An Experimental Study of Canine Isolated Double Lung Transplantation

The isolated double lung transplantation was performed in 8 adult mongrel dogs using transverse sternotomy in 6 and bilateral thoracotomy in 2 dogs. The first four dogs recieved donor lungs flushed with 4℃ UW solution. Isolated double lung transplantation was completed in 5 dogs ; in the other 3, procedure was not completed because of intraoperative cardiac arrest or massive bleeding. Two dogs with the double lung graft were sacrificed because of severe pulmonary edema, and 3 dogs died of cardiac failure 1 to 6 hours after the operation. We conclude that isolated double lung transplantation can be performed in dogs. However, survival time is limited because of progressive lung edema or cardiac failure

Local Recurrence in the Pectoralis Major Muscle Following Modified Radical Mastectomy for Breast Cancer

Local recurrence in the pectoralis muscle after modified radical mastectomy for breast cancer is rare. We encountered a 53-year-old woman who developed a small nodule on her right antero-lateral chest wall after modified radical mastectomy. Excision biopsy of the mass lesion was performed, and pathological examination revealed a local recurrence in the pectoralis major muscle. Resection of the pectoralis major and minor muscles, subclavicular lymph nodes dissection and postoperative radiation therapy were performed. After operation, no local recurrence appeared, but the patient died of multiple liver and bone metastases two and a half years later

Preoperative Serum Levels of Sialyl Lewisa, Sialyl Lewisx, and Carcinoembryonic Antigens as Prognostic Factors after Resection for Primary Breast Cancer

Sialyl Lewisa (CA19-9) and sialyl LewisX antigens (CSLEXI) may play a role in tumor metastasis by serving as functional ligands in the cell adhesion system. To determine their prognostic value, we examined preoperative serum levels of CA19-9, CSLEXI, and carcinoembryonic antigen (CEA) in 64 female patients with primary breast cancer who underwent radical mastectomy. The patients were divided into two groups, termed the low- and high-antigen groups based on a value selected as a diagnostic cut-off. Correlation between the serum antigen levels, various established clinicopathologic factors, and prognosis were studied by univariate and multivariate analysis. The high- CEA group was at a more advanced stage (including T factor, N factor, M factor, and Stage) than the low-CEA group. Patients with high serum levels of CEA had shorter disease- specific intervals than those with low serum levels (P <0.0001), whereas disease-specific intervals did not differ between low- and high-CA19-9 or CSLEXI groups. A Cox\u27s regression multivariate analysis revealed a high serum CEA level as an independent factor for worse outcome, separate from Stage. In conclusion, an elevated preoperative serum CEA level was a predictor for poor outcome after radical mastectomy for breast cancer, while CA19-9 and CSLEX1 were not

The Efficacy of Postoperative Chemotherapy with Cisplatinum and Pepleomycine for Esophageal Cancer

From May 1984 to August 1991, 58 patients without preoperative adjuvant therapy underwent resection of the esophagus for esophageal cancer. Three weeks after esophagectomy, one cycle of postoperative chemotherapy, consisting of intravenously infused cisplatinum at a dose of 70mg/m2 on day 1 and intramuscular pepleomycine at a dose of 5mg/body from day 1 to day 5, was administered in the 24 patients. In all patients receiving chemotherapy, mild fatigue or poor appetite occurred after drug administration, but severe drug toxicity, such as bone marrow depression, gastrointestinal bleeding or pulmonary fibrosis, did not occur. Eighteen patients (75%) died from cancer. The 3-year survival rate was 22.9% and the 5-year surival rate was 17.1%. In the patients who underwent curative operations, the 3-year and 5-year survival rates were 46.2% and 27.7%. However, there was no significant difference in the survival rates between the patients with postoperative chemotherapy and patients with esophagectomy alone. We conclude that one cycle of postoperative chemotherapy with cisplatinum and pepleomycin does not affect the survival of patients undergoing esophagectomy for esophageal cancer

Complications and Management of Hepatic Arterial Infusion Chemotherapy for Liver Metastasis

Complications and management of hepatic arterial infusion chemotherapy for 79 patients with liver metastasis were studied. Complications were observed in 20 cases (25.3%), who included 8 cases (88.9%) of lapalotomy group and 12 cases (17.6%) of left subclavian group. In lapalotomy group, they were 5 cases of system occlusion, 2 cases of catheter tip dislocation and catheter reinsertion through the left subclavian artery was performed in 4 cases. In left subclavian group, they were 4 cases of system occlusion, 3 cases of catheter tip dislocation, 2 cases of hepatic arterial occlusion and hepatic arterial infusion chemotherapy was continued with catheter reinsertion in 8 of the 9 cases. It was considered that positive anti-complication measures including catheter reinsertion would contribute to the improvement of therapeutic results

