Bilateral Approach for Thoracoscopic Esophagectomy in a Patient with Esophageal Cancer and Solitary Posterior Thoracic Para-aortic Lymph Node Metastasis

We report a successful dissection of metastatic posterior thoracic para-aortic lymph node (No. 112aoP) via bilateral thoracoscopic surgery. With the anesthetized patient (a 73-year-old Japanese woman) in the prone position, two working ports were inserted for the left-side approach, and artificial pneumothorax was created. Thoracoscopic examination revealed a swollen LN posterior to the descending aorta. Fat and metastatic LNs posterior to the aorta were dissected from the aortic arch level to the diaphragm while preserving intercostal arteries. For the right-side approach, two working ports were inserted and a routine thoracoscopic esophagec-tomy was performed. Gastric conduit reconstruction was achieved laparoscopically. Operation time for the left thoracic procedure: 54 min; estimated blood loss: almost none. No recurrence was detected 24 months post-operatively. There are several surgical options for approaching No. 112aoP, including transhiatal, left thora-cotomy, and thoracoscopy. Although a wide dissection of the posterior thoracic para-aortic area has not been reported, it may be feasible and safe if the artery of Adamkiewicz and intercostal arteries are preserved. A min-imally invasive bilateral thoracoscopic approach for a thoracoscopic esophagectomy is safe and useful for esophageal cancer patients with solitary No. 112aoP metastasis

ナンセイショトウ ノ ジセイショクブツシゲン ノ ユウヨウセイ ト トクサンカ ノ カノウセイ : イエジマ ニ オケル マーナ ワメイ : ハマカブラ ノ セイブントクセイ ト ヒョウカ

本研究は,南西諸島のような物理的・環境的条件の限定された地域における在来的な自生植物資源の有用性に関する研究である。沖縄県伊江村(伊江島)では,アブラナ科のハマカブラBrassica campestris L.を,マーナと称し,島の人々はかねてから利用してきた。この植物は日本全国で確認されているが,沖縄県においては自生地が限られ,またこれを日常的に食しているのは伊江島だけといわれている。雑草であるがゆえに,この植物の生産に取り組んでいる農家は,2戸に過ぎない。われわれはこのマーナに関する一般的特性に関する聞き取り調査をおこない,さらに栄養分析をおこなった。その結果,特にマーナのポリフェノール含有量は比較的高い数値で,一般的な野菜の10倍程度であった。日常的に利用されながら雑草的な扱いにとどまっているが,成分的には機能性に加え,栄養学的な面でも優れていることが示され,今後食用化が進められるべき素材であることが示唆された。伊江島では製糖工場が閉鎖され,農家の高齢化も伴って耕作放棄が目立ちつつある中で,ラッカセイ,トウガン,花卉につぐ,マーナの特産化が模索されるべきであろう。The purpose of this study is to suggest utilizing volunteer plant resources in the region such as the southwest islands, where growth is limited by physical and environmental conditions. Brassica campestris L. also known in dialect as "maana", is a kind of weed found all over Japan. In particular, people of Ie-island in the Okinawa Prefecture use them frequently. It is treated as a "weed", but there are two farmers who produce it on economic base. We researched the general growing conditions and nutritional value of Brassica campestris L.. To determine the effective use of Brassica campestris L., we studied its chemical components and nutritive values. In particular, Brassica campestris L. contains a large amount of dietary fiber. Mineral content, particularly iron, and vitamin content such as beta carotene and vitamin C were high in comparison with other vegetables. Furthermore, polyphenol content was comparatively high. Thus, its chemical component was similar to that of a green vegetable. We suggest changing Brassica campestris L.\u27s status as a "mere weed" and further capitalizing on the utilization of these volunteer plant resources. To promote maana as a special product, we should first recognize the utilization of volunteer plant resources at first, secondly analyze the habits of such volunteer plant, and develop the agricultural technology for a farming system

Seismic reflection survey using Vibroseis in Zama city and Hiratsuka city, Kanto basin, central Japan

