Bone metastasis after a resection of stage I and II primary lung cancer

In the present study, we reviewed the patients who developed bone metastases after a surgical resection of primary lung cancer and evaluated their clinicopathological features. From 1992 to 1995, 177 patients with stage I and II primary lung cancer underwent a surgical resection at the Kitakyushu Municipal Medical Center. Bone metastases were detected in 14 patients (7.9%) by follow-up examinations including bone scintigraphy (scan). Bone metastasis was one of the most frequent extra-thoracic recurrent forms. Patients with adenocarcinoma tended to develop bone metastases more frequently than those with squamous cell carcinoma. In the preoperative bone scans, an abnormal uptake was observed in 76 patients (42.9%), and 10 (13.1%) of them were found to develop bone metastases in the follow-up studies. A microscopic examination of the primary tumor demonstrated close correlation between intratumoral and peritumoral lymphatic vessel invasion and postoperative development of bone metastases. A bone scan is a very useful and indispensable procedure for diagnosing bone metastases. However, this scan may also show false positive finding in a number of benign conditions. Therefore, a surgical resection should be considered as the first-line treatment for patients with positive findings in the bone scan when the diagnosis of bone metastasis can not be confirmed based on both their symptoms and other clinical examinations.

Adoptive immunotherapy using specific cytotoxic T lymphocytes against human lung-cancer-engrafted severe combined immunodeficiency mice

OBJECTIVE

We studied the ability of human lung-cancer-specific cytotoxic T lymphocytes to suppress the growth of human lung adenocarcinoma (PC-9) engrafted in severe combined immunodeficiency mice.

METHODS

PC-9-specific cytotoxic T lymphocytes were generated by multiple stimulation with irradiated PC-9 cells of regional lymph node lymphocytes from lung cancer patients expressing the same human leukocyte antigen-A locus haplotype as PC-9 following expansion due to the administration of immobilized anti cluster of differentiation 3 mAb and interleukin-2. Cytotoxic T lymphocytes showed specific cytotoxicity against PC-9 cells in vitro. Severe combined immunodeficiency mice with a subcutaneous graft of PC-9 were treated with a PC-9-specific cytotoxic T lymphocyte by i.v. injection and/or with interleukin-2 by s.c. injection.

RESULTS

Cytotoxic T lymphocyte treatment suppressed PC-9 graft growth significantly an effect, significantly enhanced when combined with interleukin-2 injection. To evaluate the in vivo specificity of anti-PC-9 cytotoxic T lymphocytes, each mouse was subcutaneously inoculated in the right flank with PC-9, and in the left flank with A549 or Sq-1. Cytotoxic T lymphocytes plus interleukin-2 treatment was found to suppress PC-9 growth selectively, but not A549 or Sq-1 growth.

CONCLUSIONS

These results provide sufficient rationale for conducting further clinical trials on immunotherapy using cytotoxic T lymphocyte for lung cancer patients.

Evolution of peripheral lung adenocarcinomas: CT findings correlated with histology and tumor doubling time

OBJECTIVE

This study was performed to evaluate the evolution of peripheral lung adenocarcinomas using CT findings and histologic classification related to tumor doubling time.

MATERIALS AND METHODS

The subjects were 34 patients, each with an adenocarcinoma smaller than 3 cm. All patients underwent chest radiography and 10 of them had previously undergone CT more than 6 months before surgery. Tumor doubling time was estimated by examining sequential radiographs using the method originally described by Schwartz. Tumor growth was also observed by studying the changes on CT in the 10 patients who had previously undergone CT. The histologic classification (types A-F) was evaluated according to the criteria of Noguchi et al.

RESULTS

Five (83%) of the six adenocarcinomas with tumor types A or B showed localized ground-glass opacity on high-resolution CT. All six tumors had a tumor doubling time of more than 1 year. Fifteen (71%) of the 21 tumors with type C showed partial ground-glass opacity mixed with localized solid attenuation on high-resolution CT. Ten (48%) of these 21 type C tumors had a tumor doubling time of more than 1 year. In types B and C, the solid component or the development of pleural indentation and vascular convergence increased during observation before surgery. All seven tumors with types D, E, and F showed mostly solid attenuation, and the tumor doubling time was less than 1 year in six (87%) of the seven tumors.

