[Reevaluation of bronchoplasty for central-type lung cancer]

The outcome, anastomotic complications, and recurrence rate after bronchoplasty carried out in 198 patients with bronchogenic carcinoma in our institutions were evaluated retrospectively. The outcome of bronchoplasty was reasonable (5-year survival rate of 58%), but that of patients with adenocarcinoma was poor (5-year survival rate of 13%) because of their advanced stage and less complete resection. The complications of anastomosis occurred in 8.2% after bronchoplasty. Postoperative pneumonia significantly increased the risk of complications. There was no difference in the incidence of complications between patients who received end-to-end and telescope-type anastomosis. Local recurrence at the anastomosis occurred in 4.9% who underwent bronchoplasty, but in 28% who underwent carinal resection. Lymph node metastasis was a risk factor for local recurrence. Twenty patients with early superficial squamous cell carcinoma in the central bronchus were treated with photodynamic therapy without local recurrence. This new modality may be of benefit to selected patients.

Molecular detection of metastatic retinoblastoma cells by reverse transcription polymerase reaction for interphotoreceptor retinoid-binding protein mRNA

BACKGROUND

In the current study, the authors report a 4 year old girl with disseminated retinoblastoma. To find sensitive and specific molecular markers for detection of retinoblastoma cells in blood and marrow, the authors evaluated three photoreceptor-associated gene transcripts by using reverse transcription polymerase chain reaction (RT-PCR).

METHOD

Samples of bone marrow and blood were obtained from healthy donors and the patient. RT-PCR was performed to detect the cone alpha'-subunit of cGMP phosphodiesterase (cone alpha'-PDE), the rod beta-subunit of cGMP (rod beta-PDE), and the interphotoreceptor retinoid-binding protein (IRBP) gene transcript in RNA extracted from the samples.

RESULTS

While no expression of rod beta-PDE or IRBP was detected in any of the normal samples, expression of cone alpha'-PDE was detected in two out of seven normal marrow samples. Expression of rod beta-PDE was not detected in the patient samples. Expression of IRBP was detected in the patient samples obtained from iliac bone marrow before intensive chemotherapy but not thereafter.

CONCLUSION

RT-PCR for IRBP was a useful method for detecting metastatic retinoblastoma cells as well as for evaluating the therapeutic effects of treatment in this particular case.

Allelic loss on 17p13 (TP53) and allelic loss on 3p21 in early squamous cell carcinoma of the lung

Roentgenographically occult bronchogenic squamous cell carcinomas are early lung cancers that localize in the bronchial wall, and are thought to be a good model to elucidate the carcinogenesis of lung cancer. In the present study, we analyzed the incidence of allelic losses on chromosome regions 3p21 and 17p13 in 40 cases of roentgenographically occult bronchogenic squamous cell carcinomas, using three microsatellite dinucleotide polymorphic markers. We also investigated the relationship between such allelic loss and the clinicopathological findings of those cases. These chromosome regions showed frequent losses. Moreover, the incidence of loss on 17p13 increased gradually along with the advance of the depth of invasion, while the incidence of loss on 3p21 increased along with the advancing length of the longitudinal extension. These results suggested that these chromosome regions play different roles in lung cancer progression, i.e., the 3p21 chromosome region was related to the longitudinal extension of the carcinoma while the 17p13 (p53) region was related to the depth of invasion.

Preservation of the roots--management and prevention protocols for cracked tooth syndrome

It is essential that symptomatic fractures of teeth be suitably diagnosed to prevent propagation of the fracture and continuation of the symptoms. The importance of understanding the mechanism and progression of fractures within teeth is essential when considering the management of fractures within teeth. The relation of the fracture line to the pulp, periodontal ligament and root will influence the management protocols for the involved teeth. When does a Cracked Tooth Syndrome (CTS) become a cracked tooth i.e., unrestorable? Consideration is also required regarding when endodontic treatment should be commenced. Further, suitable-coronal restoration of teeth is required to prevent propagation of the fracture line and persistence of the symptoms. Patients diagnosed with CTS should be counselled in strategies to prevent CTS in other teeth.