Seismic reflection survey using Vibroseis with a line length of 13km was conducted around Zama city and Hiratsuka city, in the southwest part of the Kanto basin. Seismic refraction records were also acquired by shooting at the both ends of the survey line with over 100 vertical stacks. From the seismic section, a clear reflector interpreted as the top of the acoustic basement is identified. The basement has a very complex structure with depths varying from 200m to 1200 m. As a result of a refraction method analysis, the P-wave velocity of the basement is estimated to be about 4.3 km/s. Comparing acoustic logging data of Atsugi observation well, it corresponds to the lower part of the Aikawa Group (Miocene volcanics). The interpreted basement has a different velocity and geology from that commonly observed in the Kanto plain (4.8-5.5 km/s layer). Above the basement, sediments can be divided into two parts by a remarkable reflector seen at depths of 200 300m at both ends of the line. As this reflector has a velocity of 2.3-2.4 km/s, this corresponds to the boundary between the Sagami Group (Quaternary sediments) and the Aikawa Group observed at the Atsugi well. The Sagami Group contains sharp and continuous reflectors with flat or gentle dips, whereas the upper part of the Aikawa Group is accompanied with considerable folds and faults

Endothelial PI3K-C2α, a class II PI3K, has an essential role in angiogenesis and vascular barrier function

The class II α-isoform of phosphatidylinositol 3-kinase (PI3K-C2α) is localized in endosomes, the trans-Golgi network and clathrin-coated vesicles; however, its functional role is not well understood. Global or endothelial-cell-specific deficiency of PI3K-C2α resulted in embryonic lethality caused by defects in sprouting angiogenesis and vascular maturation. PI3K-C2α knockdown in endothelial cells resulted in a decrease in the number of PI3-phosphate-enriched endosomes, impaired endosomal trafficking, defective delivery of VE-cadherin to endothelial cell junctions and defective junction assembly. PI3K-C2α knockdown also impaired endothelial cell signaling, including vascular endothelial growth factor receptor internalization and endosomal RhoA activation. Together, the effects of PI3K-C2α knockdown led to defective endothelial cell migration, proliferation, tube formation and barrier integrity. Endothelial PI3K-C2α deficiency in vivo suppressed postischemic and tumor angiogenesis and diminished vascular barrier function with a greatly augmented susceptibility to anaphylaxis and a higher incidence of dissecting aortic aneurysm formation in response to angiotensin II infusion. Thus, PI3K-C2α has a crucial role in vascular formation and barrier integrity and represents a new therapeutic target for vascular disease.In Press / 2013-03-18公開予定

胸水細胞診で形質細胞腫が疑われた血管免疫芽球性Ｔ細胞リンパ腫

血管免疫芽球性Ｔ細胞リンパ腫（angioimmunoblastic T-cell lymphoma: AITL）は新WHO分類において末梢Ｔ細胞 / NK 細胞腫瘍に分類されているＴ細胞性腫瘍である．その臨床像は，全身リンパ節腫大，肝脾腫，発熱，多クローン性高γ グロブリン血症など多様な症状を呈することが知られている．今回，我々は胸水細胞診で形質細胞腫が疑われたAITL を経験したので報告する．症例は80歳代の女性．近医にて気管支喘息治療中に，喘息症状が悪化し，全身の皮疹が出現．両側胸水貯留，CRP 高値が出現したため，精査治療目的で当院紹介となった．血液検査で貧血を認め，末梢血に形質細胞様の異型リンパ球を10％認めた．胸水には大小不同のCD138陽性形質細胞を多数認め細胞診で形質細胞腫が疑われたが，胸水セルブロックではκ・λ の軽鎖制限を認めなかった．骨髄検査では，形質細胞の増加を認めず赤芽球癆の状態であった．皮下腫瘤を生検した結果，AITL と診断した．AITL は，腫瘍細胞が直接的・間接的にサイトカインを産生し，それに起因した多彩な臨床像を呈する．そのため，AITL は反応性に形質細胞の増加を伴うことが多く，本症例は，反応性に胸水中に形質細胞の増加を伴ったと考えられた．また，AITL は赤芽球癆を合併することも報告されている．AITL では，反応性の形質細胞増多を伴う胸水貯留や赤芽球癆をきたす場合があることに注意すべきである．Angioimmunoblastic T cell lymphoma (AITL) is a T cell-related tumor that is classified as a peripheral T cell/natural killer cell tumor according to the new World Health Organization classification. AITL shows various clinical features owing to the cytokines produced directly or indirectly by tumor cells and includes a variety of symptoms, such as general lymphadenopathy, hepatosplenomegaly, fever, and polyclonal hypergammaglobulinemia. AITL is often accompanied by reactive plasmacytosis, and it has been reported that AITL can be complicated by pure red cell aplasia. Here, we report an 80-year-old woman with AITL who was suspected to have a plasma cell tumor by cytological diagnosis of hydrothorax. The patient presented with exacerbated asthmatic symptoms as well as exanthema over her entire body. Moreover, during treatment for bronchial asthma at a local doctor’s clinic, hydrothorax in both lungs and high C-reactive protein levels were observed. She was referred to our hospital for detailed examination and treatment. Blood test results revealed anemia as well as a high proportion of plasma cell-like atypical lymphocytes in the peripheral blood. Specimens of the hydrothorax also contained CD138-positive plasma cells of varying sizes; however, there was no evidence of deviation in light chain limitation. We did not notice elevated plasma cell counts, and the patient was considered to have pure red cell aplasia based on the results of the marrow examination. However, we noted a subcutaneous mass under her shoulder blade. An excisional biopsy was performed, and she was diagnosed with AITL. The patient was considered to have hydrothorax with plasmacytosis as a reaction to AITL. As seen in our case, AITL may cause pleural effusions along with reactive plasmacytosis and pure red cell aplasia