CONCLUSION

Two main types of peripheral lung adenocarcinoma exist. The first type appears on CT as a localized ground-glass opacity with slow growth, and the other appears as a solid attenuation with rapid growth.

Chronic expanding hematoma in the chest

We report the successful surgical treatment of chronic expanding hematoma in the chest. Four patients who had previously undergone artificial pneumothorax, thoracoplasty or tumor extirpation more than 30 years earlier recently became aware of a slowly growing mass. Chronic expanding hematoma which developed into very large masses over a long period of time were thus successfully resected. These patients are now all in good health with no recurrence after the operation. It is important to monitor such patients' laboratory data for hemostasis including the platelet cell counts, the % prothrombin time and the D-dimer, both before and immediately after operation, and the intraoperative bleeding volume.

Evaluations of p53 immunoreactivity, nucleolar organizer regions, and proliferating cell nuclear antigen in non-small cell lung carcinoma

We examined p53 protein expression, proliferating cell nuclear antigen (PCNA), and argyrophilic nuclear organizer regions (AgNOR), in 102 patients with surgically-treated non-small cell lung cancer (NSCLC). p53 positive cases with DO-1 were defined when more than 10% of the tumor cell nuclei were stained. Mean AgNOR count and PCNA LI were 2.80 and 40.7 and there were no significant differences of AgNOR count and PCNA LI between p53 positive and negative cases. We assessed the relationship between the p53 immunoreactivity and various clinical or pathological parameters. p53 positive rate of stage III disease (46.3%) was significantly higher than that of stage II disease (28.6%). The p53 positive rate of squamous cell carcinoma (42.1%) tended to be higher than that of adenocarcinoma (33.9%). In the survival curves of patients with NSCLC according to the p53 immunoreactivity, there was no significant difference between p53 positive and negative cases. Eight potential prognostic parameters (p53 immunoreactivity, AgNOR count, PCNA LI, sex, age, year of operation, histology, and stage) were also estimated, using univariate and multivariate analysis. In univariate analysis, PCNA LI and AgNOR count, and stage were significantly related to shortened survival. In multivariate analysis, PCNA LI, Age, and stage were independently associated with shortened survival of NSCLC patients. PCNA staining may be more useful than p53 and AgNOR staining in assessing the aggressiveness of surgically-treated NSCLC, although the most useful clinical prognostic parameter should be achieved by the combined analysis of several prognostic indicators.

Polyarthritis nodosa with mesenteric aneurysms demonstrated by angiography: report of a case and successful treatment of the patient with prednisolone and cyclophosphamide

Polyarteritis nodosa is a necrotizing angitis that predominantly affects small and medium-sized arteries. The prognosis of untreated polyarteritis nodosa is very poor. Since symptoms are diverse and no serologic test is specific for polyarteritis nodosa, the diagnosis is difficult and often delayed. We describe a patient with polyarteritis nodosa who had gastrointestinal involvement with multiple aneurysms of the inferior mesenteric artery; only abdominal angiography provided a conclusive diagnosis. Alleviation of symptoms and regression of aneurysms were observed after combination therapy of an immunosuppressive agent, cyclophosphamide, and prednisolone. We emphasize the importance of early diagnosis by angiography and aggressive therapy in patients in whom physical signs indicating definite polyarteritis nodosa are not present.

Mediastinal parathyroid cyst: treatment with thoracoscopic surgery--a case report

Parathyroid cysts are rarely located in the mediastinum. This report describes a 45-year-old man with a mediastinal parathyroid cyst. Video-assisted thoracic surgery was successfully performed to remove the cyst.