Application of double stapling technique after anterior resection for rectal cancer

Double stapling technique (DST) were applied in 22 cases who underwent low and high anterior resection of the rectum. Postoperative complications were encounted in six, three were mild strictures and the other three were minor leakages. All were not severe, demonstrating no correlation to the conditions of the anastomosis and subsided by conservative therapy in a short period. Anastomotic leakage occurred in three but these were based on technical problems and it is possible to avoid with careful surgical management. In conclusion, DST is of great benefit for the treatment of carcinoma of the rectum to reduce the consuming operation time and to lessen the risk of bacteriological and oncological contaminations

Surgery for Stage I Lung Cancer

The surgical outcome for 209 early lung cancers was clinically evaluated. 1) Most (93%) of Stage I cancers were composed of pT1N0 and pT2N0 while 6.3 % was pT1N0. 2) Even in early cancer, nodal involvement and distant metastasis occurred and these related closely to their prognoses. 3) Reoperation should be indicated for recurrence with a 10 month or more time interval from the first operation and should be recommended, if possible. Advances in diagnostic technique for lung cancer have been achieved. As a consequence, early lung cancer has become clinically detected and the surgical curability has been improved with time. This study was undertaken to evaluate surgical treatment for stage I lung cancer patients

Allo-transplantation of the Lung Preserved 24 Hour with UW Solution and the Preventive Effect of Flush with Leukocyte-depleted Blood before Reperfusion.

The purpose of this study was to evaluate the possibility of clinical use of a 24 hour preserved donor lung with UW solution and the effects of the flush with Leukocyte depleted before reperfusion. The left canine lung was used for allotransplantation and dogs were divided into 4 groups. The donor lungs preserved for 24 hours with UW solution (Group 1 and 2) or EC solution (Group 3 and 4)were transplanted in mongrel dogs. Moreover, the flush with Leukocytedepleted blood for 30-60 minutes was performed in Group 2 and 4. The severity of reperfusion injury at 60 minutes of reperfusion was assessed and the graft funchion was observed for 14 days. The PaO2 value at 60 minutes of reperfusion was 345 ± 132, 261 ± 161, 312 ± 120, 152 ± 146 Torr, static compliance was 31.2 ± 4.5, 27.8 ± 5.0, 22.2 ± 9.0, 17.6 ± 6.1, and dynamic compliance was 13.9 ± 1.9, 14.2 ± 1.9, 10.9 ± 1.8, 11.7 ± 1.5 ml/cmH2O, respectively. There were no significant differences among the groups. And no significant deterioration was seen in these parameters as compared with the figures before harvesting. Pulmonary vascular resistance (PVR) was 1824 ± 650, 2100 ± 564, 3830 ± 1549, 4553 ± 1819 dyne sec cm-5 respectively. Group 1 and 2 showed significantly lower PVR than Group 3 and 4. Tissue Lipid Peroxide was 0.75 ± 0.15, 0.85 ± 0.21, 1.52 ± 0.85, 0.70 ± 0.27 nmolMDA/mg pt, and the ability of superoxide generation of neutrophils (SOX) was 4697 ± 1886, 4466 ± 1760, 6934 ± 156, 3125 ± 725 respectively at 60 minutes of reperfuison. Group 1, 2 and 4 showed better results than Group 3. There was a significant decrease in SOX of Group 4 as compared with Group 3. Recipients were administered Cyslospoline A (20 mg/kg/day) and Azachiopurine (2 mg/kg/day). The survival rates were 100% (6/6), 57% (4/7), 0% (0/4), 0% (0/4) respectively. And 4 of 6 in Group 1 and 3 of 7 in Group 2 functioned well with PaO2 of 354 ± 66, 317 ± 178 Torr at sacrifice (10 to 21 POD). And a slight rise in PVR was recognized in both groups as compared with the figures before harvesting. (2524 ± 894, 2947 ± 381 respectively) Histological examination after 60 minutes of reperfusion revealed mild interstitial edema in Group 1 and 2. Severe alveolar edema, marked vascular congestion, and perivascular extravasation were seen in Group 3 and 4, But the grade of vascular congestion was slightly lower in Group 4 as compared with that in Group 3. At sacrifice survivors showed rejection in three dogs and none in four dogs, in which interstitial thickening, diffues perivascular cuffing was seen. There was no significant difference between Group 1 and 2. The data suggest that UW solution may prepare the 24-hour-preserved donor lung for succesful lung transplantation. And the flush with leukocyte depleted blood showed attenuation of the tissue lipid peroxidation and superoxide generation of neutrophils in the lung preserved with EC but not with UW. The flush with leukocytedepleted blood may play a role in attenuation of neutrophils related reperfusion injury