[A case of bronchial stump recurrence of lung cancer successfully treated with chemoradiotherapy using cisplatin plus vinorelbine]

A 61-year-old man, who had undergone right upper lobectomy for lung cancer about nineteen months earlier, was examined at our hospital for hemoptysis. A bronchial stump recurrence was observed by chest CT and bronchoscopy. The patient underwent chemoradiotherapy using cisplatin (CDDP) and vinorelbine (VNB). Irradiation was started (total 60 Gy/30 fr/6 weeks) about four weeks before the onset of chemotherapy. Chemotherapy consisted of 2 cycles of CDDP 80 mg/m2 on day 1 and VNB 15 mg/m2 on day 1, 8. The dose of VNB was increased to 25 mg/m2 during cycle 2 because cycle 2 was without radiotherapy. After the chemoradiotherapy, the recurrent tumor disappeared on a CT scan and bronchoscopy. Chemoradiotherapy using CDDP plus VNB regimen is considered effective, without serious side effects for advanced non-small-cell lung cancer.

MDM2 expression is associated with progress of disease and WAF1 expression in resected lung cancer

Although MDM2, p21/WAF1, and p53 are considered as regulating each other based on in vitro studies, the relation in human lung cancer is not fully understood. The expressions of these proteins were examined immunohistochemically in 112 resected non-small cell lung cancer specimens and the correlation between them were analyzed. MDM2 was expressed in 45% of all lung cancers. In advanced stage, MDM2-positive cases were observed more frequently than in early stage, showing significant difference. No significant difference was observed in the prognosis of the patients regardless of the expression of any protein. Although no correlation was observed between MDM2 expression and p53 expression, or between p21/WAF1 expression and p53 expression, MDM2 expression was strongly related with p21/WAF1 expression. Therefore, MDM2 expression may relate to the progress of the stage of lung cancer, and MDM2 expression and p21/WAF1 expression may be associated not through the p53-related pathway.

[Strategy of treatment for roentgenographically occult lung cancer]

Roentgenographically occult bronchogenic squamous cell carcinomas(ROCs) are very small hilar type lung cancer that grow superficially and localize mainly in the bronchial wall, and these patients are expected to have an excellent prognosis after resection. When a ROC is limited within bronchoscopic visibility and less than 10 mm in longitudinal extension and its bronchoscopic findings are slight thickening and flat or wavelet, the tumor is a good candidate for photodynamic therapy. When a ROC is limited within bronchoscopic visibility, the tumor is a good candidate for segmentectomy with curative intent. The tumor invading beyond bronchial wall and/or nodal involvement should be treated by standard operation.

Chronic graft-versus-host disease in children and adolescents after bone marrow transplantation from HLA-matched donors

We analyzed 98 pediatric patients who underwent bone marrow transplantation (BMT) from serologically HLA-matched related donors (RD) or unrelated donors (UD) at our institute to clarify the actual status of chronic graft-versus-host disease (cGVHD). There were 36 evaluable cases of RD-BMT and 35 of UD-BMT. cGVHD was observed in 8 RD-BMT cases (22.2%) and in 23 UD-BMT cases (65.7%). In the RD-BMT cases, the limited and extensive types of cGVHD were observed in 4 cases each, whereas in the UD-BMT cases, the limited type was seen in 11 cases and the extensive type in 12. Prior acute GVHD was observed in 6 RD-BMT cases and in 18 UD-BMT cases. Two RD-BMT patients with extensive type cGVHD died of relapse and cytomegalovirus infection, and 4 UD-BMT patients died because of bronchiolitis obliterans, fungal infection, liver failure, and multiple organ failure, respectively. The incidence of cGVHD in these pediatric patients was as high as that in adult patients when UD-BMT was performed. Some UD-BMT patients required long-term immunosuppressive therapy after BMT. These findings suggest that cGVHD is a serious problem in pediatric UD-BMT. Therefore, intensive prophylaxis and treatment of GVHD must always be performed after UD-BMT.

