Successful tracheal transplantation with fresh allografts in a rabbit model

PURPOSE

Immunogenicity and the restoration of blood supply to the donor graft remains a clinical challenge in tracheal allotransplantation. We conducted a study on 20 rabbits of a genetically similar strain to eliminate the risk of rejection caused by immunogenicity.

METHODS

We examined the histomorphological changes related to revascularization and the immunogenic reaction of the fresh allografts after tracheal transplantation. Histomorphological assessment was conducted by investigating the anastomotic sites, graft necrosis, and epithelization. Cellular changes, including the infiltration of granulocytes, histiocytes, and fibroblast proliferation related to a granulation tissue-like reaction, were also assessed, with lymphocyte infiltration which is an indicator of graft rejection. All of these characteristics, apart from epithelization, were graded semiquantitatively as none (0), mild (1), moderate (2), and severe (3). Epithelization was graded as 0, indicating no epithelization; 1, < or =20%; 2, < or =40%; 3, < or =60%; 4, < or =80; 5, complete epithelization of the entire graft.

RESULTS

Morphologic integrity of the trachea was completely retained in 16 (80%) animals. The overall rating score of epithelization was 3.6+/-1.0, while those of the granulation tissue-like reaction and lymphocyte infiltration were 4.8+/-0.6 and 1.5+/-0.7, respectively.

CONCLUSION

These findings demonstrate that tracheal allotransplantation is possible with fresh allografts in genetically similar strains of rabbits.

Adsorption of cobalt from aqueous solutions onto sepiolite

Adsorption of Co(II) ions from aqueous sepiolite suspensions has been systematically investigated as a function of several variables including activation conditions, solid to liquid ratio, pH and temperature. The results are analyzed to identify the mechanism of cobalt uptake by sepiolite. Both abstraction and real adsorption isotherms were constructed to isolate the precipitation of cobalt from the real adsorption. Also, for the first time a plausible correlation between the released Mg(II) ions from sepiolite matrix and those adsorbed Co(II) ions is made. A one to one ion exchange mechanism is found to describe the results. The data obtained from adsorption isotherms at different temperatures were fitted to various adsorption models to calculate thermodynamic quantities such as the free energy of adsorption, heat of adsorption and entropy of adsorption. The thermodynamic data indicate that Co(II) adsorption onto sepiolite is entropically driven and characterized by physical adsorption.

Giant ancient schwannoma of the posterior mediastinum cytologically misdiagnosed as a malignant tumour. A case report

We report a case of a 45-year old woman who was found to have a giant mediastinal tumour with radiological degenerative changes. She underwent thoracotomy to remove the mass, which was eventually diagnosed histologically as an ancient schwannoma, whereas cytological interpretation of the accompanying pleural fluid was malignant. Ancient schwannoma is a rare variant of schwannoma, histologically showing atypical features that may result in erroneous diagnosis of a malignant tumour. Clinical and radiological findings are important aids for further consideration of surgical removal of these potentially resectable tumours.

Bilateral elastofibroma dorsi: proper positioning for an accurate diagnosis

Elastofibroma dorsi is a rare, slow-growing, ill-defined soft tissue tumor of the chest wall, most commonly located beneath the rhomboid major and latissimus dorsi muscles. It is usually unilateral, and bilateral involvement occurs in only 10% of patients. We report herein a case of a 56-year-old woman with bilateral elastofibroma dorsi. The patient was found to have bilateral involvement of the tumor following a physical examination with proper positioning. An elastofibroma should be considered in the differential diagnosis of tumors deeply located at the periscapular area. Meticulous physical examination may reveal a nonpalpable coexisting tumor with deep subscapular location and help the accurate diagnosis of bilateral elastofibroma dorsi, hence preventing a secondary operation.

Prognostic implications of microscopic proximal bronchial extension in non-small cell lung cancer

BACKGROUND

The loss of approximately one third of early stage lung cancer patients undergoing complete resection by the end of 5 years implies the existence of unknown or undetected factors at the time of operation. We investigated the possible correlation between microscopic proximal bronchial extension (MPBE) and survival with clinicopathologic features in patients with non-small cell lung cancer.

METHODS

The bronchial tree with the tumor was dissected and extracted from the lung parenchyma in a total of 62 surgical specimens with non-small cell lung cancer. The tumor-related bronchus was sectioned into serial blocks at a thickness of 5 mm in the transverse plane. Histologically, cut serial sections were examined for MPBE.