Different platelet aggregability during mental stress in two stages of essential hypertension

To determine whether platelet response to mental stress is altered in essential hypertension, platelet aggregability and plasma beta-thromboglobulin were determined in 24 patients with essential hypertension (11 patients with World Health Organization (WHO) stage I and 13 patients with stage II) and 14 normotensive controls before and after a 10-min arithmetic stress (serial subtraction of 7 from 1000). In normotensive subjects, arithmetic stress did not affect primary aggregations to 1.0 micromol/L adenosine diphosphate (ADP) and to 2.5 micromol/L 5-hydroxytryptamine (5-HT), ADP threshold for biphasic aggregation and plasma beta-thromboglobulin level. In hypertensive patients with WHO stage I, these parameters were similar to those in normotensives before arithmetic stress, but the arithmetic stress test significantly increased primary aggregation to reagents and beta-thromboglobulin level, and decreased threshold of ADP for biphasic aggregation. In WHO stage II patients, platelet aggregability to reagents and beta-thromboglobulin level were already enhanced as compared with WHO stage I patients and normotensive subjects before arithmetic stress. However, the stress-induced changes in platelet function were less pronounced in WHO stage II patients compared with stage I patients. In conclusion, platelet aggregability and proaggregatory effect of mental stress differed depending on the severity of hypertension in patients with essential hypertension; the transient activation of platelet function during stress with no enhancement under the resting condition in the early phase of hypertension and the continuous activation of platelet function in the advanced phase with hypertensive organ damage.

Prognostic impact of telomerase activity in non-small cell lung cancers

OBJECTIVE

To evaluate the clinical significance of telomerase activity, particularly in terms of prognostic impact, in non-small cell lung cancer (NSCLC).

SUMMARY BACKGROUND DATA

Telomerase activity has been found in various tissues. The activation of telomerase is considered necessary for the immortalization of human tumor cells, including NSCLC.

METHODS

The authors studied 103 NSCLC specimens using a polymerase chain reaction based on a telomeric repeat amplification protocol assay.

RESULTS

Telomerase activity was detected in 85 (82.5%) of 103 NSCLC specimens but in none of the paired normal lung tissue specimens. More cases of positive telomerase activity were observed in the group with advanced disease and in the group with poorly differentiated tumors. Such factors as the mean age at surgery, sex, smoking, histologic type, and size of tumor extension did not correlate with the telomerase activity. The Kaplan-Meier survival curves in all patients with NSCLC demonstrated that patients with telomerase-positive tumors survived for a significantly shorter period than those with a telomerase-negative tumor (p = 0.0058). According to a multivariate analysis, telomerase activity was identified as an independent prognostic factor (RR = 8.62, p = 0.035).

CONCLUSIONS

Telomerase activity was one of the most important prognostic factors in patients with NSCLC, and its potential prognostic implication was independent of tumor stage.

Time course of the effects of temocapril on cardiovascular structure and function in patients with essential hypertension

To investigate the time course of cardiovascular structural changes in patients with essential hypertension after angiotensin-converting enzyme (ACE) inhibition, we determined left ventricular structure, minimal vascular resistance in the forearm as an index of resistance vessel structure and stiffness beta of carotid artery in 15 essential hypertensive subjects during a placebo period and after 2, 6, and 12 months of temocapril treatment. Blood pressure decreased within 2 weeks, and the antihypertensive effects were noted throughout the 12-month administration period. Left ventricular mass index decreased significantly after 2 months (120+/-12 to 106+/-9 g/m2; p < 0.01) and was normalized after 12 months (88+/-6 g/m2). Postischemic minimal vascular resistance in the forearm decreased gradually from 2.1+/-0.5 to 1.6+/-0.4 PRU at month 12 of temocapril treatment. In contrast, increased stiffness index beta of carotid artery was not altered during a 1-year treatment period (11.4+/-4.9 to 11.6+/-3.8 at month 12 of treatment). These data indicated that the regression of structural changes of left ventricle and arterioles occurred gradually and progressively for 1-year treatment with ACE inhibition, but large arteries were not affected.

Esophagopleural fistula originating from diverticulum after pneumonectomy. A case report and review of the literature

Esophagopleural fistula (EPF) is a very rare and fatal disease. A 56 year-old man developed a pyothorax resulting from an EPF with esophageal diverticulum after a right pneumonectomy. The patient was successfully treated with a three-stage operation and control of infection and nutritional status. First, fenestration was performed, then an ante-thoracic gastroplasty, and a radical thoracoplasty was performed. Surgical management, nutritional support, and control of infection were the cornerstones of the treatment of EPF.