The effects of water extracts of CagA positive or negative Helicobacter pylori on proliferation, apoptosis and connexin formation in acetic acid-induced gastric ulcer of rats

AIM

To investigate the influence of water extracts of CagA-positive or -negative Helicobacter pylori on healing of chronic gastric ulcers and on connexin formation, proliferation and apoptosis, in acetic acid-induced chronic gastric ulcers in rats.

METHODS

Acetic acid was used to induce chronic gastric ulcers in rats, and a water extract of H. pylori was given by mouth every day. Connexin 32 formation was assessed using Western blotting as previously described. The frequencies of proliferating cell nuclear antigen staining and of TdT-mediated dUTP-biotin nick end labelling were examined.

RESULTS

In untreated rats, acetic acid-induced gastric ulcers healed after 14 days and the electrophoretic band corresponding to connexin 32 appeared 4 days after ulcer induction. Treatment with a water extract of H. pylori delayed ulcer healing, with the ulcers remaining unhealed even on the 14th day; healing was delayed more when treatment was with an extract of CagA-positive rather than CagA-negative H. pylori. Connexin 32 appeared earlier when treatment was with a CagA-negative rather than a CagA-positive extract, but in both cases later than in the untreated control group. Proliferating cell nuclear antigen labelling on the fourth day was seen in 14.5% +/- 1.6% of mucosal cells of control group, but in 35.9% +/- 1.4% and 36.5% +/- 1.4% of mucosal cells treated with either VacA(+)CagA(-) and VacA(+)CagA(+) H. pylori extract, respectively. Furthermore, extracts of both H. pylori strains, especially VacA(+)Cag(+) H. pylori promoted apoptosis.

CONCLUSIONS

A water extract of H. pylori increased both proliferation and apoptosis, which are related to exacerbation and healing of ulcer as well as appearance of connexin 32.

Bronchioloalveolar carcinoma arising in a bronchogenic cyst

We report the case of a 37-year-old woman with a radiographically cystic lung lesion. Lobectomy was performed. Histopathologic examination showed a bronchioloalveolar carcinoma arising in a bronchogenic cyst. This suggests that epithelial cells of bronchogenic cysts can undergo malignant transformation. It may be prudent to recommend complete resection of any bronchogenic cyst.

Purification and Characterization of N-Acetylglucosamine-6-phosphate Deacetylase from a Psychrotrophic Marine Bacterium, Alteromonas Species

A psychrotrophic bacterium, strain Mct-9, which produced an N-acetylglucosamine-6-phosphate deacetylase, was isolated from a deep-seawater sample in the Mariana Trough. The Mct-9 strain was identified as Alteromonas sp. The native enzyme had a molecular mass of 164,000 Da, and was predicted to be composed of four identical subunits with molecular masses of 41,000 Da. The purified enzyme hydrolyzed N-acetylglucosamine (GlcNAc), GlcNAc-6-phosphate, and GlcNAc-6-sulfate. Considering the low K(m) and high k(cat)/K(m) for GlcNAc-6-phosphate, it probably acts as a GlcNAc-6-phosphate deacetylase in vivo. The enzyme was functional in the temperature range of 5 degrees to 70 degrees C and displayed optimal activity at 55 degrees C. The optimal temperature was higher than that of the deacetylase from the mesophilic bacterium Vibrio cholerae non-O1. The characteristics of the GlcNAc-6-phosphate deacetylase from Alteromonas sp. are unique among psychrotrophs and psychrophiles, whose intracellular enzymes are mostly thermolabile.

Immunohistochemical study on tumor angiogenic factors in non-small cell lung cancer

BACKGROUND

In order to elucidate the roles of tumor angiogenesis in lung carcinogenesis, the expressions of several angiogenic factors in lung carcinoma tissues were examined.

MATERIALS AND METHODS

Tissue specimens from 112 cases of resected non-small cell lung cancer (NSCLC) were studied. The expressions of platelet-derived endothelial cell growth factor (PD-ECGF) and vascular endothelial growth factor (VEGF) were examined immunohistochemically. Microvessel density (MVD) was also evaluated.

