Reconstruction of the aortic arch in invasive thymoma under retrograde cerebral perfusion

Extensive en-bloc resection of the aortic arch and anterior wall of the main pulmonary artery was performed in a 46-year-old man with invasive thymoma. The aortic arch was replaced with a Hemashield vascular graft under hypothermic circulatory arrest with retrograde cerebral perfusion. Patch plasty with Xenomedica was performed for the anterior wall of the main pulmonary artery under cardiopulmonary bypass. The patient was treated with postoperative radiotherapy and has remained asymptomatic for 15 months after the operation. An extensive operation is considered necessary to improve the prognosis of invasive thymoma.

Vasoactive intestinal peptide ameliorates reperfusion injury in rat lung transplantation

BACKGROUND

Vasoactive intestinal peptide (VIP) has been reported to have some properties that provide protection from lung injury. Furthermore, its protective effect in cold storage of donor lungs has been confirmed. We examined its effect and the timing of administration in an in vivo rat lung transplantation model.

METHODS

All lungs were flushed with low-potassium dextran-1% glucose solution, and orthotopic left lung transplantations were performed. Rats were divided into four groups (n = 6). Group I received no preservation or storage. Groups II, III, and IV grafts were stored for 18 hours at 4 degrees C. Group II received no VIP. Group III received VIP (0.1 g/ml) via the flush solution. Group IV recipients received VIP (3 microg/kg) intravenously just after reperfusion. Twenty-four hours after transplantation, the right main pulmonary artery and right main bronchus were ligated, and the rats were ventilated with 100% O2 for 5 minutes. Mean pulmonary arterial pressure, peak airway pressure, blood gas analysis, serum lipid peroxide level, tissue myeloperoxidase activity, and wet-dry weight ratio were measured.

RESULTS

The partial O2 tension values of groups III and IV were better than group II (groups II, III, and IV: 147.4 +/- 71.4, 402.1 +/- 64.8, 373.4 +/- 81.0 mm Hg; p < 0.05). Peak airway pressure was lower in groups III and IV than in group II (groups II, III, and IV: 19.7 +/- 0.8, 16.7 +/- 0.9. and 16.3 +/- 1.0 mm Hg; p < 0.05). Mean pulmonary arterial pressure in group III was lower than group II (groups II and III: 36.3 +/- 3.0 and 22.1 +/- 2.2 mm Hg; p < 0.01). Wet-dry weight ratio in group III was lower than in groups II and IV (group II, III, and IV: 5.2 +/- 0.2, 4.4 +/- 0.2, and 5.2 +/- 0.3; II vs III; p < 0.05, III vs IV; p < 0.01). Serum lipid peroxide levels in groups III and IV were significantly lower (groups II, III, and IV: 2.643 +/- 0.913, 0.455 +/- 0.147, and 0.325 +/- 0.124 nmol/ml; p < 0.01).

CONCLUSION

VIP ameliorates reperfusion injury in an in vivo rat lung transplantation model. Either administration of VIP via the flush solution or systemically just after reperfusion was associated with improved pulmonary function.

Delayed administration of low-dose NPC18915 ameliorates lung ischemia-reperfusion injury

BACKGROUND

NPC18915, a member of new antiinflammatory agent called nactins (neutrophil activation inhibitors), has been shown to reduce reperfusion injury in rat lung transplantation at high dosage. In vitro studies have demonstrated effectiveness of this compound even at low dosage. We hypothesized that this compound ameliorates lung ischemia reperfusion injury even at low dosage levels if administration is optimally timed. The aim of this study was to determine the efficacy and the best timing for administration of low-dose NPC18915.

METHODS

Forty syngeneic rat left lung transplantations were performed. All isografts were flushed with low-potassium dextran-1% glucose solution 20 ml and preserved for 18 hours at 4 degrees C. Animals were divided into four groups. Group I animals (n = 10) served as control subjects. In groups II (n = 10), III (n = 10), and IV (n = 10), NPC18915 (0.04 mg) was added to the flush solution and was administered intravenously (0.4 mg/kg) immediately before reperfusion (group II) and 60 minutes (group III) and 120 minutes (group IV) after reperfusion. Pulmonary function was assessed 24 hours after reperfusion.

