Experimental study on lung preservationfunction of a 6 hour-preserved donor lung.

A donor lung was preserve during 6 hours by means of simple immersion with 4℃ modifield Euro-Collin\u27s Solution and it was orthotopically transplanted. The function of transplanted lung was evaluated in terms of O2 intake by gas exchange and hemodynamic study following transplantation. The results were as follows 1) PaO2 values were significantly fallen immediately after transplantation. However, these were reverted to the normal on day 7.2) Intrapulmonary shunt rates did not significantly vary. In contrast, A-aDO2 values correlated with PaO2 values, reflecting uneveness of ventilation/perfusion and failure of diffusion in the early stage of postoperation. 3) Hemodynamically the mean pulmonary artery pressure and the pulmonary vascular resistance were increased immediately after transplantation but these returned on day 14. 4) On chest x-ray film, the infiltrative shadow on the transplanted lung was gradually reduced on day 7 and on day 14, the transplanted lung had become normal aeration on chest x-ray film. 5) In the early stage of postoperation, main histologic finding of a storaged donor lung was interstitial lung edema. In conclusion, it is clinically applicable that a 6 hour storaged lung by simple immersion with modified Euro-Collin\u27s solution is well functioning and its function should be expected to be the same as that of nonstoraged one

Gene transfer of tumor necrosis factor inhibitor improves the function of lung allografts

AbstractBackgroundTumor necrosis factor is an important mediator of lung transplant acute rejection. Soluble type I tumor necrosis factor receptor binds to tumor necrosis factor-α and -β and inhibits their function. The objectives of this study were to demonstrate efficient in vivo gene transfer of a soluble type I tumor necrosis factor receptor fusion protein (sTNF-RI-Ig) and determine its effects on lung allograft acute rejection.MethodsThree groups of Fischer rats (n = 6 per group) underwent recipient intramuscular transfection 24 hours before transplantation with saline, 1 × 1010 plaque-forming units of control adenovirus encoding β-galactosidase, or 1 × 1010 plaque-forming units of adenovirus encoding human sTNF-RI-Ig (Ad.sTNF-RI-Ig). One group (n = 6) received recipient intramuscular transfection with 1 × 1010 Ad.sTNF-RI-Ig at the time of transplantation. Brown Norway donor lung grafts were stored for 5 hours before orthotopic lung transplantation. Graft function and rejection scores were assessed 5 days after transplantation. Time-dependent transgene expression in muscle, serum, and lung grafts were evaluated by using enzyme-linked immunosorbent assay of human soluble type I tumor necrosis factor receptor.ResultsRecipient intramuscular transfection with 1 × 1010 plaque-forming units of Ad.sTNF-RI-Ig significantly improved arterial oxygenation when delivered 24 hours before transplantation compared with saline, β-galactosidase, and Ad.sTNF-RI-Ig transfection at the time of transplantation (435.8 ± 106.6 mm Hg vs 142.3 ± 146.3 mm Hg, 177.4 ± 153.7 mm Hg, and 237.3 ± 185.2 mm Hg; P = .002, .005, and .046, respectively). Transgene expression was time dependent, and there was a trend toward lower vascular rejection scores (P = .066) in the Ad.sTNF-RI-Ig group transfected 24 hours before transplantation.ConclusionsRecipient intramuscular Ad.sTNF-RI-Ig gene transfer improves allograft function in a well-established model of acute rejection. Maximum benefit was observed when transfection occurred 24 hours before transplantation

Less Invasive Surgery under VATS for Synchronous Bilateral Lung Cancers

A patient with synchronous bilateral lung cancer is described. She was successfully treated with less invasive surgery by right S10 wedge resection using Video-assisted thoracic surgery (VATS) and left S6 segmentectomy. We judged she had synchronous primary lung cancers in the bilateral lung by histological study. She has remained well for 31 months. VATS is an effective approach for multicentric primary lung cancers and minimize the surgical stress of the simultaneous resection of bilateral tumor

Surgery for Tracheal Stenoses

On the basis of an analysis in the outcome of tracheal surgery, it proved useful for the relief of respiratory distress. As a result, we are confident that surgical management should be mandatory for tracheal stenoses, provided that the patient\u27s general condition is satisfactory with preoperatively meticulous cares. The incidence of occurring the risks of postoperative complications was relatively high in patients with malignant lesion. It seemd preferable to select a wide resection as far from the visible margin of the tumor as possible, in particular, in case of adenoid cystic caricnoma

Postoperative Complications and Mortality of the Patients with Esophagectomy for Esophageal Carcinoma