RESULTS

VEGF-positive cases were observed more frequently in advanced stage lung cancers than in early cancers, and VEGF-positive tumors had higher MVD than VEGF-negative tumors, while such differences were not observed for PD-ECGF. In squamous cell carcinoma, the patients with high-MVD tumor had significantly worse survival than those with low-MVD tumor.

CONCLUSIONS

Our results suggest that VEGF plays an important role in angiogenesis of lung cancers, while the contribution of PD-ECGF may be limited.

Vocal fold injection of collagen for unilateral vocal fold paralysis caused by chest diseases

BACKGROUND

Patients having malignant chest diseases sometimes suffer from vocal fold paralysis. Treatment for vocal fold paralysis is important for such patients, because vocal fold paralysis causes lack of the versatility of the human voice which is essential for our communication.

METHODS

Seventeen patients suffering from unilateral vocal fold paralysis were treated with vocal fold injections of collagen. Three patients received twice, and 20 treatments were conducted. A flexible bronchofiberscope was used under local anesthesia in order to observe the whole procedure of vocal fold injection. Using an injector and a long needle, collagen was injected with transcutaneous technique mainly through the cricothyroid membrane. The amount of collagen was determined with bronchoscopic findings.

RESULTS

During and after treatment, no complication was observed. Of 20 treatments, a marked improvement was observed in 8, and moderate improvement was observed in 9 treatments.

CONCLUSIONS

Vocal fold injection of collagen is a very useful and safe treatment for unilateral vocal fold paralysis caused by chest diseases.

Endocrinological and biophysical responses to further reduction in oxygenation following sustained hypoxemia in fetal goats

OBJECTIVE

The purpose of this study was to determine fetal endocrinological and biophysical responses to the further reduction in oxygenation following prolonged nonacidemic hypoxemia in fetal goats.

METHODS

Seven further hypoxic experiments were performed after prolonged (24-h) nonacidemic hypoxemia, caused by an infusion of nitrogen into the maternal trachea and by reducing uterine arterial blood flow in four chronically instrumented goat fetuses at 123-131 days' gestation. We measured arginine vasopressin, adrenocorticotropic hormone, cortisol, and catecholamines as endocrinological parameters. Fetal heart rate, fetal blood pressure, and fetal breathing movement were observed as biophysical parameters.

RESULTS

Fetal arterial pO2 was significantly decreased from 27.0 +/- 1.2 mmHg (control) to 18.0 +/- 0.7 mmHg and 11.3 +/- 1.3 mmHg at the end of the prolonged hypoxemia and the further hypoxia, respectively. The further hypoxia induced reductions in fetal heart rate, increases in fetal blood pressure, and a series of gasping. Arginine vasopressin and catecholamines were elevated significantly by the further hypoxia. Although adrenocorticotropic hormone and cortisol were increasingly elevated, they did not reach a significant level.

CONCLUSIONS

Some specific fetal responses-excessive elevations of fetal catecholamines, arginine vasopressin, accompanied with fetal gasping-were observed during further severe hypoxia.

Expression of Bcl-2, Bax, and p53 proteins in carcinogenesis of squamous cell lung cancer

BACKGROUND

Apoptosis is regulated by many genes, including bcl-2, p53, and bcl-2 family genes. The expression of Bcl-2, p53, and Bax in very early lung cancers or precancer lesions is not been fully understood.

MATERIALS AND METHODS

The expression of these proteins was examined immunohistochemically in 11 normal bronchial epithelia, 23 dysplasias, and 40 roentgenographically occult squamous cell lung cancers (ROCs).

RESULTS

The expression of the Bcl-2 and p53 protein increased along with the advance of the morphological atypia in bronchial epithelial cells, whereas no difference in the Bax expression. The patients with Bcl-2 positive ROCs had a better prognosis than those with Bcl-2 negative ROCs.