RESULTS

In group III, oxygenation improved in comparison to group I (247.2 +/- 59.8 versus 76.6 +/- 16.0 mm Hg, p < 0.002). Wet-to-dry weight ratio and graft myeloperoxidase activity were significantly improved (group III versus group I, 6.02 +/- 0.21 versus 7.19 +/- 0.41, p = 0.013) (group III versus group I, 0.093 +/- 0.019 versus 0.207 +/- 0.023 delta optical density/min/mg, p < 0.002). There were no significant differences in CD11b expression.

CONCLUSION

These data suggest that delayed administration of NPC18915, 60 minutes after reperfusion, dramatically improves pulmonary graft function.

Establishment and characterization of two cell lines from N-methyl-N-nitrosourea-induced mouse glandular stomach carcinomas

We previously reported the induction with N-methyl-N-nitrosourea (MNU) of mouse glandular stomach carcinomas showing a gastric phenotype but variation in histologic appearance, as with human gastric carcinomas. In the present study, we established two cell lines, designated MGT-40 and MGT-93, from MNU-induced mouse glandular stomach carcinomas. These cell lines are keratin-positive and grow as epithelial monolayers in culture, requiring transforming growth factor alpha, epidermal growth factor or insulin/transferrin for optimal growth in addition to 10% fetal bovine serum. Retention of the differentiated phenotype for gastric surface mucous cells has been confirmed by cathepsin E immunohistochemistry and reverse transcriptase-polymerase chain reaction for mouse spasmolytic polypeptide. Neither transplantability in nude mice nor colony formation on soft agar was observed, except in one subline. Chromosome analysis revealed aneuploidy with modal chromosome numbers ranging from 58 to 78 and no specific structural abnormalities. This is the first report of cell lines derived from mouse glandular stomach carcinomas. They should prove useful for studies of the mechanisms of regulation of growth and differentiation.

Correlation between the drinkability of beer and gastric emptying

A subjective evaluation of beer drinkability and the degree of stomach fullness were found to correlate with the relaxed cross-sectional area of the pylorus antrum measured by real-time ultrasonography. Five kinds of beer with a different malt/adjuncts ratio and degree of attenuation were used. Each beer was given to 9 healthy volunteers at the rate of 3 ml/kg/15 min, and they each recorded the degree of stomach fullness, desire to drink and tastiness every 30 min. With increasing volume drunk, the degree of tastiness and desire to drink were lowered, and the degree of stomach fullness raised. The relaxed cross-sectional area of the pylorus antrum measured by an ultrasonic image analyzer every 30 min was highly correlated with the degree of stomach fullness, tastiness of the beer, and desire to drink (p = 0.0021, < 0.0001, 0.001). The beer giving the lowest degree of stomach fullness was appraised to be tasty and highly drinkable. These findings suggest that the rate of gastric emptying is one of the factors determining the drinkability of beer, and that measurement of the relaxed cross-sectional area of the pylorus antrum is useful to evaluate stomach fullness during beer drinking.

Preharvest nitroprusside flush improves posttransplantation lung function

BACKGROUND

Morbidity as a result of early allograft dysfunction remains a significant problem in clinical lung transplantation. We previously demonstrated that nitroprusside (NP), a potent nitric oxide donor, administered before storage and again during reperfusion, reduced lung reperfusion injury. The purpose of the present study was to determine whether these observations were storage effects, reperfusion effects, or both.

MATERIALS AND METHODS

Fifteen dogs underwent left lung allotransplant. Donor lungs were flushed with modified Euro-Collins solution and stored for 21 hours at 1 degree C. Immediately after transplantation, the contralateral right main pulmonary artery and bronchus were ligated to assess isolated allograft function. Hemodynamics and arterial blood gas analysis (FIO2 1.0) were assessed for 6 hours before sacrifice. Allograft myeloperoxidase (MPO) activity and wet to dry weight (W/D) ratio were assessed. Animals were divided into three groups for timing of NP administration. Group I (n = 5) animals received no NP. In group II (n = 5), donor lungs received NP (10 mg/L) in the flush solution only. In group III (n = 5), recipient animals received NP (0.2 mg/kg) just before reperfusion, as well as a continuous infusion (0.1 mg/kg/hr) during the assessment period.

