[Clinicopathologic assessment of primary thymic carcinoma based on eighteen cases]

In order to study clinicopathologic characteristics of thymic carcinomas, 18 patients with thymic carcinoma and 56 patients with invasive thymoma were reviewed. All of them were underwent thoracotomy. Both 5-year and 10-year survival rates were 44% in the thymic carcinoma patients, while 5-year survival and 10-year survival rates were respectively 62% and 52% in the invasive thymoma patients. The survival rate of the thymic carcinoma cases was significantly lower than that of invasive thymoma cases (p < 0.05). Both surgical technique and anticancer chemotherapy. However, have been improved in these years, such as artificial vessels for great veins, panpleuro-pneumonectomy, cisplatin and so on. Those new techniques have brought the significantly higher survival rate in recent 10 cases of thymic carcinoma patients. Three-year survival rate of 10 cases after 1990 was 80% and it was 13% in 8 cases before 1989 (p < 0.01). We conclude that surgical procedure are necessary for the treatment of thymic carcinoma patients, and both chemotherapy and radiotherapy should be combined with the surgical procedures to completely remove the tumors.

Alterations of c-fos gene methylation in the processes of aging and tumorigenesis in human liver

The state of DNA methylation in the c-fos gene was examined in human livers of different ages, cirrhosis and hepatocellular carcinoma. The degree of methylation in the intron 1 to exon 4 region increased with age, whereas all of the 10 cirrhosis samples revealed a decrease in methylation when compared to normal livers of similar ages. The 11 hepatocellular carcinomas showed varied alterations suggesting that the alteration of the c-fos gene methylation is related to aging as well as to early-step of hepatocarcinogenesis.

Simultaneous estimation of filtration variables in isolated rat lungs in zone 3 conditions

Estimation of filtration variables (filtration coefficient, perimicrovascular pressure, and reflection coefficient) is important for evaluating pulmonary microvascular permeability to fluids, especially when the lungs are inflamed, injured, or being preserved for transplantation. Here we report a new method for estimating filtration variables simultaneously in isolated rat lung lobes in zone 3 conditions (pulmonary arterial pressure > pulmonary venous pressure > alveolar pressure). We used Krebs-Henseleit solution containing 6% bovine serum albumin for the perfusate and maintained perfusion using a constant-pressure circuit system. Pulmonary venous and alveolar pressures were kept at 2.5 and 2.0 cmH2O, respectively, and pulmonary arterial pressure was set so that lung weight did not change. Then we increased both pulmonary arterial and venous pressures by 3 cm H2O simultaneously, and recorded the weight gain. Next, we diluted the perfusate with Krebs-Henseleit solution to about half the original concentration, and recorded the weight gain. Using the Starling equation, the values we obtained for the filtration variables were filtration coefficient, 5.3 mg. min-1.cmH2O-1.g-1; perimicrovascular pressure, 1.1 cmH2O; reflection coefficient, 0.54. These values agree with values from previous reports. Since these 3 filtration variables are interrelated, this method for simultaneous measurement is more accurate than independent measurements are. The advantages of this method are that it does not require direct measurement of interstitial pressure or collection of lymph fluid. What we need to calculate these filtration variables are the initial filtration rates and the albumin osmotic pressures for perfusate.

[A case of idiopathic thrombocytopenic purpura combined with lung cancer]

A 71-year-old male was admitted to our hospital because of a chest abnormal shadow. His chest X-ray film showed a mass in the right lower lobe (S6), which was diagnosed as adenocarcinoma by transbronchial lung biopsy. A lab data on the admission showed thrombocytopenia (44,000 per cu. mm), and the results of the bone marrow aspiration was compatible with idiopathic thrombocytopenic purpura. Immediately after the right lower lobectomy with lymphnode dissection, intrathoracic bleeding from the wound due to hemorrhagic tendency appeared necessitating a re-thoracotomy. High-dose intravenous gamma-globulin infusion for 4 days and the frequent concentrated platelet transfusion were employed to prevent the hemorrhagic tendency after the 2nd operation, and the postoperative hemorrhage was successfully controlled. Perioperative high-dose intravenous gamma-globulin infusion was concluded to be useful in the patient of idiopathic thrombocytopenic purpura for preventing hemorrhagic tendency after the operation.