RESULTS

A total of 15 (24.2%) specimens showed MPBE, whereas 47 (75.8%) specimens showed no evidence of MPBE. The median survival time of MPBE-positive patients was 10.0 months, whereas that of MPBE-negative patients was 42.0 months. The 5-year survival rates of MPBE-positive and MPBE-negative groups were 13.3% and 35.8%, respectively, which was a significant difference (p = 0.0203). Multivariate analysis revealed lymph node status (p = 0.0161), histology (p = 0.0268), and MPBE-positivity (p = 0.0447) as independent prognostic factors.

CONCLUSIONS

Microscopic proximal bronchial extension has an adverse effect on survival in non-small cell lung cancer.

Transdiaphragmatic intercostal hernia following a penetrating thoracoabdominal injury: report of a case

Intercostal hernias with abdominal viscera have rarely been reported following penetrating accidental or surgical trauma. We report herein a case of a traumatic rupture of the left hemidiaphragm, presenting as an intercostal hernia 2 years after a penetrating thoracoabdominal injury. The diaphragmatic rupture had been initially very small and could not be detected in the serial chest films and abdominal computed tomographic scans. The injury was also missed during an exploratory lateral thoracotomy. The patient was admitted with the chief complaint of a painful and gradually enlarging left-sided chest wall bulge of 8 months' duration. Surgery via an anterolateral thoracotomy along the axis of the intercostal hernia was performed, and the omentum and splenic flexura of the colon were reduced.

[Tuberculosis of the lung bases]

Tuberculosis of the lung bases is a rare condition that can mimic pneumonia, bronchial carcinoma, lung abscess or bronchiectasis. Diagnostic delays, that can lead to serious complications not amenable to surgical resection, are often the result of repeatedly negative bacteriological examinations. We report a series of 10 cases of tuberculosis of the lung bases collected between 1993 and 1998 that were examined by computerised tomography. The chest x-ray most commonly showed a heterogeneous opacity. On the CT scan this corresponded with an area of alveolar consolidation which, when it was associated with centrilobular micronodules and cavitated nodules and masses, suggested the diagnosis of basal tuberculosis. Indeed the absence of apical lesions and the frequency of involvement of mediastinal and bronchial lymph nodes support the hypothesis of bronchial dissemination of the bacilli from tuberculous nodes. This explanation is supported by the high incidence of endobronchial lesions found at bronchoscopy in this form of tuberculosis.

Primary hydatid cyst of the posterior cervical triangle

Hydatid cysts in the cervical region are extremely rare. We report herein a case with a hydatid cyst that was primarily located in the posterior cervical triangle without any pulmonary or hepatic involvement. A hydatid cyst of the neck should be considered in the differential diagnosis of lesions in the cervical region, in endemic areas, so as to avoid any dangerous complications such as contamination and a fatal anaphylactic reaction.

The use of a homologous preserved costal cartilage in an infant with Poland's syndrome

Poland's syndrome is a rarely encountered congenital deficiency involving chest wall and breast deformity associated with hand anomalies. Chest wall reconstruction is necessary if the bony thorax is involved. We present the use of a homologous preserved costal cartilage for reconstruction of the chest wall in an infant with Poland's syndrome, the use of which provided optimal chest wall stability with a favourable outcome.

Implantation metastasis caused by fine needle aspiration biopsy following curative resection of stage IB non-small cell lung cancer

Fine needle aspiration is a useful procedure in the diagnosis of lung cancer, however controversy still remains as to whether it should be employed particularly in patients with operable lung cancer. We report herein a case of metastatic tumor at the site of transthoracic needle biopsy following a curative resection in a patient with stage IB bronchogenic carcinoma. The patient was managed with aggressive chest wall resection and subsequent musculocutaneus flap transposition, however he died 11 months after the initial operation. The tumor implantation risk and the related complications should be considered in patients with operable bronchogenic carcinoma undergoing a tranthoracic needle aspiration biopsy.

Successful removal of a giant recurrent mediastinal liposarcoma involving both hemithoraces

Primary liposarcomas of the mediastinum are unusual tumors. We report herein a case of a 52-year-old woman, who was found to have a mediastinal tumor involving both hemithoraces and radiologically showing non-resectable-invasive features to the adjacent vital structures. She had a history of left thoracotomy for mediastinal schwannoma 14 years previously. The patient underwent an exploratory thoracotomy following a preoperative misdiagnosis of an ancient schwannoma. Complete removal of the tumor was accomplished through a right posterolateral thoracotomy with a subsequent histological diagnosis of a recurrent low-grade liposarcoma. A resectable liposarcoma should be considered in the differential diagnosis of a mediastinal tumor, although radiologically, the tumor presents with invasive features.