RESULTS

Significant improvement in gas exchange was apparent in groups II and III compared with group I, but there was no significant difference between groups II and III. After 6-hour reperfusion, mean PaO2 values were 85.46 +/- 13.32 mm Hg in group I, 298.74 +/- 61.25 mm Hg in group II (p < 0.05), and 311.12 +/- 43.39 mm Hg in group III (p < 0.05). Systemic vascular resistance was significantly lower in group III than in group I (p < 0.05). MPO activities decreased in groups II (p < 0.05) and III (p < 0.05), indicating reduced neutrophil sequestration. W/D ratio was significantly lower in groups II and III.

CONCLUSION

Both methods of NP administration are effective, but NP administration in the recipient is accompanied by a decrease in systemic vascular resistance. From a clinical point of view, NP administration in the flush solution is a sufficiently effective and practical method to reduce lung allograft reperfusion injury.

Carbohydrate selectin inhibitor CY-1503 reduces neutrophil migration and reperfusion injury in canine pulmonary allografts

BACKGROUND

Neutrophil adhesion is initiated by the interaction of rapidly expressed endothelial selectins with oligosaccharide structures (sialyl Lewis(x) on polymorphonuclear neutrophils (PMN). The carbohydrate sialyl Lewis X analogue CY-1503 blocks selectin receptors, thereby inhibiting PMN rolling and subsequent firm adhesion and migration.

METHODS

We evaluated the inhibitory effect of CY-1503 on PMN migration and reperfusion injury in canine left lung allografts. Donor lungs were flushed with modified Euro-Collins solution (1500 ml, 4 degrees C) and preserved for 21 hours at 1 degree C. Left lung allotransplantation was subsequently performed in 14 mongrel dogs. Immediately after transplantation and allograft reperfusion, the recipient contralateral right pulmonary artery and bronchus were ligated to permit assessment of isolated allograft function during a 6-hour postreperfusion period (FIO2 = 1.0). Allograft gas exchange (q 15 minutes) and hemodynamics (q 60 minutes) were assessed. After sacrifice, allograft bronchoalveolar lavage fluid (BALF) PMN count and allograft tissue myeloperoxidase (MPO) activity were measured. Two groups were studied: In group I (n = 7) CY-1503 was added to the donor lung flush (20 mg/L) and given to the recipient (35 mg/kg intravenous bolus) before reperfusion, followed by a continuous infusion (5.25 mg/kg/h intravenously) during the 6-hour assessment period. Group II animals (n = 7) received no CY-1503.

RESULTS

Gas exchange in group I was superior throughout the assessment period (p < 0.01 at 6 hours after reperfusion). BALF PMN count in group I was reduced to 0.57 +/- 0.3 x 10(6) PMN/ml compared with 3.9 +/- 1.3 x 10(6) PMN/ml in group II (p < 0.05). Group I allograft MPO activity was 0.21 +/- 0.06 compared with 0.40 +/- 0.02 delta OD/mg/ min in controls (p < 0.02). Two animals in each group died early after reperfusion as a result of graft failure and were excluded from analysis.

CONCLUSIONS

Our observations indicate that selectin inhibition effectively reduces PMN adhesion, migration, and subsequent reperfusion injury in preserved canine lung allografts.

Comparative studies of circulating KL-6, type III procollagen N-terminal peptide and type IV collagen 7S in patients with interstitial pneumonitis and alveolar pneumonia

KL-6, a MUC1 mucin preferentially expressed in regenerating type 2 pneumocytes, has been reported to be a sensitive serum marker for evaluating the disease activity of interstitial pneumonitis (IP). Type III procollagen N-terminal peptide (PIIIP) and type IV collagen 7S (7S collagen) have also been reported to be useful in the serological evaluation of the activity. Their levels were measured and their serodiagnostic values were compared simultaneously in patients with IP and alveolar pneumonia. The study population was 45 patients with IP and 12 patients with alveolar pneumonia. Serum KL-6 levels were measured by a specific enzyme immunoassay, and both serum PIIIP and 7S collagen concentrations by their correspondent radioimmunoassay kits. There were no significant difference of serum C-reactive protein level, which was evaluated as an indicator of inflammatory process, between IP and alveolar pneumonia patients. In IP, the abnormally elevated rate of KL-6 [80% (36/45)] was significantly higher than those of PIIIP [40% (18/45)] and 7S collagen [40% (18/45)]. In alveolar pneumonia, the rate of KL-6 [0% (0/12)] was significantly lower than those of PIIIP [33% (4/12)] and 7S collagen [25% (3/12)]. There were no significant correlations among serum levels of the markers. These observations indicate that the serodiagnostic value of KL-6 for IP is superior to that of PIIIP and 7S collagen, and that KL-6 has a characteristic to discriminate IP from alveolar pneumonia.

