATS left pneumonectomy was performed and followed by right thoracotomy for carinal resection and reconstruction. Conclusions When thoracoscopic surgery becomes mainstream, this minimally invasive combined thoracoscopic approach might be an optimal option for patients who require left sleeve pneumonectomy