Fas expression in non-small cell lung cancer: its prognostic effect in completely resected stage III patients

The aim of this study was to examine Fas expression in non-small cell lung cancer (NSCLC) and examine its correlation with clinicopathological features and prognosis. Fas expression was determined by an immunohistochemical analysis using the labelled streptavidin-biotin method from 220 paraffin specimens of completely resected primary stage I-III NSCLC. 80 (36%) of 220 cases were positive for Fas immunostaining. These 80 cases included 44 adenocarcinomas (33%) and 30 squamous cell carcinomas (40%). 33 stage I (33%) 13 (43%) stage II and 34 (37%) stage III tumours were Fas positive. No statistically significant differences were observed regarding the Fas status with respect to age, sex, histological type, or stage of disease. There was no significant difference in survival between early stage (stages I-II) disease patients with positive Fas expression and those with a negative expression (P = 0.719). However, for patients with completely resected stage III tumours, the patients with positive Fas staining were found to survive for a longer period than those with negative staining (P = 0.026).

Relation of plasma brain and atrial natriuretic peptides to left ventricular geometric patterns in essential hypertension

We investigated whether plasma brain and atrial natriuretic peptide (BNP and ANP, respectively) levels could reflect left ventricular (LV) geometry and function in patients with mild to moderate essential hypertension. A positive correlation was found between LV mass index (LVMI) and plasma ANP levels in 84 untreated, hypertensive patients, but not between LVMI and plasma BNP levels. As compared with other geometric patterns, plasma BNP levels were increased in concentric hypertrophy, in which LVMI was increased and LV diastolic function was decreased. These data suggest that production of BNP was increased in hypertensive patients with concentric hypertrophy via LV overload or depression of diastolic function.

Angiotensin-converting enzyme gene polymorphism and geometric patterns of hypertensive left ventricular hypertrophy

Polymorphism in the angiotensin-converting enzyme (ACE) gene has been found to be associated with left ventricular hypertrophy (LVH) in patients with essential hypertension (EHT) in certain populations. We sought to evaluate, in a Japanese population, whether ACE genotype is related to left ventricular mass, or to the geometry of LVH in EHT. Eighty-seven patients with EHT were examined. Their relative wall thickness (RWT) and left ventricular mass index (LVMI), determined by echocardiogram, were used to divide them into 4 groups: normal (normal RWT and LVMI, n = 35); concentric remodeling (increased RWT but normal LVMI, n= 10); eccentric hypertrophy (increased LVMI but normal RWT, n = 20); and concentric hypertrophy (increased LVMI and RWT, n = 22). Genetic analysis for ACE genotypes was performed on peripheral leukocytes using PCR techniques. Interventricular septal thickness and RWT were significantly greater in the patients with the DD genotype than in those with the II genotype, but LVMI did not differ among the three ACE genotypes. The frequency of the DD genotype was higher in the concentric hypertrophy group than in each of the other groups, and the frequency of the II genotype was lower in the concentric hypertrophy group than in either the normal or eccentric hypertrophy group. The geometric pattern of hypertensive LVH was associated with ACE genotype in a Japanese population. The DD genotype may contribute to concentric hypertrophy, but not to eccentric hypertrophy.

Implications of isoform multiplicity of microphthalmia-associated transcription factor in the pathogenesis of auditory-pigmentary syndromes

Microphthalmia-associated transcription factor (MITF) is the human homolog of a basic helix-loop-helix-leucine zipper protein (Mitf), encoded by the mouse microphthalmia locus. Mutations in the MITF gene have been identified in some patients with Waardenburg syndrome type 2 (WS2), which is a dominantly inherited disorder, characterized by varying combinations of sensorineural hearing loss and pigmentary disturbances. Furthermore, mice with mutations at the Mitf locus are associated with various phenotypes, such as white coat color, small eyes, a deficiency in mast cells, and osteopetrosis. Thus, MITF/Mitf may play an important role in differentiation of melanocytes and some other cell types. Recently we have identified two MITF isoforms with extended amino-termini, MITF-A and MITF-H. Both isoforms possess unique amino-termini that are different from the amino-terminus of the originally identified melanocyte-specific MITF (MITF-M). MITF-M mRNA is exclusively expressed in melanocytes and pigmented melanoma cells, whereas MITF-A and MITF-H mRNA are widely expressed in many cell types, including retinal pigment epithelium. Transient transfection assays suggested that these isoforms possess differential transactivation capacity. It is therefore conceivable that the previously identified mutations may alter the functions of not only MITF-M but also MITF-A and MITF-H. Possible implications of the MITF isoform multiplicity in the pathogenesis of auditory-pigmentary disorders are discussed.