[A case report of anomalous systemic arterial supply to the left basal lung]

A 38-year-old woman with a history of hemosputum once in a several years was admitted to our hospital because of a mass shadow in the left lower lung field on chest X-ray film. Physical examination revealed neither cardiac murmur nor any sign of heart failure. Chest X-ray film showed a tumorous shadow in the left posterior basal segment. Chest CT scan showed that this shadow was consisted of enhanced, dilated and torutuous vessel and was connected to the descending thoracic aorta. Angiographic examinations showed that there was no normal left basal trunk of the pulmonary artery, and revealed an anomalous arterial supply to the basal segments from the descending thoracic aorta, with an expanded left inferior pulmonary vein. Broncho-fiberscopy showed no abnormal findings in the bronchial tree except for mild stenosis of the left basal bronchus. This case was diagnosed as an anomalous systemic arterial supply to the left basal lung (Pryce type I). The left lower lobe without pulmonary sequestration and the anomalous systemic artery were resected. Microscopically, the anomalous artery showed an elastic type, and the peripheral lung areas showed congestion. The postoperative course was uneventful. We collected reports of 26 cases of the same anomalies in Japan and discussed the difference of this anomaly from pulmonary sequestration.

Significance of late redistribution thallium-201 imaging after rest injection for detection of viable myocardium

The aim of this study was to determine whether late redistribution imaging after rest injection of 201Tl would provide further information on myocardial viability over conventional rest-early redistribution 201Tl imaging.

METHODS

Twenty-nine patients with coronary artery disease and left ventricular dysfunction underwent rest, early (3-4 hr) and late (20-24 hr) redistribution 201Tl and gated blood pool studies. In 14 patients with successful revascularization, gated blood pool study was repeated after the coronary intervention.

RESULTS

Nine of 29 patients showed early redistribution, and six additional patients showed further redistribution on the late images. Of 136 segments with initial 201Tl defects, 18 showed early redistribution, and 10 showed late redistribution. When a threshold of 60% of peak activity was used as an index of myocardial viability, only a small fraction (3%) of the initial 201Tl defects were additionally considered viable by the late images. In 14 patients who underwent revascularization, the positive (69%) and negative (87%) predictive values of the early redistribution images for functional recovery were similar to those obtained by the late images (68% and 86%, respectively).

CONCLUSION

Although late redistribution after rest injection of 201Tl occasionally occurs, most of the clinically relevant information on myocardial viability may be obtained by conventional rest-early redistribution 201Tl imaging when the defect severity is considered an index of tissue viability.

Hilar and mediastinal invasion of bronchogenic carcinoma: evaluation by thin-section electron-beam computed tomography

The diagnostic accuracy of thin-section incremental dynamic computed tomography (IDCT) using an electron-beam scanner in evaluating hilar or mediastinal invasion of bronchogenic carcinoma was assessed. Thirty-seven patients with proven bronchogenic carcinoma, contiguous with hilar or mediastinal structures, underwent IDCT. The area of contact was scanned using 19 contiguous 3-mm thick sections during injection of contrast material. The degree of contact between mass and pulmonary artery or vein and their distortion were recorded. Irregular thickening of the bronchial wall, soft tissue within the lumen, or distortion were used to determine airway involvement. Sixty-nine sites were assessed retrospectively and compared with pathology reports. The accuracy, sensitivity, and specificity in evaluating invasion of the pulmonary artery were 75.0%, 77.8%, and 71.4%, respectively. Limited reliability also was found for invasion of the main bronchus and "secondary" carina, with accuracies of 66.7% and 70.5%, sensitivities of 75.0% and 70.0%, and specificities of 57.1% and 71.4%, respectively. Thin-section IDCT with electron beam scanner is not accurate in the detection of hilar or mediastinal invasion by bronchogenic carcinoma.

