Importance of follow-up inspection after pulmonary angioplastic procedures for lung cancer surgery.

The original publication is available at www.springerlink.co

Lung Xenotransplantation in the Rat

The aim of this study was to investigate the functional and morphological aspects of orthotopic lung xenograft rejection in a concordant hamster-to-rat donor-recipient species combination. All transplanted lungs had infiltrates during the 3 postoperative days. Complement-dependent cytotoxicity assays revealed that anti-hamster lymphocytotoxic antibody titer increased to 5.2±1.1 (p < 0.05 vs. 1 day) 3 days after transplantation and reached 9.8±0.5 (p < 0.05 vs. 1, 3 and 5 days) 7 days after transplantation. Titers were not elevated 1 day after transplantation. The CD4+/CD8+ ratio in peripheral blood lymphocytes increased significantly at 3 days (p < 0.05, versus untransplanted) . At 5 th day, the ratio was lower than at 3 rd day (p < 0.05). There was no significant difference in B-cell population between rats before grafting and each group. Histologically, xenotrasplanted grafts were characterized by perivascular cellular infiltrates and edema 3 days after transplantation. The inflammatory infiltrate formed a dense cuff around the venules and arterioles. At 5 th day, arteriolar lumenal narrowing was observed, and air-space containing many alveolar macrophages and lymphocytes. Immunohistochemical analysis of these grafts showed strong IgM and C3 deposits in the vascular endothelium, without any igG deposits. No IgM, C3 or IgG deposits were observed in normal hamster lung. This study indicates that both the cellular and humoral immune system mediate primary acute rejection in the hamster-to-rat orthotopic lung xenograft model

Protective effect of FUT-175 on pulmonary function of xenografts in a guinea pig-to-rat lung perfusion model

Background: FUT-175 (nafamostat mesilate) has a variety of pharmacological effects; in addition to its stable potent serine protease inhibitory activity, it exerts far stronger anti-complement activity than other protease inhibitors. Here, we evaluated the protective effect of FUT-175 on pulmonary function of xenografts in an ex vivo guinea pig-to-rat lung perfusion model, using a device for analyzing pulmonary function in small animals. Methods: Animals were divided into three groups (n = 6 each), Isograft (Group I), Xenograft (Group X), and Xenograft with FUT-175 (Group XF). In the latter, 10 mg of FUT-175 was added to the extracorporeal circuit before perfusion with xenogeneic blood was started. The following parameters were serially measured in these three groups: complement activity causing 50% hemolysis (CH50 units) in the perfusion blood either before or during perfusion, pulmonary arterial pressure, dynamic pulmonary compliance, and airway resistance. In addition, Hematoxylin and Eosin staining of the lungs and assays of rat IgM, IgG, and anti-C3 deposition were carried out after perfusion. Results: The duration of satisfactory pulmonary function after the start of perfusion was significantly increased in Group XF. CH50 in Group XF decreased significantly than in Group X. In addition, FUT-175 suppressed both the increase in pulmonary arterial pressure and airway resistance, and the decrease in dynamic pulmonary compliance. In Group XF, intraalveolar hemorrhage and the thickening of the arterial wall were not observed. Groups X and XF showed deposition of IgM, IgG, and C3 at the endothelium of the pulmonary arteries but less in Group I. Conclusions: This study suggests that FUT-175 inhibited complement activation including the alternative pathway and improved lung xenograft pulmonary function. FUT-175 ameliorates hyperacute rejection in a guinea pig-to-rat ex vivo xenogeneic lung perfusion model

Prophylactic Ligation of the Innominate Artery and Creation of Tracheostomy in a Neurologically Impaired Girl: A Case Report

Tracheoinnominate artery fistula is known as a potentially fatal complication for patients who depend on tracheostomy or tracheoesophageal diversion. Since the bleeding from a TIF is often difficult to control, preventative procedures are recommended to avoid this complication. An 11-year-old girl with hypoxic-ischemic encephalopathy and scoliosis developed tracheal stenosis caused by compression from the innominate artery. Respiratory control with intubation through the tracheal stenosis was needed, and the patient was at high risk for developing a TIF. She underwent ligation of the innominate artery at tracheostomy. Subsequent tracheostomy revealed a widened tracheal lumen and no further complications. Prophylactic ligation of the innominate artery and creation of tracheostomy might be considered as a valid option for patients at high risk of developing TIF

Significance of genomic instability in breast cancer in atomic bomb survivors: analysis of microarray-comparative genomic hybridization

<p>Abstract</p> <p>Background</p> <p>It has been postulated that ionizing radiation induces breast cancers among atomic bomb (A-bomb) survivors. We have reported a higher incidence of <it>HER2 </it>and <it>C-MYC </it>oncogene amplification in breast cancers from A-bomb survivors. The purpose of this study was to clarify the effect of A-bomb radiation exposure on genomic instability (GIN), which is an important hallmark of carcinogenesis, in archival formalin-fixed paraffin-embedded (FFPE) tissues of breast cancer by using microarray-comparative genomic hybridization (aCGH).</p> <p>Methods</p> <p>Tumor DNA was extracted from FFPE tissues of invasive ductal cancers from 15 survivors who were exposed at 1.5 km or less from the hypocenter and 13 calendar year-matched non-exposed patients followed by aCGH analysis using a high-density oligonucleotide microarray. The total length of copy number aberrations (CNA) was used as an indicator of GIN, and correlation with clinicopathological factors were statistically tested.</p> <p>Results</p> <p>The mean of the derivative log ratio spread (DLRSpread), which estimates the noise by calculating the spread of log ratio differences between consecutive probes for all chromosomes, was 0.54 (range, 0.26 to 1.05). The concordance of results between aCGH and fluorescence in situ hybridization (FISH) for <it>HER2 </it>gene amplification was 88%. The incidence of <it>HER2 </it>amplification and histological grade was significantly higher in the A-bomb survivors than control group (P = 0.04, respectively). The total length of CNA tended to be larger in the A-bomb survivors (P = 0.15). Correlation analysis of CNA and clinicopathological factors revealed that DLRSpread was negatively correlated with that significantly (P = 0.034, r = -0.40). Multivariate analysis with covariance revealed that the exposure to A-bomb was a significant (P = 0.005) independent factor which was associated with larger total length of CNA of breast cancers.</p> <p>Conclusions</p> <p>Thus, archival FFPE tissues from A-bomb survivors are useful for genome-wide aCGH analysis. Our results suggested that A-bomb radiation may affect the increased amount of CNA as a hallmark of GIN and, subsequently, be associated with a higher histologic grade in breast cancer found in A-bomb survivors.</p

