An Experimental Functional Evaluation of End to Side Anastomosis Related to Operative Procedures of Tracheobronchial Reconstruciotn

End to side anastomosis between the trachea and the bronchus was widely employed as one of bronchial reconstructed method. However, functional evaluation undergone bronchial reconstruction did not completely display its superiority functionally. This study was undertaken to determine whether end to side anastomosis was far superior in regard to reserved pulmonary function by means of observation on changes in size of anastomotic area on xp film delineated during inspiration and exspiration simultaneously and also by intrabronchial pressure tracing. The results were as follows. 1) The creation of window defect on the tracheal wall prior to anastomosis was necessary to maintain an adequate anastomotic area. 2) The end to side anastomosis obliquely results in an excellent ventilation functionally. In contrast, the ill effects were disclosed by moderate angulation as far as exceeded 45 degree against tracheal wall owing to loss of rigidity in bronchial wall. From the present study, we concluded that end to side anastomosis obliquely with moderate degree should be avoided because of bronchial stenosis produced by bronchial collapse due to loss of supporting ability of bronchial cartilage

Clinical Evaluation of Immune Response in Patients with Cancer

Immune response was clinically evaluated in 25 patients with carcinoma compared with 26 of non cancer patients by means of lymphocyte transformation against PHA which was shown as stimulation index. In patients with cancer, stimulation index showed apparently as low as an average of 38 compared with 82 of non-cancer patients. Furthermore, the level of stimulation index was a corresponding correlation to age in which low activation was presented in the elderly. According to diseased organs, the weak response of stimulation index against PHA were observed in patients with the carcinoma of the esophagus and the lung. The response of skin test for PPD, PHA, SK-SD and candida were inhibited in patients with advanced cancer of stage III and IV compared with that of stage I and II. These responses were also suppressed in postoperative course until at least 6 months after surgery. From these results, it was noted that operative procedures provoked the induced weakness against host defense immunologically. However, it was certified that the use of immunopotentiator faciliated the activity of immune response during postoperative period for the patients with no severely advanced lung cancer of stage I and II despite of little effects for patients with advanced lung cancer of stage III and IV. It was concluded that immune response of patients with cancer was inhibited by advancing carcinoma and by operative procedures but the use of immunopotentiator was beneficial to promote the host defense during postoperative period

A Functional Evaluation of Bronchial Reconstructed Lung with Special Reference to Denervation

Bronchoplastic procedures for lung cancer were suitable operative method to reserve pulmonary function and to enlarge the resected area. However, functional evaluation is not necessarily achieved in bronchial reconstructed lung, especially with reference to denervation. In this study the influence of denervation was investigated experimentally by pulmonary perfused wedge method in which vascular tonus was directly illustrated and by measurement of oxygen saturation (Sao2) of pulmonary venous blood in which the ability of oxygen uptake was elucidated. When comparing the results of denervation with regard to operative procedures of bronchoplasty, bronchoplasty with sleeve anastomosis of pulmonary artery and autotransplantation respectively, the deteriorate effects related to bronchoplasty were not observed as compared to autotransplantation

Inhibition of plasminogen activator inhibitor type-1 activity enhances rapid and sustainable hematopoietic regeneration

The prognosis of patients undergoing hematopoietic stem cell transplantation (HSCT) depends on the rapid recovery and sustained life-long hematopoiesis. The activation of the fibrinolytic pathway promotes hematopoietic regeneration; however, the role of plasminogen activator inhibitor-1 (PAI-1), a negative regulator of the fibrinolytic pathway, has not yet been elucidated. We herein demonstrate that bone marrow (BM) stromal cells, especially osteoblasts, produce PAI-1 in response to myeloablation, which negatively regulates the hematopoietic regeneration in the BM microenvironment. Total body irradiation in mice dramatically increased the local expression levels of fibrinolytic factors, including tissue-type plasminogen activator (tPA), plasmin, and PAI-1. Genetic disruption of the PAI-1 gene, or pharmacological inhibition of PAI-1 activity, significantly improved the myeloablation-related mortality and promoted rapid hematopoietic recovery after HSCT through the induction of hematopoiesis-promoting factors. The ability of a PAI-1 inhibitor to enhance hematopoietic regeneration was abolished when tPA-deficient mice were used as recipients, thus indicating that PAI-1 represses tPA-dependent hematopoietic regeneration. The PAI-1 inhibitor not only accelerated the expansion of the donor HSCs during the early-stage of regeneration, but also supported long-term hematopoiesis. Our results indicate that the inhibition of PAI-1 activity could be a therapeutic approach to facilitate the rapid recovery and sustained hematopoiesis after HSCT

The Clinical Evaluation of Radical Lobectomy with Sleeve Resection of both the Bronchus and the Pulmonary Artery for Lung Cancer

Operative procedures of lobectomy with sleeve anastomosis of both the bronchus and pulmonary artery were evaluated in 5 patients undergone surgery. 1) The indications of this operation exist in patients with hillar type of lung cancer with cancerous invasion into the wall of the pulmonary artery segmentally. The lesions in left side were not infrequently indicated rather than that in right side. 2) Three patients were followed for three months to 2 years and 3 months. Two of them are alive from 3 months to 2 years and 3 months without recurrence respectively. The remaining one died in one year and half postoperatively of local recurrence and distant metastasis. 3) We encountered in 2 cases of hospital death unrelated operative techiniques. From one experience of autopsy on postoperative 12th day, the ischemic lesion of the lung was detected following the cessation of pulmonary flow by torsion in the anastomotic site. It was emphasized that pulmonary blood flow is necessary to nourish the lung under interruption of bronchial flow by bronchoplastic procedure. The cause of the remaining one was hemorrhagic diathesis owing to hyperfibrinolytic activity