Usefulness of ultrasonography in operation for pulmonary arteriovenous fistula

A 54-year-old woman presented with nonhereditary, bilateral pulmonary arteriovenous fistulas. One of them was small (10 x 10 mm) and embedded in the parenchyma; it was neither visible nor palpable from the pleural surface. We therefore used intraoperative ultrasonography and succeeded in detecting and enucleating the small fistula with minimal resection of the normal lung tissue.

Binding of hemoglobin to the envelope of Porphyromonas gingivalis and isolation of the hemoglobin-binding protein

The binding activity of the Porphyromonas gingivalis envelope and hemoglobin was examined over a wide range of pH values from 4.5 to 9.0. The binding activity in low-pH buffers was much higher than that at high pH; the optimum pHs for the binding were found to be 4.5 and 5.0. Since the hemoglobin bound to the envelope was found to dissociate in the pH 8.5 and 9.0 buffers, the binding is reversible. We hypothesized that hemoglobin-binding protein (HbBP), responsible for the binding to hemoglobin, exists in the envelope and confirmed its presence by dot blot determination with peroxidase-conjugated hemoglobin. Then we attempted to isolate HbBP from the solubilized (by a detergent) materials of the envelope by affinity chromatography. The molecular mass of HbBP was 19 kDa, and the isoelectric point was 4.3.

[Two cases of the congenital posterolateral diaphragmatic hernia were reported]

Case 1, a 9-year-old woman, was admitted to our hospital because of nausea, vomiting, and epigastralgia. Diagnosis of Bochdalek hernia was made by the unusual course of naso-gastric tube. At surgery through the left posterorateral thoracotomy, the herniation of the stomach, small intestine, and colon to the thoracic cavity through the dorsolateral defect of the diaphragm were revealed. Case 2, a 35-year-old man, was admitted to our hospital because of dyspnea. Similar diagnosis was made by the examination of upper G1 series and barium enema, which demonstrated the presence of multiple loops of the small intestine and colon in the left thoracic cavity. Their postoperative courses were uneventful. Most of Bochdalek hernia is observed in infancy, and adolescent or adult case is is rarely reported (approximately 10% of all cases). Since this often misdiagnosed as pleuritis or pulmonary tuberculosis, a cautious examination is necessary for the establishment of the correct diagnosis.

[Assessment of a new TNM classification produced by UICC for resected lung cancer with intrapulmonary satellite tumor(s)]

We examined the efficacy of a new classification produced by International Union Against Cancer (UICC) in 1993 for 61 patients who underwent resection of lung cancer with intrapulmonary satellite tumor(s) during 1952 to June 1991. Survival rate after resection was calculated according to the new classification. Survival rate of patients with stage I lung cancer was 67% at four years after surgery, that with stage IIIA was 33% and stage IIIB 5% at five years after surgery. There was a significant difference between the survival of stage IIIA and stage IIIB. Five year survival of patients with N0 or N1 lung cancer was 62%, which was significantly better than four year survival (3%) with N2, N3, or NX lung cancer. Five year survival for patients with squamous cell carcinoma was 61%, which was significantly better than that (9%) with adenocarcinoma. The new TNM classification produced by UICC is acceptable in investigating lung cancer with ipsilateral satellite tumor(s). It is necessary to investigate lung cancer with contralateral satellite tumor(s). Prognosis of patients with N0 or N1 lung cancer, especially squamous cell carcinoma, even if with intrapulmonary satellite tumor(s), was relatively good after resection. Such lung cancers may be synchronous multiple lung cancers from a therapeutic point of view.

