Extended operation for T4 lung carcinoma

The extended surgery for T4 lung carcinoma was reviewed. From literature in the last decade, the 5-year survival rate has been under 10% worldwide. However a more favorable prognosis will be expected nowadays because of the progress of perioperative intensive care and appearance of effective anticancerous agents for induction chemotherapy. We compared the results of surgery for T4 lung carcinoma from 1978 to 1989, to those from 1992 to 1997. The 3 and 5-year survivals in the former period were 6.8% respectively, however in the latter period the 3-year survival rate rose to 24.6%. In patients with T4, the prognoses are different according to the involved organs by lung carcinoma. Generally, combined resection of the trachea, carina, descending aorta and left atrium show better prognoses compared to that of the esophagus and liver. We consider that malignant pleural effusion with N2 should not be the object for panpleuropneumonectomy. In our series from 1992 to 1997 median survival time (MST) of T4 with N0 or N1 was 25.5 months, on the other hand MST with N2 or N3 was 14.2 months. Histologically patients with squamous cell carcinoma showed a better prognosis than those with adenocarcinoma. From these results, in the extended operation for T4 we may expect more favorable prognoses in cases with involvements of the trachea, carina, aorta and left atrium, and with N0 or N1, histologically squamous cell carcinoma.

[Therapeutic strategy for pleural mesothelioma]

Generally pleural mesothelioma is divided into two histologic types: localized and diffuse. Most cases of the former are considered to be benign and the latter malignant. The treatment strategy for these tumors has been investigated, including various surgical and chemotherapeutic approaches. In spite of these efforts. no curative method for malignant mesothelioma has been established yet, although the gene therapy is expected to be the most powerful tool in the near future.

Y-shaped tracheobronchial stent for carinal and distal tracheal stenosis

A Y-shaped tracheo-bronchial tube was designed and used for two patients with carinal stenosis following a lower tracheal resection in one case and a malignant tracheal fistula in the other. The tube consisted of three parts including a Y-shaped, thin-walled, soft silicone stent; a spiral-wire-reinforced main tube; and a curved tracheostomy tube. The stent was inserted easily and comfortably through the tracheostomy under fiberoptic bronchoscopic guidance with minimal local anesthesia. The positioning stability of the tube was excellent because of the carina-shaped structure of the tube end. Resistance to compression was satisfactory due to the embedded spiral wire. The insertion procedure through the tracheostomy was smooth, even in patients whose respiratory condition was severe or critical. Satisfactory phonational activity was also provided by breathing through the hole on the tube back up to the vocal cord. Bronchoscopic inspection was uncomplicated, and the patients themselves could easily clean the stent. Since palliation of the airway obstruction is the main purpose of such a stent for patients with either severe lower tracheal or carinal stenosis, and because of the difficulty of ordinary stent insertion in this part of the airway, this device appears to offer excellent stability and easy insertion of the stent. In addition, the ease of maintenance and suctioning through the tracheostomal end allows for an excellent quality of life in which the patients are able to return to their homes.

Expression of four CEA family antigens (CEA, NCA, BGP and CGM2) in normal and cancerous gastric epithelial cells: up-regulation of BGP and CGM2 in carcinomas

Four human carcinoembryonic antigen (CEA) family members, CEA (CD66e), non-specific cross-reacting antigen (NCA, CD66c), biliary glycoprotein (BGP, CD66a) and CEA gene-family member 2 (CGM2), are expressed in normal mucosal epithelia of the colon. Expression of BGP and CGM2 has recently been demonstrated to be down-regulated in colorectal adenocarcinomas. We have now investigated the expression of the 4 CEA family antigens in gastric adenocarcinoma and carcinoma cell lines in comparison with adjacent normal gastric mucosa. The transcripts of the CEA, NCA and BGP genes evaluated by reverse transcription-polymerase chain reaction were detectable at various levels in all the gastric adenocarcinoma cell lines tested, while CGM2 mRNA was detectable in the cell lines of poorly differentiated but not of well-differentiated carcinomas. The levels of CEA mRNA in normal gastric mucosa were variable but mostly increased in adenocarcinomas. The sparse expression of NCA observed in the normal tissues was markedly up-regulated in the carcinomas. In contrast to previous findings on normal and cancerous colonic tissues, the transcripts of CGM2 were totally undetectable and those of BGP were recognized only marginally, if at all, in normal gastric mucosa, while both messages were detected at significant levels in most of the gastric adenocarcinomas. This was confirmed by in situ hybridization. Our findings indicate that expression of the CEA family antigens, particularly that of BGP and CGM2, is differently regulated in epithelial cells of the colon and the stomach.

