[Functional diagnosis of tracheal stenosis and tracheoplasty in non-neoplastic disease]

Over the past ten years we have performed 47 tracheoplasty for non-neoplastic disease. Of the 47 patients, 17 had post-tracheostomy stenosis and 17 tracheobronchial tuberculosis. Non-neoplastic disease causes stenosis in the trachea to various degrees. Provided the lung function of these patients is not reduced, tracheoplasty may not be necessary. Functional diagnosis of the tracheal stenosis is therefore important in determining the indications for tracheoplasty in this condition. Clinically, evaluation of the flow plateau of the flow-volume curve has been utilized as a method for detection of fixed upper airway obstruction and the ratio of FEV1.0 to PEFR is helpful for an assessment of the degree of stenosis. But it has not been explained why the ratio correlates with the degree of stenosis. In this study, fixed-type tracheal stenosis was simulated in seven normal subjects by the use of a mouthpiece with an orifice of variable diameter. We derived the experimental formulae of FEV1.0/PEFR as follows. FEV1.0/Qp = FVC/Qp-e2(FVC/Qp-1.5)/2 Qp = 48.7 alpha 1.12 (1-1.1 alpha) (Qp; the plateau flow of the flow-volume curve) (alpha; the ratio of the cross-sectional area of the stenotic portion to that of normal trachea) The values of FEV1.0/Qp calculated from FVC and alpha using these formulae were equal to or in the neighborhood of the experimental values. On the basis of these calculations we concluded that the ratio FEV1.0/PEFR is helpful in the assessment of the degree of stenosis.(ABSTRACT TRUNCATED AT 250 WORDS)

Effects of a concanavalin A-binding biliary glycoprotein on nucleation time of gallbladder bile

A study was performed to determine quantitative differences in the total protein concentration of gallbladder bile from gallstone patients and to isolate nucleation-promoting factors from the bile. Total protein concentrations in cholesterol gallstone bile (3.6 +/- 0.6 mg/ml, mean +/- SD, n = 10), calcium bilirubinate gallstone bile (4.2 +/- 1.1 mg/ml, n = 10), black pigment gallstone bile (1.9 +/- 0.6 mg/ml, n = 4) and control gallbladder bile (2.3 +/- 0.5 mg/ml, n = 9) were not significantly different. Also no statistically significant differences in cholesterol saturation index were found among these groups. Gallbladder bile from cholesterol gallstone patients showed significantly faster nucleation than that of controls, calcium bilirubinate gallstone, or black pigment gallstone patients. We partially purified biliary glycoproteins proteins from cholesterol gallstone bile or calcium bilirubinate gallstone bile by chromatography on concanavalin A Sepharose. Nucleation time was measured following the addition of these proteins to control bile in vitro. The glycoproteins obtained from cholesterol gallstone bile had significant nucleation-promoting activity, but nucleation time was not changed following the addition of biliary glycoproteins from calcium bilirubinate gallstone patients. These results suggest that qualitative differences in individual proteins of gallbladder bile are responsible for nucleation-promoting activity in vitro.

[Change of number of oral Candida species by tongue brushing]

The purpose of this study was to investigate the influence of tongue brushing on the change of oral Candida species. Among the tongue brushing programs for 50 days, 5 subjects wearing dentures were measured the number of Candida species at tongue, denture and denture bearing mucosa and in oral rinsing. The following results were obtained. 1. After the tongue brushing program, the number of Candida species at tongue and in oral rinsing decreased significantly. 2. The tongue brushing with denture plaque control decreased in number of Candida species at denture more effectively than without denture plaque control. 3. The number of Candida species at denture bearing mucosa decreased by tongue brushing. 4. It seemed that the tongue brushing was effective to prevent denture stomatitis caused by denture plaque.

[Total gastrectomy after VEPA therapy in a case of primary gastric lymphoma (stage III of Naqvi's clinical staging)]

A 51-year-old male was referred to our hospital with complaints of chest and back pain. He was diagnosed as primary gastric lymphoma after medical examination. Because of a spreading of the lesion and his poor condition, we concluded that a curative operation would be impossible, and used VEPA therapy as combination chemotherapy. After three cycles of VEPA therapy, the man underwent total gastrectomy, which resulted in better prognosis and no malignant cells in the resected stomach. According to Naqvi's clinical staging, stage III gastric lymphoma is inoperable. We report here a case of stage III gastric lymphoma which could undergo curative operation after chemotherapy and continue to be in good condition.