CONCLUSIONS

Bcl-2 and p53 proteins play important roles in early steps of carcinogenesis in squamous cell lung cancer of central type. The Bcl-2 protein could be a prognostic marker in ROCs.

Five-year survivors with resected pN2 nonsmall cell lung carcinoma

BACKGROUND

Some patients with resected pN2 lung carcinoma were long term survivors. To determine appropriate therapeutic modalities for the selected patients, the clinicopathologic characteristics of these patients were examined using the actual number of survivors rather than the cumulative survival rate because the cumulative survival rate occasionally is confounded due to patients with short follow-up periods.

METHODS

Between 1981-1990, 178 patients with pN2 nonsmall cell lung carcinoma underwent complete resection with systemic lymph node dissection. The ratios of 5-year survivors to all patients in groups with several clinicopathologic factors were compared.

RESULTS

Gender, the side that was operated on, location of the tumor, histologic type, or surgical procedure were not related to the ratio of 5-year survivors. However, T classification, skip metastasis, and the number of levels involved were associated with the ratio significantly. The authors also found that the location of the involved lymph node(s) affected the ratio.

CONCLUSIONS

Even in the presence of pN2 disease, lung carcinoma patients with T1 tumors, skip metastasis, or single level mediastinal lymph node involvement, especially Level 4, Level 5, or Level 6 lymph nodes, had a relatively favorable prognosis and may be candidates for primary resection.

Chromosome bands 3p14.2, 9p21, and 13q14 are frequently deleted in roentgenographically occult bronchogenic squamous cell carcinoma of the lung

Roentgenographically occult bronchogenic squamous cell carcinomas are early lung cancers that localize mainly within the bronchial wall and are thought to be a good model for elucidating chromosomal alterations during lung cancer progression. In this study, we analyzed allelic losses on chromosome regions 1p36, 3p14.2, 9p21, 10q25.3-q26.1, 13q14.12-q14.2, and 16q24.1-q24.2, in which there are putative tumor suppressor genes that may play roles in lung carcinogenesis. Forty-five cases with roentgenographically occult bronchogenic squamous cell carcinoma (ROC) and 47 cases of bronchogenic carcinoma with abnormal shadows (roentgenographically nonoccult bronchogenic squamous cell carcinoma [RNOC]) were examined. Highly frequent LOHs in both ROCs and RNOCs were observed in chromosome regions 3p14.2, 9p21, and 13q14.1-q14.2. LOHs were more frequently observed in RNOCs than in ROCs at two loci: 10q25.3-q26.1 and 16q24.1-q24.2. These results suggested that (1) putative tumor suppressor genes exist on 3p14.2, 9p21, 10q25.3-q26.1, 13q14.12-q14.2, and 16q24.1-q24.2, which may play important roles in lung carcinogenesis; (2) mutations in genes at 3p14.2, 9p21, and 13q14.12-q14.2 represent rather early events in lung carcinogenesis; and (3) mutations in genes on 10q25.3-q26.1 and 16q24.1-q24.2 represent rather late events.

[Ultrasonographic findings of diseases in peripheral lung fields using transtracheobronchial endoscopic ultrasonography (TUS)]

Nineteen patients with diseases in peripheral lung fields, including 14 with lung cancer, 1 brochiectasis, 1 with pleural effusion, 1 with sclerosing haemangioma and 2 with inflammatory lung diseases were examined with transtracheobronchial endoscopic ultrasonography (TUS) using an Olympus EU-M 20 and UM-2 R (12 MHz) or UM-3 R (30 MHz). The internal structures of the lesions, including necrosis and bronchial tissues, were readily observable, as were the intrapulmonary lymph nodes, including the swollen and heterogenous internal structures of metastatic lymph nodes. TUS is useful for diagnosis of peripheral lung diseases.

