Inhibition of inducible nitric oxide synthase prolongs rat lung allograft survival

Nitric oxide (NO) has been demonstrated to be an important immunoregulation molecule in the process of cellular immunologic interactions. Our recent results demonstrated that NO is produced in association with acute allograft rejection and NO inhibition may suppress rejection histologically. This data provides direct evidence of NO in allograft rejection and the immunosuppressive potential of NO inhibitors. In this paper, the effect of NO inhibition on allograft survival was evaluated to investigate the capacity of NO inhibitors as immunosuppressive agents. Seventeen rat left lung transplants from BN donors to F344 recipients were accepted for this study. After surgery, recipients were randomized into two groups and received either aminoguanidine (AG), a highly selective NO synthase inhibitor, 200 mg/kg, intra-peritoneal every 6h (n = 13) or normal saline treatment (n = 4). No production was determined from the recipient's serum nitrite and nitrate levels. Graft survival was monitored via semi-quantitative radiographic aeration scores (AS: 0 = opaque lung to 6 = normal appearing lung). The nitrite and nitrate levels were clearly detectable before the radiographic finding associated with rejection became obvious. Production of NO was significantly inhibited by AG treatment. AG treatment prolonged allograft survival radiographically (12.0 days and 6.0 days for treated and untreated groups respectively, p = 0.0001). These data suggest that the inducible NO is produced in association with acute lung allograft rejection and may serve as a sensitive rejection marker. NO inhibition significantly prolonged rat lung allograft survival but failed to induce immunological tolerance.

Is video-assisted thoracoscopic surgery suitable for resection of primary lung cancer?

We investigated the validity of thoracoscopic surgery-in patients with primary lung cancer undergoing lobectomy. 14 primary lung cancer patients treated by typical VATS lobectomy and one by anatomical segmentectomy, were compared with 56 patients with Stage-I lung cancer undergoing standard lobectomy (control group), the results focusing on the lymph-nodes dissected. All 14 lobectomy patients showed primary lesions of size less than 3 cm. Following classification of the lymph-nodes into groups I (hilar lymph node) and II (mediastinal lymph node), we compared results according to the sites of the lobectomies conducted. Numbers of dissected lymph-nodes were similar in patients whether undergoing standard thoracotomy or VATS lobectomy. We also investigated what histological types of cancer should be treated by VATS lobectomy by comparing preoperative and operative staging in the control group. The results showed that in most patients with squamous-cell carcinoma judged as T1 N0 M0 the staging corresponded, the other patients actually being in N1 (Stage II). Of Patients with adenocarcinoma of T1 N0 M0, however, 14% had lymph-node metastasis even into the superior mediastinum, i.e., Stage III. The overall findings suggest at present that VATS lobectomy should be applied preferably to patients with a histological typing such as squamous cell carcinoma or alveolar cell carcinoma of relatively early stage, i.e. preoperative Stage I.

Potassium transport and potassium channels in the kidney tubules

A variety of K+ channels have been identified using electrophysiological techniques including the patch-clamp method. The types of channels include inwardly-rectifying, ATP-dependent, Ca(2+)-dependent, voltage-gated, and so on. Some of them have been cloned by expression and/or PCR cloning techniques, which give us their amino-acid sequences and molecular topology in the cell membrane. Immunohistochemical studies have shown the proteins (channels) to be localized to the luminal and/or basolateral membranes of a certain nephron segment. However, the relationships of these proteins with the ionic channels identified functionally must be examined by their reconstitution in cell-free systems (lipid bilayer membrane) and/or their expression in cells lacking native K+ channels. Much more care should also be taken to avoid artifacts due to channel-inducing factors (CHIF). Structure-function studies at the molecular level will advance our knowledge of the renal K+ channels and provide us with a further understanding of the role of the kidney in K+ homeostasis.

Graft damage after a single lung transplantation for pulmonary hypertension in a rat model