[Effect of time in culture on modulation of Na(+)-K(+)-ATPase activity in rat alveolar type II cells]

To determine the effect of time in culture on epithelial cell function, we evaluated the modulation of Na(+)-K(+)-ATPase activity in rat alveolar type II cells in culture. Ouabain sensitivity testing revealed that the alpha-1 predominance in the enzyme's isoforms was maintained over the 120 hours in culture. Basal Na(+)-K(+)-ATPase activity in the whole cell homogenate did not differ significantly between cells cultured for 48 hours and those cultured for 120 hours. Terbutaline (10 mM) did not activate Na(+)-K(+)-ATPase in the cells cultured for 48 hours, but, it significantly increased the activity of this enzyme in the cells cultured for 120 hours cells cultured for 48 hours, produced intracellular cyclic AMP after exposure to 10 mM of terbutaline. These results indicate that the coupling between Na(+)-K(+)-ATPase and the beta-adrenergic pathway in alveolar type II cells can be influenced by the time in cell culture.

Preservation of alveolar epithelial fluid transport mechanisms in rewarmed human lung after severe hypothermia

Although hypothermia abolishes alveolar fluid clearance in the in situ goat lung and in the ex vivo human lung, it is unknown whether alveolar fluid clearance resumes in lungs that are rewarmed after severe hypothermia. An isosmolar albumin solution was instilled into resected human lungs that were rewarmed to 37 degrees C after hypothermia (7 +/- 3 degrees C), and then alveolar fluid clearance was measured by the concentration of albumin in the alveolar fluid sample after 4 h. In control experiments in lungs that had not been cooled and rewarmed, alveolar fluid clearance was 11 +/- 2% over 4 h. In separate experiments, hypothermia completely abolished alveolar fluid clearance. However, alveolar fluid clearance resumed to a normal level of 12 +/- 1% over 4 h in the lungs that were rewarmed after hypothermia. Amiloride decreased alveolar fluid clearance by 47% in the rewarmed lungs. Terbutaline increased alveolar fluid clearance by nearly 300% in 2-h experiments in the rewarmed lungs (P < 0.05). The results of this study indicate that alveolar sodium-channel transport mechanisms are preserved in resected human lungs that are exposed to rewarming after hypothermia.

[Detection of early cancer by lung cancer screening]

A total of 1,615,010 person-years in 64 local municipalities were screened from April 1982 through March 1990. All participants were screened annually by chest X-ray, and participants of high risk group were screened by both chest X-ray and sputum cytology. 76,522 person-years(4.7%) were screened by sputum cytology. Among 148 lung cancer patients(0.194%) detected by sputum cytology, 132 were squamous cell carcinoma, and 116(78%) were chest X-ray negative. 90 patients were proved to be Stage 0 or I after resection, and 47 were less than 10 mm in diameter. On the contrary, 166 out of 432 detected patients detected by chest X-ray only, were proved to be Stage I after resection, and 4 patients were less than 10 mm in diameter. Thus, sputum cytology for high risk group were effective to detect early lung cancer.

[A study of surgical treatment in lung cancer over 75 years of age-effect of epidural anesthesia for protection of postoperative coughing disturbance]

29 patients over 75 years of age in 221 patients undergoing resection of lung cancer from January of 1990 through December of 1994 were studied for the occurrence of expectoration disturbance (atelectasis), the effect of epidural anesthesia for protection of it. Atelectasis was observed in 8 (27.6%) of 29. In a group received epidural anesthesia (EA) during the early postoperative phase, 1 of 5 patients developed atelectasis. In 192 patients below 75 years of age, atelectasis was observed in 40 (20.8%) of them, so in a group received epidural anesthesia (EA) during the early postoperative phase, only 2 of 42 patients (4.8%) developed atelectasis. This value was significantly lower than that value (25.3%) in a group without EA. In conclusion, in the group below 75 years of age, EA during the early postoperative phase may be useful in inhibiting the occurrence of atelectasis, an important one of the postoperative lung complications.