Application of western blotting procedure for the immunodiagnosis of visceral larva migrans in mice by using excretory/secretory antigens

A Western blotting procedure with excretory/secretory antigens from Toxocara canis larvae was developed for immunodiagnosis of visceral larva migrans in mice. In this study, eighty Swiss albino mice were allotted into two groups of 40 each as control and experimental groups, and T. canis ova containing infective larvae were given to mice in the latter group to form visceral larva migrans. Blood samples were taken from 5 infected and 5 control mice on days 25, 30, 35, 40, 45, 50, 55, and 60 after infection. After bleeding, the mice were necropsied. Slides were prepared from their brain tissues and examined for visceral larva migrans. Following this procedure, their guts were also examined for intestinal parasites. Protein bands of excretory/secretory antigens of 2nd stage larvae of Toxocara canis were determined by using SDS-PAGE. Sera from the mice were tested by Western blotting and results were compared to the protein bands obtained by SDS-PAGE to determine specific bands. Specific protein bands for visceral larva migrans were determined as 24, 28, and 48 kDa according to our test results.

Proximal bronchial extension with special reference to tumor localization in non-small cell lung cancer

OBJECTIVE

Surgery is the optimal treatment in patients with non-small cell lung cancer (NSCLC) and tumor-negative bronchial resection margins should be maintained for a curative resection. The epidemiology of NSCLC, including the aspects of tumor localization, has been changing during the recent decades. The aim of this study was to evaluate microscopic proximal bronchial extension with special reference to the site of the tumor.

METHODS

Surgical specimens of 70 NSCLC cases were examined histologically for proximal bronchial extension of the tumor. The entire bronchial tree with the tumor was extracted from the specimen and serially cut at a thickness of 5 mm in the transverse plane of the bronchus. Microscopic proximal extension of the tumor was classified as either endobronchial or peribronchial.

RESULTS

Thirty-three (47.1%) tumors had central and 37 (52.9%) had peripheral localization. Among the central and peripheral tumors, 10 (30.3%) and seven (18.9%) had microscopic proximal extension, respectively. In total, the mean length of proximal extension was 10.94 +/- 7.07 mm. The mean length of extension for peripheral tumors was 15.71 +/- 8.38 mm, significantly greater than that of central tumors, which was 7.60 +/- 3.47 mm (P = 0.026). Peripheral tumors showed a significant peribronchial extension (P = 0.024).

CONCLUSIONS

A greater percentage of central tumors show microscopic proximal bronchial extension, whereas the length of microscopic proximal bronchial extension is significantly greater in peripheral tumors. Peripheral tumors preferentially have a peribronchial extension pattern.

A family-based strategy to identify genes for diabetic nephropathy

Diabetic nephropathy (DN) clusters in families and specific ethnic groups, suggesting a genetic basis of disease transmission. Identification of DN susceptibility loci should reveal new therapeutic targets but requires accurate phenotyping. A powerful family-based strategy, which is novel to the pursuit of nephropathy genes in type 2 diabetes, is being used to collect a sample for candidate gene and genome scan analyses. Sib pairs that include DN index cases plus (1) sibs concordant for type 2 diabetes and DN (affected sib pairs [ASPs]) and (2) sibs concordant for type 2 diabetes but discordant for DN (discordant sib pairs [DSPs]) are targeted specifically for recruitment. Type 2 diabetes and DN phenotype criteria for index cases include diabetes onset after 38 years of age, duration 10 years or longer, no initial insulin treatment, diabetic retinopathy, end-stage renal disease (ESRD), and history of nephrotic proteinuria. ESRD patients were screened by questionnaire and medical record review (n = 2114). Of 666 patients with ESRD secondary to DN, 227 had a family history of ESRD, 150 had a living diabetic sib, and 124 families were enrolled. Sixty-five families, with 86 diabetic relative pairs (69 sibs, 17 children), have been completely phenotyped. If nephropathy in diabetic sibs is defined as albuminuria greater than 0.3 g/24 h, 31 ASPs and 26 DSPs (diabetic sib with albuminuria <0.3 g/24 h) were identified. Applying more stringent criteria, only 12 ASPs (sib with diabetes >10 years, diabetic retinopathy, and nephrotic proteinuria) and 9 DSPs (sib with diabetes >10 years and normal urine albumin excretion) were identified. Extrapolating from the number of subjects recruited using stringent phenotyping criteria, nearly 10,000 ESRD patients are required for screening to achieve adequate statistical power for linkage analysis (80% power to detect locus-specific relative risk of 2.2 at a lod score of 3.0). Careful phenotyping requires a large recruitment effort but is necessary to reduce population heterogeneity, a strategy that increases the likelihood of identifying DN loci.