The hemodynamic effect and degree of damage in grafts of single lung transplants for pulmonary hypertension were studied in rats with monocrotaline-induced pulmonary hypertension. Inbred male Lewis rats (weight 200-230 g) were divided into two groups. Group 1 (control group, n = 16) underwent isogenic left lung transplantation, while group 2 (n = 15) received an intravenous administration of monocrotaline (80 mg/kg i.v.) and underwent isogenic left single lung transplantation 3 week later. Hemodynamic evaluations were performed prior to transplantation, at 1 h postoperatively, and on days 3 and 7 after transplantation. Mean pulmonary arterial pressure (mPAP) rapidly declined after transplantation in group 2, from 39.3 +/- 8.7 mmHg to 18.5 +/- 3.0 mmHg 1 h after transplantation, and remained stable on day 7 after transplantation. No significant difference in the mPAP between the two groups was observed after transplantation. The extravascular lung water volume (ELWV: dry/wet ratio) in the right lung of group 2 significantly increased on day 3 (0.86 +/- 0.02) (P < 0.01), and subsequently decreased to control levels on day 7 (0.83 +/- 0.02). There was no significant difference in the ELWV in the grafted lungs between the two groups (0.84 +/- 0.03 vs 0.86 +/- 0.04), but there was tendency toward an increase in ELWV in group 2 on days 3 and 7. These data thus demonstrated that a hemodynamic improvement was obtained by single lung transplantation; however the degree of graft damage was remarkable in the pulmonary hypertension group.

Induction of TNF-alpha mRNA in murine macrophages by virulent and avirulent strains of Salmonella choleraesuis serovar typhimurium and serovar Choleraesuis

TNF-alpha mRNA induction in murine macrophages by virulent and avirulent Salmonella strains was measured in vitro by RT-PCR method. Virulence plasmid-cured strains of S. choleraesuis serovar Typhimurium and serovar Choleraesuis, and rpoS-defective mutant of S. choleraesuis serovar Typhimurium induced significantly higher level of TNF-alpha mRNA than their parent (virulent) strains in macrophages of C3H/HeN mice. When macrophages of LPS-low responder (C3H/HeJ) mice were used, the difference of the induction level was not observed, indicating that LPS was involved in the enhanced level of TNF-alpha mRNA induction by avirulent Salmonella strains. LPSs from virulent and avirulent strains were analysed, but no difference was found for cytokine-inducing activity, and chemical properties. Those results suggested that avirulent Salmonella strains were damaged more easily, and released more LPS in macrophages to enhance TNF-alpha induction.

Carinal resection and reconstruction for recurrent lung cancer

A patient with a recurrent tumor in the trachea adjacent to the right main bronchus was treated by surgical resection 19 months after undergoing surgery for the primary cancer. The patient had previously undergone right upper lobectomy for T1N0M0 stage I squamous cell carcinoma. A carinal resection was performed which included 4 rings of the trachea, 2 rings of the right main bronchus, and 1 ring of the left main bronchus. Reconstruction consisted of an end-to-end anastomosis of the trachea and left main bronchus, and an end-to-side anastomosis of the right and left main bronchi. The postoperative course was uneventful, and at present the patient is healthy 12 months following reoperation.

Y-26763 protects the working rat myocardium from ischemia/reperfusion injury through opening of KATP channels

This investigation was undertaken to determine the possible protection against ischemia afforded by Y-26763, [(-)-(3S,4R)-4-(N- acetyl-N-hydroxyamino)-6-cyano-3,4-dihydro-2,2-dimethyl-2H-1-benzopyran- 3- ol], which has K+ channel-opening properties, in isolated rat hearts under working conditions. This preparation was subjected to 28 min of global ischemia followed by 30 min of reperfusion. Drugs were injected into the aortic cannula prior to ischemia. Compared to control, Y-26763 (1 microM) resulted in a significant recovery of post-ischemic cardiac functions, significant reduction of cellular enzyme loss, and preserved significantly the stocks of cellular high-energy phosphates and the myocyte ultrastructure. These effects of Y-26763 were completely prevented by glibenclamide (10 microM), a specific K+ channel blocker of KATP channels. In non-ischemic conditions, Y-26763 significantly increased coronary flow without affecting cardiac output and heart rate. The data were analyzed statistically by analysis of variance. The results clearly demonstrate that Y-26763 protects the myocardium from ischemic injury by opening KATP channels.

Thoracoscopic approach to the diagnosis and treatment of diaphragmatic disorders

Thoracoscopy was used in the diagnosis and treatment of three patients with diaphragmatic disorders, including traumatic injury of the diaphragm, partial eventration of the diaphragm, and catamenial pneumothorax (endometriosis of the diaphragm). An excellent view of the diaphragm was obtained by using thoracoscopy. The diaphragmatic injury was repaired primarily, the eventration plicated, and the focal endometriosis resected. Recovery was rapid and uneventful in all three patients. Thoracoscopic surgery, although relatively new, may be an acceptable alternative to the conventional operative management of diaphragmatic disorders and may actually reduce the morbidity and mortality associated with thoracotomy.

