Living-donor lobar lung transplantation for rapidly progressive interstitial pneumonia associated with clinically amyopathic dermatomyositis: report of a case.

Diffuse interstitial pneumonia (IP) associated with collagen disease is a rare indication for lung transplantation. The manifestations of collagen disease are variable and dermatomyositis (DM) is often considered a contraindication for lung transplantation because of active myositis and a high incidence of malignancy. Furthermore, clinically amyopathic dermatomyositis (C-ADM) is associated with rapidly progressive IP resulting in a poor prognosis. Bilateral living-donor lobar lung was transplanted in a 52-year-old female with rapidly progressive IP associated with C-ADM, and the postoperative course was uneventful. To our knowledge, this case represents the first living-donor lobar lung transplantation for a patient with rapidly progressive IP associated with C-ADM

ジュンカン テイシゴ isoflurane キュウニュウ ワ オンキョケツ サイカンリュウ ショウガイ カラ ハイ オ ホゴスル

京都大学0048新制・論文博士博士(医学)乙第12016号論医博第1922号新制||医||952(附属図書館)UT51-2007-H571京都大学大学院医学研究科外科系専攻(主査)教授 福田 和彦, 教授 三嶋 理晃, 教授 米田 正始学位規則第4条第2項該当Doctor of Medical ScienceKyoto UniversityDA

Posterior reversible encephalopathy syndrome due to immunosuppressant after living-donor lobar lung transplantation: report of a case.

Living-donor lobar lung transplantation was performed in a 10-year-old boy with bronchiolitis obliterans after bone marrow transplantation for recurrent acute myeloid leukemia. He developed posterior reversible encephalopathy syndrome (PRES) due to calcineurin inhibitor (CNI) postoperatively, which was recovered with suspension of CNI. PRES should be considered one of the important morbidity after lung transplantation

Survival and relapse pattern after trimodality therapy for malignant pleural mesothelioma.

PURPOSE: Multimodality therapy has been applied to resectable malignant pleural mesothelioma, but the tolerability of the treatment and relapse pattern in detail remain unknown. We reviewed our experience of trimodality therapy as a single-institution study in Japan. METHODS: A total of 16 patients with resectable malignant pleural mesothelioma were intended to treat with extra-pleural pneumonectomy followed by platinum-based chemotherapy and external beam radiation therapy. The histology of the tumors was epithelioid in 10, sarcomatoid in 4, and biphasic in 2. International Mesothelioma Interest Group staging was stage II in 1, stage III in 11, and stage IV in 4. The tolerability to the combined treatment, the survival, and the relapse pattern were examined. RESULTS: All patients underwent a macroscopic complete resection. In all, 14 patients received chemotherapy, and subsequently 13 underwent radiotherapy, indicating a tolerability of 81%. The overall median survival was 28.1 months; and the 2-year and 5-year survival rates were 53.3% and 26.7%, respectively. In patients with stage III or lower disease, the median survival was 37.9 months. Recurrence was seen in eight patients; the first relapse site was local in seven and distant in two. The local recurrences occurred within 24 months, mostly around 12 months, after the extrapleural pneumonectomy, whereas the distant metastases occurred later. CONCLUSION: Trimodality therapy showed a survival benefit in patients with stage III or lower malignant pleural mesothelioma. Most of the recurrences were local. Therefore, better local control is required to improve the prognosis of the disease

Pharmacokinetic Study of Weekly (Days 1-5) Low-dose S-1 in Patients with Non-Small-Cell Lung Cancer

[Background]: S-1, an oral fluoropyrimidine, is usually given for 4 weeks (80 mg/m2/day) followed by a 2-week rest. However, compliance with this regimen is unsatisfactory because of adverse events such as leukopenia, anorexia, and nausea. To reduce adverse effects and improve compliance, we studied a "5-day on/2-day off" low-dose regimen of S-1 and evaluated pharmacokinetics in patients with non-small-cell lung cancer (NSCLC). [Methods]: Twelve patients with NSCLC were divided into 2 groups and received S-1 in a dose of 25 mg twice daily (level 1, n = 6) or 40 mg twice daily (level 2, n = 6) for 5 consecutive days followed by a 2-day rest (5 days on/2 days off) every week. Plasma 5-fluorouracil (5-FU) concentrations were measured. [Results]: The maximum concentration in plasma and the area under the plasma concentration-time curve from 0 to 9 h were respectively 55.3 ± 21.1 ng/ml and 290.2 ± 95.7 ng・hr/ml for level 1, as compared with 104.2 ± 33.5 ng/ml and 541.9 ± 232.3 ng・hr/ml for level 2. These values were similar to those previously reported for a continuous intravenous infusion of 5-FU. Adverse events were grade 1 fatigue (n = 1 in each group) and anorexia (n = 1 in each group). [Conclusions]: A "5-day on/2-day off" low-dose (40 mg twice daily) regimen of S-1 is feasible for the treatment of NSCLC, with acceptable plasma 5-FU concentrations and minimal adverse effects. A phase II or III trial of this regimen in an adjuvant setting is warranted in patients with NSCLC

ABO-incompatible living-donor lobar lung transplantation.

ABO-incompatible living-donor lobar lung transplantation was performed in a 10-year-old boy with bronchiolitis obliterans (BO) after bone marrow transplantation (BMT) for recurrent acute myeloid leukemia (AML). His blood type had changed from AB to O since he underwent BMT and he had no anti-A/B antibody, and received type B and AB donor lobar lungs. To our knowledge, this case represents the first successful living-donor lobar lung transplantation from ABO-incompatible donors

Effect of preprocurement ventilation on lungs donated after cardiac death in a canine lung transplantation model.

[Background.] One method of countering chronic lung donor shortages is the practice of donation after cardiac death (DCD). However, this technique inevitably leads to pulmonary dysfunction related to warm ischemia. One promising method of alleviating this problem is ventilation. However, it can rarely be initiated from the onset of cardiac arrest, particularly in uncontrolled DCD donors. We investigated the protective effect of the last 60 min of ventilation during a 240-min warm ischemic time. [Methods.] We rendered donor dogs cardiac dead and left them at room temperature. Six dogs received ventilation with 100% oxygen for 60 min starting at 180 min after cardiac arrest (ventilation group). Eight dogs received no ventilation. Lungs were harvested 240 min after cardiac arrest, then transplanted into recipient dogs. At 60 min after reperfusion, the right pulmonary artery was ligated, and the function of the left transplanted lung was evaluated. [Results.] In the ventilation group, all six animals survived for 240 min after reperfusion, whereas in the nonventilation group, only four of eight survived. The ventilation group demonstrated significantly better pulmonary oxygenation, shunt fraction, and wet-to-dry weight ratio. Furthermore, the ventilation group revealed significantly higher levels of high-energy phosphates in the lung tissues, fewer apoptotic cells, lower levels of tumor necrosis factor-α and interleukin-8 messenger RNA in the lung tissues, and lower levels of interleukin-6 messenger RNA in the serum. [Conclusion.] Our results suggest that ventilation during the late phase of the preprocurement period may ameliorate ischemia-reperfusion injury in DCD donors