Effects of a novel calcium antagonist, benidipine hydrochloride, on platelet responsiveness to mental stress in patients with essential hypertension

The effects of a novel calcium antagonist, benidipine hydrochloride, on responses of platelets to mental stress were evaluated in nine patients with essential hypertension. Before and 12 weeks after the monotherapy with benidipine (2-4 mg/day), platelet aggregability and plasma beta-thromboglobulin were determined during rest and after a 10-min arithmetic stress. Before the treatment, arithmetic stress significantly increased platelet aggregability in response to adenosine diphosphate (ADP) and plasma beta-thromboglobulin level. Blood pressure, pulse rate, and plasma catecholamines also increased during arithmetic stress. The treatment with benidipine did not affect resting values of platelet functions, but attenuated significantly stress-induced alterations in primary aggregation to 1.0 microM ADP (34 +/- 4% to 40 +/- 3% before treatment vs. 32 +/- 2% to 34 +/- 3% after benidipine), ADP threshold for biphasic aggregation (2.2 +/- 0.4 to 1.8 +/- 0.3 microM before treatment vs. 2.2 +/- 0.3 to 2.2 +/- 0.4 microM after benidipine) and plasma beta-thromboglobulin level (74 +/- 16 to 104 +/- 15 ng/ml before treatment vs. 60 +/- 10 to 52 +/- 8 ng/ml after benidipine; p < 0.05 for Stress x Treatment interactions in all values). The pretreatment elevations in blood pressure and sympathetic activity with stress were not modified by benidipine treatment. In conclusion, the monotherapy with benidipine did not affect platelet function during the resting condition, but significantly suppressed the platelet activation induced by arithmetic stress in patients with essential hypertension.

Successful tracheocarinal transplantation

BACKGROUND

When extensive portions of the trachea and carina are resected, grafting is required.

METHODS

Two experiments were performed in dogs to assess the feasibility of extensive tracheocarinal replacement using short-segment tracheocarinal autografts, only to avoid the immunologic complexity of allografts. To determine the effect of tension on graft survival, extensive tracheal defects (12 to 18 rings) were created in four animals. These were subsequently reconstructed using 6-ring autografts. In the second experiment, three animals underwent excision of a maximal length of trachea determined in experiment 1 including the carina. Long-term viability of each graft was assessed using bronchoscopy and histologic examination.

RESULTS

The limit of tracheal resection successfully reconstructed using a 6-ring autograft was 14 rings (experiment 1). The tracheal grafts in which the tension was greater than 1.2 kg did not maintain their structural integrity. All of the autografts in experiment 2 were subjected to a tension of less than 1.0 kg at the anastomoses, and showed long-term viability.

CONCLUSIONS

We conclude that extensive tracheal and carinal defects may be successfully reconstructed using short-segment tracheocarinal grafts if the anastomoses are subjected to less than 1.0 kg of tension.

An L1 element intronic insertion in the black-eyed white (Mitf[mi-bw]) gene: the loss of a single Mitf isoform responsible for the pigmentary defect and inner ear deafness

Waardenburg syndrome type 2 (WS2) is an autosomal dominant disorder characterized by a combination of pigmentary and auditory abnormalities. Approximately 20% of WS2 cases are associated with mutations in the gene encoding microphthalmia-associated transcription factor (MITF). MITF plays a critical role in the development of both neural-crest-derived melanocytes and optic cup-derived retinal pigmented epithelium (RPE); the loss of a functional Mitf in mice results in complete absence of all pigment cells, which in turn induces microphthalmia and inner ear deafness. The black-eyed white Mitf mi-bw homozygous mouse normally has a pigmented RPE but lacks melanocytes essential for the pigmentation of the body and hearing. We show here that Mitf mi-bw is caused by an insertion into intron 3 of a 7.2 kb novel L1 element, L1bw, which belongs to an actively retrotransposing TF subfamily. The L1bw insertion reduces the amount of mRNAs for two Mitf isoforms, Mitf-A and Mitf-H, by affecting their overall expression levels and pre-mRNA splicing patterns, while it abolishes mRNA expression of another isoform, Mitf-M, which is specifically expressed in neural-crest-derived melanocytes. The consequence of the L1 insertion in the black-eyed white Mitf mi-bw mouse is that the developmental programme for RPE cells proceeds normally, most likely because of the presence of residual, full-length Mitf-A and Mitf-H proteins, whereas the lack of Mitf-M results in loss of the melanocyte population. The results suggest that melanocyte development depends critically on a single Mitf isoform, Mitf-M, and raise the possibility that specific mutations affecting MITF-M, the human equivalent of Mitf-M, may be responsible for a subset of WS2 conditions.