[Combined treatment with resection, intraoperative hypotonic and post-operative systemic chemotherapy using cis-platinum for a mediastinal yolk sac tumor: a case report]

Generally yolk sac tumor in the mediastinum is a rare and highly malignant neoplasm. We report a case of yolk sac tumor, which was treated with resection, and then intraoperative hypotonic and postoperative systemic chemotherapy. A 33-year-old man was diagnosed as a mediastinal tumor with chest X-ray and chest CT findings. At operation he had mediastinal tumor which invaded to the part of the right upper lobe and pericardium, disseminated on the right diaphragm. A large tumor was removed with partial pericardiectomy and wedge resection of the right upper lobe. After resection hypotonic chemotherapy with cis-platinum was performed. This tumor had endodermal sinus structure, Schiller-Duval body, and eosinophilic hyaline globolus which were histological characteristics of yolk sac tumor, and the value of serum alpha-fetoprotein (AFP) was high. After operation with this diagnosis systemic chemotherapy consisted of cis-platinum, etoposide were performed. Patient was discharged uneventfully 8 months later.

Reconstruction of trachea and carina with immediate or cryopreserved allografts in dogs

BACKGROUND

Grafting is required when primary reconstruction of a tracheocarinal defect is not feasible. To determine the viability of and the nature of the healing process occurring in the cryopreserved graft, we performed tracheocarinal transplantation in dogs.

METHODS

We performed 32 tracheocarinal reconstructions in dogs using autotransplanted, immediately transplanted, or cryopreserved allografts. The viability of each graft was evaluated serially by fiberoptic macroexamination and by measurement of the tracheal mucosal blood flow using a hydrogen clearance method. In group A (n = 8), the tracheal carina was removed and reimplanted immediately. In group B (n = 8), the tracheocarina was allotransplanted immediately after harvest. In group C (n = 8), allotransplantations were performed using grafts cryopreserved for 1 to 3 weeks by freeze-drying. In group D (n = 8), we attempted to achieve immunosuppression-free transplantation with the cryopreserved allografts.

RESULTS

Sufficient viability and good healing (6/8, 75%) occurred in the dogs with cryopreserved tracheocarinal allotransplants. Three of 8 dogs (38%) with cryopreserved allotransplants survived for 25 to 57 days without immunosuppression.

CONCLUSIONS

The cryopreservation of tracheocarinal allografts for 3 weeks without the use of a preservative solution was shown to be feasible. Cryopreservation prolonged the survival of nonimmunosuppressed allotransplants in dogs.

Concordant lung xenograft rejection in a hamster-to-rat model

This study was conducted to investigate the functional and morphological aspects of orthotopic lung xenograft rejection in a concordant hamster-to-rat donor-recipient species combination. By postoperative day (POD) 3, allotransplanted grafts demonstrated good aeration, but infiltrates were seen in all the xenotransplanted lungs. Antihamster lymphocytotoxic antibody titers increased to 5.2 +/- 1.1 by POD 3 (P < 0.05 vs POD 1) and reached 7.0 +/- 0.8 by POD 5 (P < 0.05 vs PODs 1 and 3). The CD4+/CD8+ ratio in peripheral blood lymphocytes increased significantly on POD 3 (P < 0.05 vs untransplanted), but decreased by POD 5 (P < 0.05). Histologically, on POD 3 the xenotransplanted grafts were characterized by perivascular cellular infiltrates and edema. Cytologically, the cells consisted of small round lymphocytes, monocytes, and occasional neutrophils. Immunohistochemical analysis showed heavy IgM and C3 deposits in the vascular endothelium, without any IgG deposits. Allotransplanted grafts showed moderate W 3/25 + (28.3 +/- 17.3%) and MRC OX8 + (38.7 +/- 0.7%) cellular infiltrations on POD 3, but ED1 + (8.0 +/- 3.7%) cells were rare. Conversely, in the xenotransplanted grafts, ED1 + (34.2 +/- 16.4%) cells were more prevalent than MRC OX8 + (18.1 +/- 16.5%) cells on POD 3, at P < 0.01 and P < 0.05 vs allograft, respectively. These results indicate that both antidonor antibodies and macrophages/monocytes play an important role in the concordant lung xenograft rejection.