Relaxation of human isolated pulmonary arteries by amrinone

Amrinone, a selective phosphodiesterase III inhibitor, has been developed as a nonglycoside, noncatecholamine agent with positive inotropic effect. In this study, we examined the effect of amrinone on human pulmonary arterial strips in vitro to understand its action on human pulmonary circulation. Amrinone (10(-5)-10(-3) g/ml) caused dose-dependent relaxation of human pulmonary arterial strips precontracted with 60 mM KCl. Preincubation with either meclofenamate (3.1 microM), a cyclooxygenase inhibitor, or L-N(G)-nitroarginine (100 microM), a competitive inhibitor of EDRF/NO, failed to inhibit amrinone-induced pulmonary vasodilation. The cyclic AMP (cAMP) levels in the supernatant of the lung vessel homogenates increased after incubation with amrinone (10(-3) g/ml). These findings indicate that amrinone causes vasodilation of human pulmonary artery in vitro, and suggest a possible role for cAMP in the mechanisms of amrinone-induced pulmonary vasodilation. Because it is suggested that amrinone has not only positive inotropic effect but also pulmonary vasodilative effect in human in this study, we speculate that amrinone could be an useful agent for the treatment of an increase in right heart afterload and consequent pulmonary hypertension and right heart failure after lung resection in human.

[Two cases of clear cell tumor of the lung]

We report two cases of benign clear cell tumor of the lung, which were found as well-circumscribed lesions on chest X-ray films without any symptoms, and removed surgically. Light microscopy showed proliferation of clear cells filled with glycogen in both cases. Immunohistochemical examination performed in a case suggested that the tumor cells might be associated to a derivation from neural and/or smooth muscle cells, because of positive staining for NSE and SMA. In another case, the tumor formed a necrotic cavity, which could be detected by the preoperative MRI examination. This report might introduce a note of caution for the pathologic and radiographic diversity of this disease.

[Long-term effect of a beta-adrenergic agonist on sodium uptake into cultured rat alveolar type II cells]

To evaluate the long-term effect of a beta-adrenergic agonist on Na(+)-channel function in cultured rat alveolar type II cells, we measured 22Na+ uptake into type II cells cultured in the presence and absence of 0.1 mM terbutaline for up to 5 days. Terbutaline did not influence the growth, morphology, or protein content of the cells. Terbutaline increased amiloride-inhibitable 22Na+ uptake into the cells at day 2 in culture, but there was no significant difference at day 5. Because amiloride-inhibitable 22Na+ uptake reflects Na(+)-channel function, these data indicate that terbutaline may transiently upregulate Na(+)-channel function. This study provides direct evidence of a long-term effect of a beta-adrenergic agonist on Na(+)-channel function in alveolar type II cells.

[Effects of subacute hypoxia on alveolar epithelial ion transport in rats]

To study the effects of subacute hypoxia on alveolar epithelial ion transport, alveolar fluid clearance was measured in isolated fluid-filled rat lungs. After instillation of a solution containing about 5% bovine albumin, an increase in alveolar fluid clearance was measured over 2 hours. Alveolar fluid clearance was lower when rats were kept in hypoxic conditions (FiO2 = 0.1) for 48 hours. Neither 10(-5) M amiloride (a Na(+)-channel blocker) nor 10(-3) M ouabain (an inhibitor of Na(+)-K(+)-ATPase) inhibited fluid clearance in the hypoxia group, but they did in the normoxia group. These results indicate that subacute hypoxia may down-regulate both the Na(+)-channl and Na(+)-K(+)-ATPase, and thus decrease the absorption of excess alveolar fluid.

[Reconstruction after wide resection of the chest wall: application of plates as rigid prosthetic materials]

Wide resection of the chest wall requires reconstruction with rigid prosthetic material to protect the thoracic organs and to avoid flail chest. We tried to use three kinds of plates for chest wall reconstruction in 4 cases: acrylic plate for 1, ultra-high-molecular-weight polyethylene (UHMWP) plate for 1 and methyl metacrylic resin (MMR) plate for 2. Marlex mesh was utilized to strengthen the rebuilt chest wall sandwiching rigid prosthesis in UHMWP plate and MMR plate. Except for somewhat local accumulation of serous fluid in two cases of acrylic plate and MMR plate, postoperative courses were uneventful in all cases. Acrylic plate which was used for patient with metastatic sternal tumor was easily damaged by heat. UHMWP plate which was used for patient with large benign sternal tumor was expensive and took a long time to make. On the other hand, MMR plates which were used for two patients with malignant lateral chest wall tumor were easy to handle on the spot and not expensive. MMR plate sandwiched by Marlex mesh seems to be more suitable and available for chest wall reconstruction.