Quantitative rest technetium-99m tetrofosmin imaging in predicting functional recovery after revascularization: comparison with rest-redistribution thallium-201

OBJECTIVES

This study was undertaken to 1) compare the regional myocardial tracer distributions between rest technetium (Tc)-99m tetrofosmin and rest-redistribution thallium (Tl)-201 images in patients with coronary artery disease and left ventricular dysfunction; and 2) assess the comparative values of these agents for predicting functional recovery after revascularization.

BACKGROUND

Tc-99m tetrofosmin is a new myocardial perfusion imaging agent, but its role for detecting viable myocardium is still unclear.

METHODS

Thirty-six patients with coronary artery disease and left ventricular dysfunction underwent rest Tc-99m tetrofosmin, rest-redistribution Tl-201 and gated blood pool scintigraphy. In 21 patients with successful revascularization confirmed by follow-up angiography, gated blood pool scintigraphy was repeated after revascularization. Optimal threshold cutoffs to separate reversible from irreversible dysfunction were determined by receive operating characteristic analysis.

RESULTS

Regional Tc-99m tetrofosimin activity highly correlated with redistribution Tl-201 activity (r = 0.93). The diagnostic performance for predicting functional recovery, as measured by the area under the receiver operating characteristic curves, measured 0.66 +/- 0.07 (mean +/- SD) for Tc-99m tetrofosmin and 0.67 +/- 0.07 for Tl-201 (p = 0.60, 96.7% power to detect difference in area of 0.10). The optimal threshold cutoffs for viability were considered to be 50% of peak activity for Tc-99m tetrofosmin and 55% of peak activity for Tl-201. The positive and negative predictive values for reversible dysfunction were, respectively, 69% and 82% for Tc-99m tetrofosmin and 69% (p = 0.99 vs. Tc-99m tetrofosmin) and 71% (p = 0.66 vs. Tc-99m tetrofosmin) by Tl-201.

CONCLUSIONS

The diagnostic performance of quantitative rest Tc-99m tetrofosmin imaging in predicting functional recovery after revascularization is comparable to that of rest-redistribution Tl-201.

Inhaled nitric oxide at the time of harvest improves early lung allograft function

BACKGROUND

Inhalation of nitric oxide (NO) has been shown to have beneficial effects on a variety of acute lung injuries, including lung allograft reperfusion injury. The purpose of the present study was to investigate the effects of inhaled NO at the time of harvest on function of canine left lung allografts after transplantation.

METHODS

Ten dogs underwent left lung allotransplantation. Donor lungs were flushed with modified Euro-Collins solution and stored for 21 hours at 1 degree C. Immediately after transplantation, the contralateral main pulmonary artery and bronchus were ligated to assess isolated allograft function. Hemodynamics and arterial blood gases (inspired oxygen fraction, 1.0) were assessed intermittently for 6 hours prior to sacrifice. Allograft myeloperoxidase activity and wet to dry weight ratio were assessed. Donor animals were divided into two groups. Group I animals (n = 5) received no NO. In group II (n = 5), donors received inhaled NO (60 ppm) at the time of harvest.

RESULTS

Pulmonary vascular resistance decreased to 79.6% of baseline because of inhalation of 60 ppm NO in group II donor animals. Thiobarbituric acid-reactive materials were reduced during the storage period in group II, a finding suggesting less oxidant injury during storage in donor lungs treated with NO. Throughout the 6-hour assessment, oxygenation in group II was superior to that in group I (p < 0.05). At 360 minutes of assessment, mean arterial oxygen tension in groups I and II was 88.9 +/- 11.4 mm Hg and 169.1 +/- 33.0 mm Hg, respectively. Myeloperoxidase activity was significantly decreased in group II (p < 0.05), data indicating reduced neutrophil sequestration. Wet to dry weight ratio was significantly lower in group II.

CONCLUSIONS

These data suggest that inhaled NO at the time of harvest improves early function of preserved lung allografts by attenuating oxidant injury during storage and subsequent neutrophil sequestration.