臍帯血移植後発症した early lesion of PTLD の剖検例

移植後リンパ増殖性疾患（post-transplant lymphoproliferative disorders, PTLD）は，同種造血幹細胞移植後の生命を脅かす予後不良な合併症の一つである．臨床症状は非特異的であるが，PTLD を疑った場合はPCR 法による血中EB（Epstein-Barr）ウイルス-DNA 量を測定し，高値を示した場合はPTLD と判断する必要がある．今回，造血幹細胞移植後に高EB ウイルス血症を認め，急激な病状の悪化により死亡した症例を経験したため剖検所見を含め報告する．症例は，40歳代男性でフィラデルフィア染色体陽性急性リンパ性白血病を発症し，治療にて寛解を得た後に臍帯血移植を施行した．移植後280日に高熱が出現し，胸部CT 検査から細菌性肺炎と診断し入院．抗菌薬治療を開始するも効果不良であり，呼吸状態の悪化と，意識障害が出現した．血液，肺胞洗浄液と髄液から，EB ウイルス-DNA 異常高値が検出された．PTLD と判断したが，急激に呼吸状態が悪化し死亡した．剖検では，肺胞内出血を認め，急激に悪化した原因と考えられた．そして，肺門部リンパ節や肺にはEBER（EBV-encoded small RNA）陽性細胞を多数認め，一部では大型多核細胞も散見され，early lesion of PTLD と判断された．Early lesion of PTLD であっても，本症例のように肺病変を認めた場合，出血による呼吸状態の悪化から急激な経過をたどることがあり，早期の対応が必要と考えられた．Post-transplant lymphoproliferative disorder (PTLD), a life-threatening condition with poor prognosis, can arise after allogeneic hematopoietic stem cell transplantation. The clinical symptoms are non-specific, but if PTLD is suspected, the blood levels of Epstein-Barr (EB) virus DNA are measured using PCR. Here, we report our experience with a patient who showed high levels of EB virus DNA in the blood and a rapidly worsening condition resulting in death, after undergoing hematopoietic stem cell transplantation. The patient was male and in his 40s; he had developed Philadelphia chromosome-positive acute lymphoid leukemia and achieved remission with treatment, and he later underwent umbilical cord blood transplantation. A high fever appeared 280 days after transplantation, and he was hospitalized and diagnosed with bacterial pneumonia following a thoracic CT examination. He was initiated on antimicrobial therapy, but responded poorly, exhibiting a worsening respiratory condition and disturbance of consciousness. Abnormally high EB virus DNA levels were detected in his blood, bronchoalveolar lavage fluid, and cerebrospinal fluid. He was diagnosed with PTLD, but his respiratory condition deteriorated rapidly and he died. The autopsy revealed alveolar hemorrhage, which was thought to be the cause of the rapid deterioration. A large number of EBER (EBV-encoded small RNA)- positive cells were also found in hilar lymph nodes and lungs, which were deemed to be early lesions of PTLD. Therefore, timely action is crucial if lesions are presents as even early PTLD lesions can progress rapidly owing to bleeding that can result in the deterioration of the respiratory condition