Sleeve superior segmentectomy of the right lower lobe for endobronchial neurinoma. Report of a case

A 30-year-old woman was found to have an obstructive intrapulmonary tumor at the right intermediate bronchus which caused atelectases of both right middle and lower lobes. The diagnosis of endobronchial neurinoma was made by bronchofiberscopic biopsy. Since the tumor was benign, we considered an operative procedure which would enable both complete resection of the tumor and preservation of the pulmonary function. By utilizing the techniques of sleeve superior segmentectomy of the right lower lobe and telescoping bronchial anastomosis, both objectives were achieved.

[Role of peptide leukotrienes in monocrotaline-induced lung disease]

Monocrotaline (MCT) causes lung inflammation and right ventricular hypertrophy associated with lung vascular thickening in rats. We hypothesized that peptide leukotrienes play a role in MCT-induced lung disease, and examined the effect of ONO 1078, a specific antagonist of LTC4, D4 and E4 receptors on MCT-induced right ventricular hypertrophy and on lung vascular thickening. Next, we measured leukotriene C4 (LTC4) levels in the lung tissue of MCT-treated rats. Within 3 weeks after the injection MCT had caused an increase in the ratio of right ventricular weight to left ventricle+septum weight (RV/(LV+S)) and an increase in media wall thickness of the muscular arteries of the lung. In rats given both ONO 1078 and MCT, these changes were significantly less severe than in rats given MCT only. The LTC4 levels in MCT-treated rats were significantly higher than in saline-treated control rats. These results indicate that this antagonist of peptide leukotriene receptors inhibits right ventricular hypertrophy induced by MCT, and suggest a role for peptide leukotrienes in the inflammatory process that contributes to lung vascular remodeling in MCT-treated rats.

[An experience of surgery for thymolipoma in a patient with amyotrophic lateral sclerosis]

A 48-year-old male with amyotrophic lateral sclerosis (ALS) was revealed to have an anterior mediastinal tumor, occupying left hemithorax on a chest CT. The tumor compressed the left lower lobe, resulting in a hypoventilation, which required a continuous ventilatory support. Although ALS has poor prognosis in general, we decided to remove the tumor surgically. Because the symptoms related to ALS was limited to his extremities, indicating he could potentially reestablish his life under ventilator-free condition, when a remove of the tumor improved a hypoventilation. A remove of the tumor was performed via antero-axillar thoracotomy, and reexpansion of the left lower lobe was achieved, followed by improvement of lung function and of respiratory symptoms. Histological examination revealed that the tumor was composed of mature adipose tissue and thymic tissue, diagnosed as thymolipoma. Postoperative course was uneventful.

Adhesion molecule CD18 on polymorphonuclear cells correlates to the lung injury caused by continuous infusion of endotoxin in sheep

We investigated the mechanisms of increase in the pulmonary vascular permeability, focusing on the changes in the peripheral white blood cell (WBC) counts and the surface expression of CD18 on polymorphonuclear cells (PMNs). Anesthetized sheep with chronic lung lymph fistulas were used in this study. We infused synthetic endotoxin (LPS) at a rate of 10 ng/kg/min (i.v.) continuously for 24 hr. We measured lung lymph flow, lymph-to-plasma protein concentration ratio and WBC counts in blood and lung lymph, and the PMNs' surface expression of CD18 before and at 2, 10 and 24 hr after the start of endotoxin infusion, respectively. CD18 was analyzed by flow cytometry using monoclonal anti-CD18 antibody. We found that the pulmonary vascular permeability increased during 2-4 hr after the start of endotoxin infusion, and returned to the baseline over 10 hr. At time 2 hr period, the number of WBCs in the lung lymph increased, the number of peripheral WBCs, mostly PMNs, decreased and the surface expression of CD18 on the peripheral PMNs was up-regulated. At time 10 and 24 hr, the number of WBCs in lung lymph decreased, the number of peripheral WBCs increased and CD18 expression was down-regulated. These data indicate that up-regulation of CD18 expression promotes the PMN adherence to the pulmonary endothelium, migration into the lung and increases the pulmonary vascular permeability. We conclude that the continuous endotoxin infusion up-regulates CD18, which contributes to the PMN migration into the lung.