Indications and operative techniques for combined aortoesophageal resection

Combined aortoesophageal resection was performed in 8 patients, including 7 with esophageal carcinoma and 1 with aortoesophageal fistula. Aortic resection procedures included segmental resection with permanent aorto-aortic bypass (1 case), segmental resection with graft interposition (1 case), semicircumferential resection with patch aortoplasty (3 cases), wedge resection with lateral aortorrhaphy (1 case), and resection of adventitia (2 cases). Protective methods during aortic cross-clamping included one aorto-aortic permanent bypass, one subclavian-aortic bypass, and three axillo-femoral bypass. Postoperative complications include mediastinal abscess, paresis, arrythmia, and pneumonia. Five patients with esophageal carcinoma died within 6 postoperative months. In 4 of these 5 nonsurvivors, metastasis to distant organs including the liver, bone and peritoneal cavity were found at the time of death or autopsy. Those early recurrence cases were characterized by skip lesions and extensive lymph node metastasis with extranodal invasion. The clinical benefit of aortoesophageal resection will be attained by careful preoperative evaluation for case selection and a sufficient protective method for aortic cross-clamping.

Unfavorable prognosis of patients with stage II non-small cell lung cancer associated with macroscopic nodal metastases

BACKGROUND

Patients with stage II-N1 non-small cell lung cancer (NSCLC) make up an intermediate group of patients with an unsatisfactory prognosis even though complete resection is usually possible. We retrospectively analyzed postoperative prognostic factors to devise guidelines for the proper management of this patient population.

STUDY DESIGN

Among 546 patients with NSCLC who underwent surgical resection from 1979 to 1995, 43 patients were pathologically defined to be at stage II-N1 (T1-2N1M0). The influence of the following variables on postoperative survival was analyzed: gender, age, cell type, pathologic T factor, number of metastatic nodes, station of metastatic nodes (hilar or pulmonary nodes), status of nodal metastasis (macroscopic, gross involvement confirmed histologically; or microscopic, metastasis first defined by histologic examination), surgical methods, and adjuvant therapy (including 18 of chemotherapy and 2 of radiotherapy).

RESULTS

The 5-year survival rates (5YSRs) of patients with microscopic (n = 21) and macroscopic nodal metastasis (n = 22) were 76.0% and 27.6%, respectively (p = 0.001). The 5YSRs of 20 patients who received adjuvant therapy and 23 who did not receive adjuvant therapy were 57.6% and 46.6%, respectively (p = 0.036). Other variables did not affect survival. The Cox proportional hazards model analysis indicated that the presence of a macroscopic nodal metastasis and postoperative adjuvant therapy were independent prognostic factors. Among patients with macroscopic N1 NSCLC, 9 patients who had undergone adjuvant therapy showed a more favorable prognosis than the 13 patients who had not received adjuvant therapy (3-year survival rate, 55.6% vs 18.5%; p = 0.037; and recurrence rate, 30.0% vs 77.8%), whereas no significant influence of adjuvant therapy on survival was observed among patients with microscopic N1 NSCLC.

CONCLUSIONS

Stage II-N1 NSCLC was categorized into microscopic and macroscopic N1 diseases. The latter had a poor prognosis, which might be improved by adjuvant therapy, although a suitable regimen has not been established.

Maximal period of cryopreservation with the Bicell biofreezing vessel for rat tracheal isografts

OBJECTIVE

The maximal period of cryopreservation for the trachea is still unsolved. We assessed the maximal period of cryopreservation using the Bicell biofreezing vessel as an easy and cheap slow-freezing instrument for viable tracheal grafts in 95 rats.