The number of lymph node metastases influences survival in esophageal cancer

BACKGROUND AND OBJECTIVES

Lymph node involvement adversely affects the survival of patients with esophageal cancer. We retrospectively investigated whether the number of involved lymph nodes and the degree of lymph node dissection affect survival.

PATIENTS AND METHODS

Eighty-eight patients underwent surgical resection and reconstruction for T -T3 thoracic esophageal squamous cell carcinoma. Patients were classified into three groups: group 1, 32 patients without lymph node involvement; group 2, 26 patients with 1 to 3 positive nodes; and group 3, 30 patients with > or = 4 involved lymph nodes.

RESULTS

The 3-year and 5-year survival rates were 34.8% and 30.0% in group 1, 30.0% and 22.7% in group 2, and 14.8% and 0% in group 3, respectively. The mean survival time (MST) X +/- SD of the patients in group 3 (453.06+/-74.5 days) was significantly shorter than in group 1 (450.1+/-450.5, P = 0.0005) and group 2 (937.3+/-1317.9, P = 0.0295). For patients in groups 1 and 2, the MST for three-field lymph node dissection (1136.9+/-1476.4 days) was longer than for two-field lymph node dissection (1007.4+/-1476.4 days, P = 0.0355). However, in group 3, there was no survival advantage to three-field lymph node dissection.

CONCLUSION

We conclude that the survival in patients with thoracic esophageal cancer involving four or more nodes, is poorer than in patients with lesser involvement. Three-field lymph node dissection does contribute to prolonged survival in patients with node-negative disease or fewer than four positive nodes.

Expression of four CEA family antigens (CEA, NCA, BGP and CGM2) in normal and cancerous gastric epithelial cells: up-regulation of BGP and CGM2 in carcinomas

Four human carcinoembryonic antigen (CEA) family members, CEA (CD66e), non-specific cross-reacting antigen (NCA, CD66c), biliary glycoprotein (BGP, CD66a) and CEA gene-family member 2 (CGM2), are expressed in normal mucosal epithelia of the colon. Expression of BGP and CGM2 has recently been demonstrated to be down-regulated in colorectal adenocarcinomas. We have now investigated the expression of the 4 CEA family antigens in gastric adenocarcinoma and carcinoma cell lines in comparison with adjacent normal gastric mucosa. The transcripts of the CEA, NCA and BGP genes evaluated by reverse transcription-polymerase chain reaction were detectable at various levels in all the gastric adenocarcinoma cell lines tested, while CGM2 mRNA was detectable in the cell lines of poorly differentiated but not of well-differentiated carcinomas. The levels of CEA mRNA in normal gastric mucosa were variable but mostly increased in adenocarcinomas. The sparse expression of NCA observed in the normal tissues was markedly up-regulated in the carcinomas. In contrast to previous findings on normal and cancerous colonic tissues, the transcripts of CGM2 were totally undetectable and those of BGP were recognized only marginally, if at all, in normal gastric mucosa, while both messages were detected at significant levels in most of the gastric adenocarcinomas. This was confirmed by in situ hybridization. Our findings indicate that expression of the CEA family antigens, particularly that of BGP and CGM2, is differently regulated in epithelial cells of the colon and the stomach.

The number of lymph node metastases influences survival in esophageal cancer

BACKGROUND AND OBJECTIVES

Lymph node involvement adversely affects the survival of patients with esophageal cancer. We retrospectively investigated whether the number of involved lymph nodes and the degree of lymph node dissection affect survival.

PATIENTS AND METHODS

Eighty-eight patients underwent surgical resection and reconstruction for T -T3 thoracic esophageal squamous cell carcinoma. Patients were classified into three groups: group 1, 32 patients without lymph node involvement; group 2, 26 patients with 1 to 3 positive nodes; and group 3, 30 patients with > or = 4 involved lymph nodes.

RESULTS

The 3-year and 5-year survival rates were 34.8% and 30.0% in group 1, 30.0% and 22.7% in group 2, and 14.8% and 0% in group 3, respectively. The mean survival time (MST) X +/- SD of the patients in group 3 (453.06+/-74.5 days) was significantly shorter than in group 1 (450.1+/-450.5, P = 0.0005) and group 2 (937.3+/-1317.9, P = 0.0295). For patients in groups 1 and 2, the MST for three-field lymph node dissection (1136.9+/-1476.4 days) was longer than for two-field lymph node dissection (1007.4+/-1476.4 days, P = 0.0355). However, in group 3, there was no survival advantage to three-field lymph node dissection.