Association of p53 protein expression in stage I lung adenocarcinoma with reference to cytological subtypes

Since the nuclear accumulation of p53 protein is known to correspond well with mutation of the p53 tumor-suppressor gene, we analyzed the p53 protein immunohistochemically with the anti-p53 mouse monoclonal antibody, DO-7, in 105 stage I lung adenocarcinomas. The p53 immunoreactivity was detected in the nuclei of cancer cells in 51 cases (49%). The p53-positive cases had a significantly poorer prognosis compared with the p53-negative cases (log-rank test; P < .001) When p53 expression was compared among the cytological subtypes of adenocarcinoma, the incidence of p53 expression in the bronchial surface epithelial cell type (11 of 15) was significantly higher than in the goblet cell type (1 of 6) and tended to be higher than the Clara cell/alveolar type II pneumocyte type (27 of 59). These findings indicate that immunohistochemical examination of the p53 protein is a potential prognostic factor in stage 1 lung adenocarcinomas, and that p53 expression has been associated with the cytological subtype.

[Two cases of tracheal injuries secondary to blunt trauma]

We present two cases of injury to the cervical trachea and the tracheal bifurcation due to blunt trauma. A 20-year-old man sustained complete disruption of the cervical trachea during a traffic accident. He underwent end-to-end anastomosis of the disrupted trachea. Nevertheless, 3 weeks after the initial surgery, tracheostomy was required because of suture failure. Two months after the second procedure, he underwent closure of the tracheostoma. Granulation developed temporarily, but diminished thereafter. The second case was a 14-year-old boy. He sustained a longitudinal laceration about 3 cm from the tracheal over the membranous portion during a traffic accident. The laceration was successfully repaired by interrupted sutures with absorbable materials. Our experiences emphasize the importance of debridement of the injured cartilageous portion during treatment of tracheal injury due to blunt trauma and the difficulty in managing complete disruption of the cervical trachea with bilateral paralysis of the recurrent nerve.

The clinical implications of glutathione S-transferase-pi expression in lung cancer

We performed immunohistochemical staining of glutathione S-transferase-pi (GST-pi) in 97 lung cancer specimens. In untreated patients, 86% (48/56) of NSCLC and none (0/8) of SCLC stained for GST-pi, and all squamous cell carcinomas were positive (28/28). The proportion of positive NSCLC with preoperative chemotherapy was similar to that of the untreated NSCLC, but the proportion of treated SCLC positive for GST-pi (14/18) was significantly higher than untreated tumors. GST-pi in NSCLC may be a tumor marker rather than being involved in drug resistance, and GST-pi-induction by chemotherapy may relate to acquired resistance in SCLC.

[Quantitative evaluation of regional pulmonary functions after lung resection using three-dimensional images of ventilation and perfusion SPECT]

To evaluate changes after Lobectomy in the regional functions of the remaining lung and of the unaffected lung, three-dimensional (3-D) images of lung ventilation and perfusion SPECT were studied. In 60 patients who underwent lung resection, ventilation (99m Tc-phytate aerosol inhalation) and perfusion (99m Tc-MAA) SPECT were performed before and one month after operation. 3-D images were obtained from SPECT by the volume-rendering method setting thresholds at three levels, and the 3-D functional capacity of the right and left lung was determined at a threshold of 25%. Changes were evaluated using the ratio of the value obtained after operation to the one obtained before operation. The remaining rate of perfusion in the remaining lung was 0.58 +/- 0.22 after the right upper lobectomy, 0.32 +/- 0.04 after the right upper & middle bilobectomy, 0.86 +/- 0.11 after the right middle lobectomy, 0.55 +/- 0.17 after the right lower lobectomy, 0.24 +/- 0.18 after the left upper lobectomy, 0.46 +/- 0.05 after the left lower lobectomy, and 0 after the left pneumonectomy. The remaining rate was significantly low in the right upper & middle bilobectomy and the left upper lobectomy. The large decrease in the rate in these operations was considered to have resulted from a shift of the remaining lung towards the head and excessive expansion of the remaining lung. The distribution of the aerosol inhalation decreased more significantly than that of perfusion in almost all patients. The remaining rate of ventilation of the remaining lung after the lower lobectomy was lower than that after the upper lobectomy. This may have been due to the characteristics of the aerosol practices. We found that changes in the regional functions of the lung after lung resection can be topographically and quantitatively evaluated by 3-D image processing of pulmonary ventilation and perfusion SPECT, such analysis is usefulness in evaluation of function preservation operation.