Interactions of water-soluble porphyrins with hexadeoxyribonucleotides: resonance raman, UV-visible and 1H NMR studies

The interactions of the water-soluble porphyrins M(TMpy-P4) [M = H2, Cu(II), Ni(II), and Co(III); TMpy-P4 = tetrakis(4-N-methylpyridyl)porphyrinato ion], with the hexadeoxyribonucleotides d(CGTACG)2, d(TACGTA)2, d(GCATGC)2, d(TGTGCA)2, and d(CTATAG)2 have been investigated by resonance Raman and/or UV-visible spectroscopy. The results indicate that all hexamers containing the 5'CG3' as well as the 5'GC3' site, and also the mismatched hexamer d(TGTGCA)2, are capable of intercalating the H2, Cu(II) and Ni(II) porphyrins. 1H nuclear magnetic resonance spectra of d(CGTACG)2 mixed with Cu(TMpy-P4) have provided further evidence for the intercalation. For the other cases, outside binding by localized electrostatic interaction is suggested. There is no evidence of groove binding to any of the hexamers. Possible reasons for different binding properties of long and short helices are discussed.

The effect of ischemic time and temperature on lung preservation in a simple ex vivo rabbit model used for functional assessment

Despite 25 years of research in lung transplantation, little progress has been made in methods for improving lung preservation. To evaluate many factors that may affect lung function after preservation, we have developed a simple, reliable, and inexpensive animal model. This consists of an isolated rabbit lung preparation perfused with blood and ventilated with a closed-circuit system. Heart-lung blocks were harvested and the left lung was assessed after ligation of the right pulmonary artery and right main-stem bronchus. On completion of a storage period, the left lung was ventilated and perfused with fresh rabbit venous blood at a rate of 40 ml/min for 10 minutes. Assessment of lung function included gas analysis of infused and effluent blood, oxygen uptake, mean pulmonary artery perfusion pressure, and mean airway pressure. A control group and six preservation groups were evaluated, each with different storage temperatures (38 degrees C, 34 degrees C, 23 degrees C, 15 degrees C, 10 degrees C, and 4 degrees C). For each temperature, ischemic periods ranging from 1 to 30 hours were studied. In the control group, the lungs were assessed immediately after being harvested. In the preservation groups, the lungs were kept partially inflated, stored at a predetermined temperature by immersion, and later assessed after variable ischemic periods. Our studies demonstrated the following: (1) The degree of impaired lung function produced by ischemia is reflected by a decrease in oxygen uptake and in oxygen tension of the effluent pulmonary venous blood and an increase in pulmonary artery perfusion pressure; (2) hypothermia improves ischemic tolerance; (3) preservation of lung at 10 degrees C is superior to preservation at 15 degrees C and 4 degrees C. This screening model has allowed evaluation of independent multiple factors and methods pertinent to lung preservation and enables one to assess lung function reliably and rapidly.

Statistical survey of tracheobronchoplasty in Japan

In a survey of 142 hospitals in Japan, 1562 operations involving tracheobronchoplasty, 565 involving tracheoplasty, and 992 involving bronchoplasty were found to have been done from 1954 to 1984. The number of operations showed a steep increase from 1965 and reached more than 200 a year by 1984. This increase comes from larger numbers of bronchoplasty procedures being performed for lung cancer (58.8% in toto) and of tracheoplasty procedures for thyroid cancer (9.7% in toto). Fifty-seven operative modes could be classified, in which bronchial anastomosis was most frequent (62.1%), followed in order by tracheal anastomosis (18.0%), and tracheobronchial anastomosis (5.9%). Complications, encountered in 16.9% in toto, resulted in death in 22.3%, with fistula bleeding in all and anastomotic stricture in 47.7%. Anastomotic stricture alone had a higher mortality rate than anastomotic stricture combined with recurrent palsy (p less than 0.01). The tracheal anastomosis mode had a higher complication rate than that of the bronchial anastomosis mode (p less than 0.01). Among the 57 modes, the complication rates were lower than those of each stem mode in the following: suture of the tracheal wall (p less than 0.05), tracheal patch grafting (p less than 0.01), sleeve resection of the right main bronchus (p less than 0.02), and sleeve lobectomy of the right lower lobe (p less than 0.001). Complication rates were higher than those of each stem mode in these procedures: prosthetic replacement of the trachea (p less than 0.001), sleeve resection of the right main bronchus (p less than 0.05), and the montage-type carinal reconstruction (p less than 0.05) modes. The tracheal anastomosis mode was classified into two categories, standard and extensive. The latter showed complication rates higher than the former (p less than 0.01), tracheoplasty (p less than 0.0025), and the tracheal anastomosis stem mode (p less than 0.0025). Complication rates have decreased with time, being 21.8% with the tracheal anastomosis mode and 10.8% with the bronchial anastomosis mode in the past 9 years.