[Contribution of oxidative stress to pulmonary hypertension induced by chronic hypoxia]

Chronic hypoxia causes pulmonary hypertension and right ventricular hypertrophy associated with media wall thickening of pulmonary arteries in rats. Platelet-activating factor plays an important role in the pulmonary vascular remodeling induced by chronic hypoxia, and reactive oxygen species are involved in tissue injury induced by platelet activating factor. We therefore hypothesized that reactive oxygen species contribute to the pulmonary hypertension induced by chronic hypoxia, and examined the effect of N-acetyl-L-cysteine (NAC), a free radical scavenger and the precursor of glutathione sulfhydryl (GSH), on hypoxia-induced pulmonary hypertension. We used a chemiluminescence-HPLC assay to measure the levels of phosphatidylcholine hydroperoxide (PCOOH) in the rat lungs exposed to hypoxia. Three weeks of normobaric hypoxia (FiO2 = 0.1) with NAC significantly reduced pulmonary hypertension, right ventricular hypertrophy, and media wall thickening of the pulmonary arteries. NAC had no effect on the hematocrit of normoxic or chronically normobaric hypoxic rats. Lung PCOOH levels were significantly higher in the hypoxic rats than in the control rats, and those in the NAC-treated rats were significantly lower than those in the hypoxic rats that were not given NAC. Lung PCOOH levels were significantly higher in the hypoxic rats than in the control rats, and those in the NAC-treated rats were significantly lower than those in the hypoxic rats that were not given NAC. These results indicate that hypoxia induces oxidative stress in the lung tissue, and that oxidative stress may have a role in the development of pulmonary hypertension induced by chronic hypoxia in rats.

[A true aneurysm of the right internal mammary artery, accompanied by diminished grasping power of the right hand]

A 69-year-old man was admitted to our hospital after an abnormal shadow was found on a chest radiograph. The preoperative diagnosis was right subclavian aneurysm. Loss of grip in the right hand developed, and the patient underwent surgery. During surgery, the aneurysm was found to have originated from the right internal mammary artery. The root of the right internal mammary artery was tied and the right subclavian artery, which had been compressed and displaced by the aneurysm, was replaced. A chest radiograph obtained 6 months after surgery showed that the trachea was no longer displaced. However, the gripping force of the right hand had not recovered.

[Leukocyte-mediated production of eicosanoids in rat lungs: modulation by a calcium antagonist]

Formyl peptide (fMLP) by itself does not increase eicosanoid levels in rat lungs, but eicosanoid levels and edema do increase if endotoxin (ETX) is given before an fMLP challenge. The role of pulmonary intravascular leukocytes in fMLP-induced eicosanoid production in rat lungs was studied, as was the effect of a calcium antagonist (Ro 40-5967). ETX increased the levels of 6-keto PGF1 alpha, but not the levels of TXB2 or LTB4. A second challenge with fMLP in ETX-primed rats resulted in increased production of these three eicosanoids, and increased neutrophil accumulation, as assessed by myeloperoxidase assay. The calcium antagonist attenuated both the production of eicosanoids and the accumulation of neutrophils in the lung. The levels of both 6-keto PGF1 alpha and TXB2 correlated well with lung neutrophil accumulation. Leukocytes isolated from the pulmonary vasculature released TXB2 and LTB4 when stimulated with fMLP in vitro. The amount of these eicosanoids released from pulmonary intravascular leukocyte suspension was well correlated with neutrophil counts in a leukocyte suspension. These data indicate that fMLP-induced production of eicosanoids in the lung, especially production of TXB2, is mediated by pulmonary intravascular neutrophils, and that calcium antagonists can attenuate eicosanoid production by decreasing the accumulation of neutrophils in the lung.