Comparative studies of CAM 123-6 and carcinoembryonic antigen for the serological detection of pulmonary adenocarcinoma

Carcinoembryonic antigen (CEA) has been clinically used as a serum marker for lung cancer, especially for pulmonary adenocarcinoma. Since we had developed a tumor marker against pulmonary adenocarcinoma, CAM 123-6 belonging to KL-6 MUC 1 mucin, we compared its clinical value with that of CEA, in combination with squamous cell carcinoma-related antigen (SCC) and neuron-specific enolase (NSE). The subjects were 30 patients with adenocarcinoma, 23 with squamous cell carcinoma, 16 with small cell carcinoma, and 20 with benign lung disease. For discriminating lung cancer from benign lung disease, the combination of CAM 123-6, SCC, and NSE showed 64% diagnostic accuracy, and the combination of CEA, SCC, and NSE 65%. In differentiating pulmonary adenocarcinoma from other lung cancer, the diagnostic accuracy of CAM 123-6 was 81% and that of CEA was 74%, although there was no significant difference between them. These observations indicate that the diagnostic accuracy of CAM 123-6 is similar to that of CEA. Neither marker is sufficiently specific to differentiate pulmonary adenocarcinoma from other forms of lung cancer.

[Residual activity or defect reversibility on stress-redistribution-reinjection 201T1 SPECT: which is the better marker of myocardial viability?]

Although both residual T1 activity and defect reversibility are used as a marker of myocardial viability on stress-redistribution-reinjection T1 (T1-RI) imaging, it is not yet fully understood which marker better predicts reversible dysfunction after revascularization. The aim of this study was to assess the comparative efficacies of these criteria for prediction of functional recovery after revascularization. Twenty-five patients (LVEF 41%) who underwent successful revascularization were studied with T1-RI SPECT and gated blood pool scintigraphy before revascularization. The gated blood pool study was repeated at mean 2 months after revascularization. The left ventricular myocardium was divided into 9 segments and the mean regional activities were calculated for each segment. In this study, two independent criteria were used as a viability index; (A) the presence of residual T1 activity (> 50% of peak) on the final image (reinjection image), (B) reversible defect (> 10% increase on the subsequent images) or normal T1 uptake (> 80% of peak) on the initial image. Functional recovery occurred in 51 of 88 dysfunctional segments. The presence of residual T1 activity was a highly sensitive (96%) but poorly specific (35%) marker of reversible dysfunction, while a reversible defect or normal T1 uptake was a less sensitive (67%) but more specific (59%) predictor of functional recovery. In conclusion, defect reversibility provides unique information on myocardial viability which cannot be obtained by assessing residual T1 activity alone.

Near-death asthmatic reaction induced by disodium cromoglycate

A near-death asthmatic reaction was induced by disodium cromoglycate (DSCG) as evidenced by positive skin and inhalation provocation tests. The patient's history revealed an episode of exacerbation by inhalation of DSCG. In spite of such an experience, he inhaled DSCG for relief of asthmatic attack, resulting in near-death exacerbation. This patient emphasizes the need to re-recognize that DSCG is not a reliever and the DSCG could cause fatal asthma.

A comparison of epidermal growth factor receptor levels and other prognostic parameters in non-small cell lung cancer

Epidermal growth factor receptor (EGFR) was measured using a competitive radioligand binding assay in membrane preparations from 74 primary human non-small cell lung cancer (NSCLC) tissues and 20 pathologically normal peripheral lung tissues. The mean EGFR level in tumours was 30.38 fmol/mg (+/-41.95 S.D.) of membrane protein (mg.p), significantly higher (P = 0.00016) than in normal tissues (mean, 10.26 +/- 10.02 fmol/mg.p). The mean EGFR concentration was also significantly higher in pathological stage IV tissue than in stages I (P = 0.049) and II (P = 0.040), and the mean EGFR concentration was significantly higher in cases with mediastinal involvement than in cases without it (P = 0.029). The mean EGFR level was higher in DNA aneuploid and multiploid cases than in DNA diploid cases, but there was no significant difference. No significant relationships were found to exist between receptor concentrations and pathological tumour size or histological type, or patient gender or age. From the above findings, a possible prognostic role for EGFR in primary NSCLC should be investigated.