Arthralgia and Osteolytic Lesions Associated with Traumatic Pancreatitis in a 10-Year-Old Girl

A case of traumatic pancreatitis with subsequent joint pain and osteolytic lesions is presented. A 10-year-old girl was admitted to our hospital with abdominal pain caused by blunt epigastric injury. She was diagnosed with traumatic pancreatitis, and multiple pancreatic pseudocysts subsequently developed. Two weeks after admission, she complained of joint pain, and MR revealed osteolytic lesions of both knee joints. On the 58th day, endoscopic transgastric pseudocyst drainage was performed. Joint pain and osteolytic lesions resolved rapidly, in parallel with the decrease in serum amylase level and pseudocyst size

Resection of Segments 4, 5 and 8 for a Cystic Liver Tumor Using the Double Liver Hanging Maneuver

To achieve complete anatomic central hepatectomy for a large tumor compressing surrounding vessels, transection by an anterior approach is preferred but a skillful technique is necessary. We propose the modified technique of Belghiti's liver hanging maneuver (LHM). The case was a 77-year-old female with a 6-cm liver cystic tumor in the central liver compressing hilar vessels and the right hepatic vein. At the hepatic hilum, the spaces between Glisson's pedicle and hepatic parenchyma were dissected, which were (1) the space between the right anterior and posterior Glisson pedicles and (2) the space adjacent to the umbilical Glisson pedicle. Two tubes were repositioned in each space and ‘double LHM’ was possible at the two resected planes of segments 4, 5 and 8. Cut planes were easily and adequately obtained and the compressed vessels were secured. Double LHM is a useful surgical technique for hepatectomy for a large tumor located in the central liver

Ischemic time by the intermittent occlusion of hepatic inflow (Pringle’s maneuver) influences surgical outcome after hepatectomy

Background: Intermittent occlusion of hepatic inflow, so-called Pringle’s maneuver, is a useful technique to control intraoperative bleeding; however, it can lead to ischemia-reperfusion injury. We examined the influence of ischemic time on surgical factors, posthepatectomy liver function and morbidity. Methods: The clinical records of 296 patients who underwent an elective hepatectomy for liver disease between 2004 and 2013 were retrospectively examined. Univariate and multivariate analyses of clinicopathological and surgical factors associated withhepatic-inflow occlusion time were performed. Results: The mean and median times of total hepatic-inflow occlusion were 47±23 minutes (5-173 mL) and 45 minutes, respectively. The occlusion time was significantly correlated with increased indocyanine-green retention rate, total operation time, amount of blood loss or red cell transfusion, postoperative morbidity and hospital stay (each p<0.05). Blood loss upon the use of occlusion tended to be lower than that in its absence (568±602 mL vs. 887±841 mL) (p=0.075). The occlusion time was shorter in limited resection and longer in central bi-segmentectomy or sectionectomy (p<0.05). The occlusion time was significantly correlated with the maximum alanine aminotransferase level (r=0.291, p<0.01). The predictive cut-off value of occlusion time for these correlated parameters ranged between 45 and 46.5 minutes (p<0.05). Hepatic-inflow occlusion was not associated with morbidity in cirrhosis. Conclusion: A longer ischemic time induced increased blood loss or related transfusion, operating time, postoperative liver injury, complication rate and duration of hospital stay

Thoracoscopic repair of neonatal congenital diaphragmatic hernia

Purpose: To describe the surgical technique and criteria for neonatal congenital diaphragmatic hernia (CDH) repair. Methods:CDH repairs were carried out by a thoracoscopic approach between February 2013 and April 2014. Preoperatively, the neonateswere stabilized with high-frequency oscillatory ventilation and nitric oxide inhalation. They had no associated cardiac anomalies. Confirmation of the appropriateness of thoracoscopic repair was determined based on the patient’s stability in the decubitus position and no clinical signs of pulmonary hypertension. The operation was carried out with one optical and two operating trocars. The hernia defect was closed by interrupted nonabsorbable sutures. The more lateral portion of the defect was repaired with a U-shaped stitch using a laparoscopic percutaneous extraperitoneal closure needle. Results: Three neonates underwent repair via thoracoscopy. Two patients underwent primary CDH repair, and conversion to laparotomy was required in the other because of a large diaphragmatic defect. There was no intraoperative cardiorespiratory instability or postoperative complications. Conclusions: Thoracoscopic repair of neonatal CDH is a feasible and safe procedure for the patients who have respiratory stability in the decubitus position, no pulmonary hypertension and no intra-thoracic liver herniation