Interactions of water-soluble metalloporphyrins with nucleic acids studied by resonance Raman spectroscopy

The resonance Raman spectra of water-soluble porphyrins, M(TMpy-P4) (M = Cu(II), Ni(II) and Co(III] and their mixtures with poly(dG-dC)2, poly(dA-dT)2 and calf thymus and salmon DNAs were measured using a divided rotating cell to determine the magnitudes of frequency shift and intensity variation resulting from M(TMpy-P4)-nucleic acid interactions. Bands II(C beta-H bending, approximately 1100 cm-1) and VIII(C beta-C beta stretch, approximately 1570 cm-1) show a large and small upward shift, respectively, when Cu(TMpy-P4) and Ni(TMpy-P4) are intercalated at the G-C sites. In contrast, these bands show a small upward and downward shift, respectively, when Co(TMpy-P4) is groove-bound at the A-T sites of nucleic acids. Both Bands V (approximately 1260 cm-1) and IX (approximately 1646 cm-1) which originate in the N-methylpyridyl group always show small downward shifts due to coulombic interaction between the N-CH3+ group of TMpy-P4 and the PO2 group of the nucleic acid.

Tracheobronchoplasty for lung cancer

Forty-seven patients were pathologically studied in order to identify the kind of local tumoral spread occurring in lung cancer with particular reference to direct infiltration, intra and peribronchial metastasis and multicentricity. The potential absolute and relative criteria for bronchoplasty for lung cancer are discussed. Eighty-three patients were treated over a five-year period with bronchoplasty for malignancy. Survival data show that bronchoplasty can cure some patients with an absolute indication and save lobar function or improve surgical radicality in patients with relative indications.

[Prognostic values of the doubling time of serum carcinoembryonic antigen and calcitonin levels in medullary thyroid carcinoma]

Fifteen patients operated on for medullary thyroid carcinoma with elevated postoperative serum calcitonin (CT) levels underwent serial measurements of serum CT and carcinoembryonic antigen (CEA) levels. Both CT and CEA levels showed an exponential increase in 12 patients and a slight decrease in three. CEA levels manifested less fluctuation than CT levels. The doubling time of these tumor marker levels calculated from the regression line in each patient showed a strong correlation with three-year survival, recurrence within five years, and the time interval between surgery and recurrence of the tumor, allowing quantitative prediction of the prognosis. However, the doubling time of CEA was longer than that of CT in most patients.

[Successful chemotherapy in postoperative brain metastasis of breast cancer using ACNU--two case reports]

Two cases of postoperative brain metastasis of breast cancer were evaluated after chemotherapy using ACNU. Case 1: A 47-year-old female, who had undergone right standard radical mastectomy in 1979 for breast cancer (T2 N0M0, papillo-tubular carcinoma), was treated with ADM, TAM, and 60Co irradiation for bone metastasis in 1983. In 1984, she complained of loss of consciousness and paralysis of the extremities due to brain metastasis. After chemotherapy using ACNU (100 mg X 3), brain metastasis could not be detected on CT. She remained asymptomatic for more than 9 months without recurrence after therapy. Case 2: A 46-year-old-female, who had undergone left standard radical mastectomy in 1980 for breast cancer (T1 N1 M0, medullar tubular carcinoma), complained of headache and vertigo accompanying a hard tumor in the scalp. Chest X-ray and CT demonstrated right lung metastasis and left cerebellar metastasis. After combination chemotherapy using ACNU (100 mg) + MMC (4 mg) i.v. and FT (600 mg/day) p.o., symptoms and tumor on CT disappeared for 10 months after therapy. However, the patient died of aggravation of angina pectoris and D.M. from which she had been suffering for several years previously. These two cases correspond to complete response (CR) according to the response criteria proposed by Koyama-Saitoh.