Nicorandil, a potent adenosine triphosphate-sensitive potassium-channel opener, ameliorates lung allograft reperfusion injury

BACKGROUND

Lung allograft ischemia-reperfusion injury, characterized by increased pulmonary vascular resistance, pulmonary edema, and hypoxia, is the most frequent cause of early graft failure. Exogenous nitric oxide has been shown to reduce lung allograft reperfusion injury. During hypoxia, the adenosine triphosphate-sensitive potassium channel is an important ionic channel that links the bioenergetic metabolism to membrane excitability. It has been shown to play a critical role in vascular permeability and in activation of neutrophils and their subsequent interaction with vessel wall cellular components. The purpose of this study was to investigate whether nicorandil, a novel nitric oxide generator and adenosine triphosphate-sensitive potassium-channel opener, might enhance lung preservation and prevent allograft reperfusion injury.

MATERIALS AND METHODS

Fourteen dogs underwent left lung allotransplantation. Donor lungs were flushed with modified Euro-Collins solution and stored for 21 hours at 1 degree C. Immediately after transplantation, the contralateral right main pulmonary artery and bronchus were ligated to assess isolated allograft function. Hemodynamics and arterial blood gas analysis (inspired oxygen fraction 1.0) were assessed for 6 hours before the dogs were put to death. After the assessment, activity of allograft myeloperoxidase and protein levels of bronchoalveolar lavage fluid were measured. Control animals (group I, n = 5) received no nicorandil. In group II (n = 5), the donor lung received nicorandil (24 mg/L) in the flush solution. In addition, recipient animals received nicorandil (0.5 mg/kg, intravenously) just before reperfusion, as well as a continuous infusion (0.74 +/- 0.03 mg/kg per hour) during the 6-hour assessment period. In group III (n = 4), glibenclamide, a selective adenosine triphosphate-sensitive potassium-channel blocker, was administered 15 minutes before nicorandil administration to both donor and recipient. The animals in group III received nicorandil in the same regimen as group II.

RESULT

Superior gas exchange and hemodynamics were observed in lungs receiving only nicorandil. Allograft myeloperoxidase activity and protein levels in bronchoalveolar lavage fluid were significantly reduced in group II. Glibenclamide eliminated the beneficial effects of nicorandil.

CONCLUSIONS

Nicorandil administration in the flush solution and during the reperfusion period ameliorates lung allograft dysfunction, improves blood flow, and reduces pulmonary vascular resistance and myeloperoxidase activity in the transplanted lung. The present study suggests that nicorandil reduces lung allograft reperfusion injury. The beneficial effects of nicorandil may be attributed to its properties as an adenosine triphosphate-sensitive potassium-channel opener.

Early and delayed technetium-99m-tetrofosmin myocardial SPECT compared in normal volunteers

This study was performed to test the feasibility of early SPECT imaging with 99mTc-tetrofosmin with the presence of high hepatic activity.

METHODS

Thirteen normal volunteers were injected 600-740 MBq of 99mTc-tetrofosmin at rest and were imaged at 10 min and 1 hr after injection. The SPECT images were reconstructed for 180 degrees 360 degrees data. The early and delayed SPECT and anterior planar projection images were analyzed.

RESULTS

After excluding one subject because of high hepatic activity overlapping to the myocardium, 4 of 12 subjects (33%) had abnormal scans with reduced uptake in the inferior wall on the early 180 degrees SPECT image. In contrast, only one (8%) showed equivocally reduced uptake on the 360 degrees SPECT image. In the delayed images, all subjects had a normal 180 degrees and 360 degrees SPECT scan. Quantitative data showed reduced regional activities in the inferior wall on the early SPECT scan, especially in the 180 degrees data. There were no changes in the mean anterior-to-inferior ratio in the anterior planar projection images over time, suggesting that the reduced activity in the early SPECT images reflected an artifactual effect.

CONCLUSION

Our data indicate that it would be best to perform late imaging in patients with suspected coronary artery disease using 99mTc-tetrofosmin.