METHODS

Each isograft was harvested from 17 donor rats, immersed in the preservative solution, and stored in a Bicell device in a deep freezer at -80 degrees C. The tracheal isografts were then randomly assigned to 9 groups according to cryopreservation periods ranging from 0 to 12 months. Included in the 9 groups were 2 subgroups (n = 6 per subgroup) that were observed immediately after being thawed and 1 month after heterotopic transplantation into the omentum after being thawed. Four subgroups (n = 6 per subgroup) were added according to the cryopreservation period for 1, 3, 6, and 12 months to evaluate the graft morphology 3 months after being thawed and transplanted heterotopically.

RESULTS

A prolonged period of cryopreservation had a degenerative effect on both the epithelium and cartilage. One month after transplantation, degeneration was more pronounced in the cartilage than in the epithelium, as characterized by the viable chondrocyte ratio and the epithelial score of isografts undergoing cryopreservation for more than 9 months. Three months after transplantation, the morphology of the epithelium and cartilage in isografts undergoing cryopreservation for less than 3 months was better preserved, whereas the morphology of both deteriorated in isografts undergoing cryopreservation for more than 6 months.

CONCLUSIONS

We conclude that the permissible period of cryopreservation to maintain tracheal isograft viability in this simple system using a Bicell biofreezing vessel is 3 months.

Bronchial arterial infusion is an effective therapeutic modality for centrally located early-stage lung cancer: results of a pilot study

OBJECTIVE

This pilot study was done to assess the effectiveness of bronchial arterial infusion (BAI) as a therapeutic modality for centrally located early-stage lung cancer.

PATIENTS AND METHODS

Seven patients who had endoscopically evaluated, centrally located early-stage squamous cell lung carcinoma, including three patients with synchronous multiple primary lung cancers, were offered BAI with cis-diamminedichloroplatinum (CDDP; dosage, 50 to 150 mg/body, 35 to 100 mg/m2), a radical therapeutic method, as an alternative to a resection.

RESULTS

All early-stage lesions showed complete remission within 1 to 6 weeks (median, 3.3 weeks) after BAI. In the three patients with multiple lung cancers, BAI was used to treat accessible early-stage lesions, although a surgical resection was required for advanced lesions. Three of the seven patients suffered from severe bronchial ulcers after BAI. Six of the patients in the study had no disease relapse to date at a median follow-up time of 19.8 months (range, 11 to 32 months), but the other patient died of a pulmonary hemorrhage 3 months after BAI.

CONCLUSION

Based on our findings, BAI with CDDP should be reappraised as an effective therapeutic modality for centrally located early-stage lung cancer and as an acceptable primary treatment.

Video-assisted thoracoscopic pericardiectomy for severe pericardial effusions

Video-assisted thoracic surgery (VATS) has proven to be extremely useful in the diagnosis and treatment of multiple thoracic problems. We used the VATS technique to successfully treat refractory pericardial effusions associated with pericarditis by performing pericardiectomy.

MUC1 mucin mRNA expression in stage I lung adenocarcinoma and its association with early recurrence

BACKGROUND

MUC1 is a membrane-bound mucin with an extensively O-glycosylated core protein and is developmentally regulated and aberrantly expressed by carcinomas. A high level of MUC1 mucin expression and secretion is associated with high metastatic potential and a poor prognosis. We studied the expression of MUC1 messenger ribonucleic acid (mRNA) in stage I lung adenocarcinoma by reverse transcriptase-polymerase chain reaction and examined its correlation with early recurrence.

METHODS

The expression of MUC1 mRNA, in surgical specimens from 33 patients with stage I lung adenocarcinoma was determined by reverse transcriptase-polymerase chain reaction. The MUC1 and beta-actin sequences were subsequently coamplified to analyze the semiquantitative determination by polymerase chain reaction. The ratio of MUC1 to beta-actin product was used for further analysis.

RESULTS

An analysis of the disease-free survival (median follow-up, 33.4 months) revealed that a high expression of MUC1 was associated with early recurrence (p = 0.0191). Six of the 33 patients had recurrence within 2 years after operation. The recurrence sites suggested hematogenic metastasis.

CONCLUSIONS

Our results indicate that MUC1 mRNA level may be useful as a marker of early recurrence in stage I lung adenocarcinoma.