Autocrine motility factor receptor expression in patients with stage I non-small cell lung cancer

BACKGROUND

Expression of autocrine motility factor receptor (AMFR) associates with increased cell migration and poor survival in certain types of human cancers. We assessed the possible correlation between AMFR, clinicopathologic features, and survival in stage I non-small cell lung cancer (NSCLC).

METHODS

AMFR expression was analyzed immunohistochemically, using a monoclonal antibody (3F3A) in tumor specimens from 97 patients with curative resection. Vascular endothelial growth factor (VEGF) expression was also examined after accounting for AMFR expression.

RESULTS

Out of 97 tumors, 38 (39.2%) were positively stained with AMFR. The AMFR expression was significantly associated with histologic type of tumor, mainly in adenocarcinoma. Overall survival of patients with AMFR-positive tumors was significantly worse than that of AMFR-negative tumors (p = 0.0050). The AMFR expression appears to be associated with VEGF expression. Patients who were AMFR positive and had high VEGF expression had a worse prognosis compared with the AMFR-negative and low VEGF-expression group (p < 0.0001). Multivariate analysis revealed an independent prognostic impact of AMFR on survival (p = 0.0039).

CONCLUSIONS

These results indicate that evaluation of AMFR expression may provide useful guidance in follow-up of patients with NSCLC.

Changing patterns of lung cancer; (3/4 in.) 1.9 cm; still a safe length for bronchial resection margin?

BACKGROUND

Surgical resection is the best treatment modality in non-small cell lung cancer (NSCLC). As a guideline, it is suggested that at least a bronchial resection margin of 1.9 cm from the macroscopic tumor might provide a tumor-free margin in lung cancer. In some recent reports, there is great emphasis on the changing histopathological patterns of lung cancer, but no concern for the proximal extension of lung cancer. The aim of this study was to determine the validity of this guideline in the current time.

METHODS

Surgically resected specimens of NSCLC cases (n = 70) were examined. The bronchial tree including tumor was dissected and beginning from the edge of the visible tumor, the bronchus were cut into serials in its transverse plane, 5 mm apart from each other. Cut sections were examined for proximal extension of tumor at different levels.

RESULTS

Microscopic proximal extension was observed in 24.2% (n = 17/70) of all the cases. Peribronchial extension (n = 9/17) (52.9%) was more predominant compared with bronchial extension (n = 8/17) (47.0%). Squamous cell carcinoma (n = 11/38) (28.9%) showed proximal extension more than adenocarcinoma (n = 5/23) (21.7%). Adenocarcinoma showed more peribronchial extension (n = 4/5) (80.0%) whereas squamous cell carcinoma (n = 7/11) (63.6%) showed more bronchial extension. The farthest extension was 3.0 cm for adenocarcinoma and 2.0 cm for squamous cell carcinoma. Excluding tumor positive specimens beyond 1.5 cm level to the bronchial resection margin, all tumors accounted for 96% of the whole series.

CONCLUSIONS

Microscopic proximal extension of lung cancer occurs in 24.2% of NSCLC cases. Squamous cell carcinoma extends more proximally compared with adenocarcinoma in ratio whereas adenocarcinoma extends more in length. A bronchial resection of 1.5 cm in length from the macroscopic tumor will provide clear margins in 93% of NSCLC cases.

Intercostal arteriovenous hemangioma

We report a case of a 46-year-old man who presented with a chest wall tumor in the right hemithorax. He underwent thoracotomy to remove the mass, which was found to be an arteriovenous hemangioma arising from the intercostal muscle. Arteriovenous hemangioma is a rare tumor and chest wall is an extremely rare site for this tumor. This tumor should be considered in the differential diagnosis of the chest wall tumors. Complete surgical excision offers the best treatment.