Between 1970 and 1989, 154 patients underwent esophagectomy for esophageal cancer in our department. One hundred and twenty-one patients underwent esophageal resection and reconstruction and 14 had esopahgectomy alone without reconstruction. There were 26 operative deaths within 30 days after operation. However, the mortality rate was 29.1% during the 1970 to 1979 period, and 10.1% after 1980. Predominant postoperative complications were anastomotic leak, pneumnia, sepsis and recurrent laryngeal nerve paralysis. The rates of postoperative complications during 1970 to 1970, was 67.3% and was 43.3% after 1980. The rate of anastomotic leak was 45.4% in the former years, but it improved to 26.6% in the later period. To prevent the postoperative complications, careful perioperative management of the patients are essential

Thymectomy for myasthenia gravis

The effect of thymectomy on elimination of a myasthenic symptom was clinically evaluated. The operative approach was primarily extended thymectmy of choice via midsternotomy in all but one of transcervical approaches. Most of them belonged to Osserman II b and II a of the disease type. Thirteen cases were in combination with thymoma and thirty-five were not in combination. Thymectomy yields a 53.8% effectiveness rate for patients with thymoma and a 65.7% for patients without thymoma. There was no defenitive relationship between the operation effectiveness and the suffering duration of time. However, aggravation and no improvement of a clinical sign after thymectomy were observed in patients with a severe or moderate degree of germinal center formation

Risk Factor for Recurrence of Breast Cancer

The risk factors of recurrence following surgical treatment for patients with breast cancer were clinically evaluated on the basis of a result of clinical analysis. In this study, it is emphasized that special attention should focus on tissue CEA and DNA analysis. In conclusion, clinical uses of tissue positive CEA and aneuploid pattern in analysis of nuclear DNA content in cancer cells are of great value to forecast recurrence

Paget\u27s Disease of the Female Breast

Eight patients of Paget\u27s disease of the breast operated during 1969 and 1990 were studied. Four patients had Paget\u27s diseases confirmed to the nipple and remaining 4 patients had an associated palpable tumor. Seven patients had invasive intraductal carcinoma and only one had noninfiltrative ductal carcinoma. None of the patients without palpable mass had axillary lymph node metastasis, while three of four patients (75%) with palpable mass in the breast had axillary lymph node metastases. One patient of 4 without palpable mass died of lung cancer 19 years and 8 months after operation. Remaining 3 are alive and well 3 years, 4 years and 16 years following mastectomy. Two of 4 patients with palpable breast mass died of metastasis 6 months and 8 months after surgery. Remaining 2 are alive and well 7 months and 22 years following mastectomy

Recurrent Breast Cancer with Bone Metastasis

Twenty patients with bone metastasis following surgery for recurrent breast cancer were clinically evaluated in analysis of clinicopathologic aspect in comparison with those with metastases in other organ. It is more likely that bone metastasis occurs in younger patients as compared with other organ metastasis. However, there were no certain clinical patterns of patients with bone metastasis including the survival time, as compared with those with other organ metastasis. In this series, ER and PgR failed to measure and to elucidate the effect of hormore therapy because a subject includes parts of patients prior to development of ER and PgR measurement. In conclusion, there were no clinicopathologic features in patients with bone metastasis following surgical treatment of breast cancer except for occurrence in younger patients

Long-term Survivors after Pulmonary Resection for Bronchogenic Carcinoma

Surgical resection is the most useful modality of treatment for patients with lung cancer. However, two third of the patients who underwent pulmonary resection died within 5 years after operation due to recurrent diseases. This study reviewed long-term survivors (more than 10 years after lung resection) and examined the factors relating to prognosis and the quality of life of the patients after 10 years. Two-hundred and forty-nine patients underwent pulmonary resections for bronchogenic carcinoma in the First Department of Surgery of Nagasaki University Hospital between 1955 -and 1978. Among 237 who tolarated operations, 32 patients (13.5%) survived more than 10 years after pulmonary resections. There were 23 men and 9 women. Among the patients with stage I, 25/85 (29.4%) survived more than 10 years, while in the cases with Stage III, only 3/122 (2%) survived. There was no difference with survival rate between the patients with squamous cell carcinoma and those with adenocarnoma. Thirty patients underwent lobectomy and only two with pneumonectomy survived more than 10 years after surgery. Among 32 patients, 21 are alive and well without recurnce, 3 died of secondary primary lung cancer, one died of recurrent disease, and one died of gastic cancer. Most of the patients were free of respiratory symptoms after 10 years. The favorable factors contribuitng to long-term survival after pulmonary resection for the patients with lung cancer are small and early lesions (Stage I, T1, N0, N1 ), lobectomy, cell types of squamous cell carcinoma or adenocarcinoma, and ages under 70 years. However, secondary lung tumors would occur to the patients who survived more than 10 years after pulmonary resection, thus requiring continuous follow-up