The pathogenesis of the transepithelial elimination of the collagen bundles in acquired reactive perforating collagenosis. A light and electron microscopical study

Two cases of acquired reactive perforating collagenosis with poorly controlled diabetes mellitus were studied by histochemistry and by electron microscopy. In excoriated wound the necrotic mass on the bottom of the ulcer contained the collagen bundles which were continuous with the collagen bundles in the reticular layer. In the developing stage, the epidermis regenerated between the necrotic mass and the reticular dermis, and the collagen bundles in the reticular dermis were in continuity with those in the necrotic mass through the epithelial tunnels. The collagen in the epidermal channels did not degenerate ultrastructurally. In the mature lesion, collagen bundles being eliminated through the epidermis were surrounded by the fibroblasts at the basal cell layer. Collagen fibers were seen in the cytoplasm of these fibroblasts. From these findings, the mechanisms of the formation of the eruption in acquired reactive perforating collagenosis might be as follow: 1) In the developing stage, the regeneration of epidermis progresses between the necrotic mass and the reticular dermis, and among the collagen bundles. As a result, the collagen bundles remain in the channels of the epidermis. And then, 2) the regenerated epidermis makes the thick horny layer. As a result, the necrotic masses are lifted up and the collagen bundles are pulled up from the dermis through the epidermal channels.

[Dynamic stent useful for trachocarinal stenosis due to lung cancer]

In this study, a new tracheobronchial stent was used for treating a patient with tracheocarinal stenosis due to lung cancer. The patient was 41 year-old male with lung mass in the right upper lobe and metastatic mediastinal lymph node which caused tracheocarinal stenosis. The stent was introduced under general anesthesia with a jet ventilator. The respiratory condition of the patient could be controlled fairly well, and the ventilation tube didn't interfere with the stenting. The stent was a tracheobronchial silicone stent provided with a flexible posterior membrane and tracheal cartilage-shaped steel struts. Coughing is less difficult than other stents owing to better design. This patient has been able to cough up sputum from the day of the operation and there has been no need for bronchoscopic examination for removal of secretions.

[Relationship of hypertension prevalence in companies to business type and scale--from an analysis of health examination results in Fukui prefecture]

The results of health examinations of 89,299 examines from companies in Fukui Prefecture conducted pursuant to the Occupational Safety and Health Act were analyzed to study the relationship between the prevalence in these companies of hypertension, and company size business type. The Mantel-Haenszel method was utilized to adjust for age structure of the examinees according to gender and the type of business of their companies to compare prevalence of hypertension. The results of the analysis indicated that the prevalence of hypertension was significantly higher in small-scale companies for the female examinees working in pulp/paper processing and motor freight transport business than in large-scale companies, but no significant difference was seen for scale of business when the female examinees were grouped without regard to the business type of their companies. In the case of the male examinees, the analysis results revealed that the prevalence of hypertension was significantly higher in small-scale companies for those working in ceramic/earth/rock, motor passenger transport and hotel/restaurant business than in large-scale industry while the prevalence of hypertension was significantly higher in large-scale companies for those working in non-ferrous metal industry, financial and other types of business. Moreover, the analysis results for the male examinees grouped without regard to the type of business of their companies indicated that the prevalence of hypertension remained significantly higher in small-scale companies. The above also suggests the need for measures for health care of workers that considers business type and scale for the purpose of primary prevention of hypertension.

Nodular lymphoid hyperplasia in the lung

We describe an immunocompetent adult patient presenting with cough and hemoptysis who was found to have a pulmonary mass localized to the right upper lobe. Lobectomy was performed and pathological examination revealed nodular lymphoid hyperplasia (pseudolymphoma) of the bronchus-associated lymphoid tissue.

Bronchoscopic evaluation of bronchial healing after carinal reconstruction

Bronchoscopic evaluation of the anastomoses created by carinal reconstruction was carried out over a period of 7 weeks in 6 patients who had undergone carinal and lobar resections for lung cancer, and 4 who had undergone carinal resection without pulmonary resection for carinal tumors. The techniques of reconstruction included end-to-end and end-to-side tracheobronchial anastomoses with omental, fat, or pleural wrapping. Bronchial healing at the anastomosis was evaluated using a bronchial healing score (BHS) based on the bronchoscopic findings. The degree of healing was scored on a 0 to 4 scale, with 0 indicating normal mucosa; 1, edema or reddening; 2, mucosal color changes; 3, ulceration; and 4, diffuse ulceration. One postoperative death occurred as a result of anastomotic leakage. The remaining nine patients were divided into three groups according to the bronchoscopic findings on postoperative day (POD) 7: group A (n = 3) had mild ischemia at the anastomosis, group B (n = 3) had moderate ischemia at the anastomosis, and group C (n = 3) had severe ischemia at the anastomosis. Bronchial healing of the anastomosis improved over a 7-week period in groups A and B, but was delayed in group C. These findings led to the conclusion that wound healing of the anastomosis following carinal reconstruction requires more than 7 weeks due to the consequent devascularization resulting from the extended bronchial resection and lymph node dissection.