[Carotid body tumors: contribution of the various imaging techniques. A report of six cases]

INTRODUCTION

Carotid body tumors are rare hypervascular lesions arising from neural crest paraganglion cells.

MATERIALS AND METHODS

We retrospectively analyzed the imaging features of six patients with carotid body tumors to precise their imaging characteristics in order to find specific signs and elaborate a strategy for diagnosis.

RESULTS

Imaging features detect the vascular nature of these tumors of the carotid space causing characteristic widening of the carotid bifurcation. Two patients had multiple (two or more) localizations and one had a family history of glomus tumor.

CONCLUSION

MRI with MRA is considered as the gold standard imaging technique for the evaluation of glomus tumors as it allows a multiplanar approach which is important in the preoperative study.

[Pelvic ganglioneuroma. Case report]

Ganglioneuroma is a neurogenic tumor originating from autonomic ganglia. It most commonly occurs in patients younger than 20 years with a slight predominance of females. The pelvic localization is rare. Imaging can lead to diagnosis but it is not specific. The diagnosis can only be confirmed by the pathologic study. The authors report one case of pelvic ganglioneuroma diagnosed in an 11-year-old child who also had hypertension and renal failure.

Staphylococcal pyomyositis in a patient with non-Hodgkin's lymphoma

Pyomyositis is a rare disease, encountered mainly in tropical climates. The diagnosis of this entity is difficult, if not misdiagnosed, because of its rarity and its subacute presentation. We report of a 42-year-old man, in whom pyomyositis developed while he was receiving the standard chemotherapy for T-cell non-Hodgkin's lymphoma (NHL). Three months following splenectomy, multiple abscesses occurred in the muscles of both thighs while the patient was receiving the third course of the CHOP regimen. A purulent exudate was aspirated from the abscesses under computed tomographic guidance. Coagulase-positive Staphylococcus aureus was cultured in the aspirate. Pyomyositis was completely resolved following the surgical drainage and the antistaphylococcal antibiotic treatment. This patient has shown that immunosuppression due to splenectomy, NHL, and chemotherapy, especially when using steroids, could be risk factors for pyomyositis in nontropical or semitropical countries.

Transdermal drug delivery using electroporation. II. Factors influencing skin reversibility in electroporative delivery of terazosin hydrochloride in hairless rats

A previous study indicated that the parameters governing the performance of electroporative delivery to the skin, are voltage, pulse length, number of pulses and electrode area.1 This article describes a study in which the reversibility of the electroporation technique is evaluated with in vitro methods. The skin's reversal from an enhanced permeation mode as a result of electroporation to the base level was used as an index to understand the mechanism of drug delivery and also as a preliminary indicator of safety. Maximum delivery of the model drug, terazosin hydrochloride, occurred during the pulsing. Electroporative delivery with a wire electrode (small-area electrode, 0.56 cm(2)) using 20 pulses at U(skin,0) 88 V, and pulse length 20 ms, did not cause any damage to the skin. Increasing the pulse length to 60 ms, while keeping the rest of the parameters fixed, caused a visible change in the external appearance of the skin. However, with the use of a spiral electrode (large-area electrode, 2.74 cm(2)) at 60-ms pulse length, there was minimal damage to the skin. This may be attributed to the more uniform flow of current over the whole skin area. The large-area electrode required a smaller electrode voltage, U(electrode,0) for any given U(skin,0) and also delivered nearly double the instantaneous power density compared with the small-area electrode. These findings indicate that using shorter pulses and large-area electrodes is a safer technique than large pulses and small-area electrodes when electroporation is used to enhance skin's permeability for drug delivery.

Transdermal drug delivery using electroporation. I. Factors influencing in vitro delivery of terazosin hydrochloride in hairless rats

The use of electroporation pulses as a physical means of enhancing the permeability of skin to deliver drugs is in the early stages of development. In this article, a systematic study examining the parameters influencing electroporative transdermal delivery of terazosin hydrochloride to hairless rat skin are reported. It was found that voltage, pulse length (tau), and number of pulses were the three most important parameters, in that order. For creating a significant enhancement in drug delivery to the skin, without causing any apparent change in its external appearance, it was necessary to deliver five or more exponentially decaying electroporation pulses, at 88 +/- 2.5 V (voltage across the skin), with a decay time constant of 20 ms. Electrodes with larger area could attain the same voltages across the skin with a much lower applied voltage and possessed other advantages with regard to performance of the drug delivery system.