Sequential loss of heterozygosity in the progression of squamous cell carcinoma of the lung

Radiographically occult bronchogenic squamous cell carcinomas are early lung cancers that localize mainly in the bronchial wall, and are thought to be a good model for investigating genetic alterations through lung cancer progression. In order to elucidate sequential genetic changes in lung cancers, we analysed the incidence of allelic losses on chromosome regions 2q33, 3p21, 5q21, 7q31, 9p21 and 17p13 for 40 cases of radiographically occult bronchogenic squamous-cell carcinomas and 40 cases of advanced lung cancers microdissected. In this study we used eight microsatellite dinucleotide polymorphic markers. Frequent loss of heterozygosity (LOH) was observed on 3p21 (53%), 5q21 (44%) and 17p13 (61%) in roentgenographically occult bronchogenic squamous cell carcinomas. 2q, 7q and 9p were lost less frequently in both roentgenographically occult bronchogenic squamous cell carcinomas and advanced lung cancers. These results suggest that several tumour-suppressor genes are associated with lung cancer progression and that genetic changes on 3p21, 5q21 and 17p13 are early events.

What kind of hilar lung cancer can be a candidate for segmentectomy with curative intent?: Retrospective clinicopathological study of completely resected roentgenographically occult bronchogenic squamous cell carcinoma

Although a randomized control trial demonstrated that limited surgery for small peripheral lung cancers was not as curative as lobectomy, there have been no reports concerning segmentectomy for small hilar lung cancers. In this study, we analyzed the clinicopathological features of roentgenographically occult bronchogenic squamous cell carcinomas in order to select candidates for limited resection with curative intent. From April 1982 through June 1995, 105 roentgenographically occult bronchogenic squamous cell carcinomas whose proximal edge of the lesion was more peripheral than the orifice of the segmental bronchus were completely resected. The bronchoscopic findings of the lesions were classified into three categories: remarkable, minute and hidden. Moreover, in terms of the range of endoscopic visibility, the lesions were classified into two categories: lesions within the range of endoscopic visibility and those beyond it. If lymph nodes show no signs of metastasis, roentgenographically occult bronchogenic squamous cell carcinoma is regarded as localized carcinoma and can be a candidate for segmentectomy with curative intent. In cases with minute or hidden bronchoscopic findings or of lesions within the range of endoscopic visibility, metastatic lymph nodes were never observed. Accordingly, roentgenographically occult bronchogenic squamous cell carcinomas with minute or hidden bronchoscopic findings or those within the range of endoscopic visibility can be candidates for curative segmentectomy.

[Value of transtracheobronchial ultrasonography in the assessment of mediastinal lymphadenopathy in patients with lung cancer]

In patients with lung cancer, decisions regarding treatment can depend on the diagnosis of hilar and mediastinal nodal involvement. We prospectively compared the diagnostic value of computed tomography (CT) with that of transtracheobronchial ultrasonography (TUS) in the evaluation of lymphadenopathy. Five patients with resectable lung cancer were studied. TUS was done with EU-M 20 or M 30 and lymph nodes located at #3, #4, #7, ipsilateral #10, and #11 were observed and measured. TUS findings, CT findings, and histological findings were evaluated and compared. The sizes of lymph nodes as measured by TUS were similar to or slightly smaller than their sizes as measured by CT. Hilar lymph nodes and lymph nodes located at right #4 were clearly observed with TUS, but were sometimes unclear with CT. Diagnosis of model involvement by TUS needs further study.

[A child of malignant lymphoma diagnosed by transbronchial aspiration cytology under general anesthesia with a laryngeal mask]

A 8-year-old male with Wiskott-Aldrich syndrome was admitted to our hospital because of left hilar swelling on a chest roentgeonogram. Bronchofiberscopy and transbronchial aspiration cytology (TBAC) was performed under general anesthesia with a laryngeal mask. The specimen obtained by TBAC was immediately stained and diagnosed as malignant lymphoma. One month later, thoracotomy was performed in order to get more detail diagnosis, which is necessary to determine the regimen of chemotherapy, and the nodal specimen were diagnosed as Hodgkin's disease. The ABVD therapy was performed which induced the complete remission. The laryngeal mask is a useful device for bronchofiberscopy in children.