CONCLUSION

We conclude that the survival in patients with thoracic esophageal cancer involving four or more nodes, is poorer than in patients with lesser involvement. Three-field lymph node dissection does contribute to prolonged survival in patients with node-negative disease or fewer than four positive nodes.

Plasma thrombospondin levels in patients with colorectal carcinoma

BACKGROUND

Thrombospondin in a 450-kilodalton glycoprotein, first described as a secretion product of thrombin-stimulated platelets. In a recent study, thrombospondin was discovered not only to accelerate platelet aggregation and to promote construction of the extracellular matrix but also to be involved in the progression of malignant tumors. In another study, plasma thrombospondin was reported to be elevated in patients with colorectal carcinoma with hepatic metastasis. Moreover, venous invasion in colorectal carcinoma is well known to be involved profoundly in organ metastasis.

METHODS

Blood samples from patients with colorectal carcinoma were collected preoperatively by venipuncture using ice-chilled tubes, and immediately centrifuged at 4 degrees C. The plasma was aspirated and frozen until the concentration of thrombospondin was measured using a competitive enzyme-linked immunoadsorbent assay. The degree of venous invasion in each case was evaluated pathologically using resected specimens to examine for any correlation with the plasma thrombospondin level.

RESULTS

The plasma thrombospondin level was significantly higher in those patients with malignant venous invasion than in those patients with no venous invasion, according to Dukes staging. There was a direct correlation between the plasma thrombospondin level and the degree of venous invasion.

CONCLUSIONS

Venous invasion by colorectal carcinoma was found to play an important role in the elevation of the plasma thrombospondin level. Alternatively, a high concentration of thrombospondin may support metastasis and progression of this malignancy.

Clinical use of a front lifting hood rectoscope tube for transanal endoscopic microsurgery

BACKGROUND

Transanal endoscopic microsurgery (TEM), a procedure developed by Buess et al. requires a specially designed surgical rectoscope system, and adequate training for its operation is mandatory. In order to simplify the performance of TEM, and to allow the use of additional surgical instruments and devices, we have developed a new rectoscope tube.

METHODS

The forward half of the tube can be opened longitudinally by hand. Our working insert platform is hollowed and includes a channel for an endoscope. The resection procedure can be performed under normal atmospheric pressure. This newly developed rectoscope system has already been employed clinically. TEM was performed using our original forward lifting hood rectoscope tube in 20 patients, including 12 cases of sessile adenoma and eight cases of early carcinoma.

RESULTS

The forward hood of the tube was opened to the maximum angle of 25 degrees in eight patients and 15-20 degrees in the other 12 patients. The visible field of the rectal interior was extended in direct proportion to the angle. Through our working insert platform, instruments and devices could be used for either laparoscopic or open surgery.

CONCLUSIONS

These modifications have made TEM easier and will therefore make the procedure available to more surgeons.

Detection of chromogranin A mRNA in small cell lung carcinoma using a new, highly sensitive in situ hybridization method with a non-radioisotope oligonucleotide probe

BACKGROUND

Immunoreactivity for chromogranin A (Cg A) is associated with the presence of neurosecretory granules in tumor cells, but immunohistochemical staining for Cg A may be absent in small cell lung carcinoma (SCLC), which has only a few secretory granules. Localization of Cg A mRNA is a useful indicator of the site of synthesis of a particular protein and possibly the rate of synthesis, and it is not dependent on posttranslation events within the cells. However, it is difficult to detect the low levels of mRNA copies using the standard non-radioisotope (RI) oligonucleotide probe.

METHODS

The authors analyzed Cg A mRNA in 20 cases of SCLC in formalin fixed, paraffin embedded tissue using a new, highly sensitive in situ hybridization method that was developed from the maximized immunohistochemistry (ImmunoMax) method. They also investigated Cg A mRNA in nonsmall cell lung carcinoma (NSCLC), including ten cases each of adenocarcinoma and squamous cell carcinoma of the lung.

RESULTS

All examined SCLC tissues showed a positive reaction for Cg mRNA. No NSCLC specimens showed any positive reaction for Cg A mRNA.

CONCLUSIONS

The detection of Cg A mRNA using the new, highly sensitive in situ hybridization method with a non-RI oligonucleotide probe can be used to characterize neuroendocrine differentiation of lung tumors even when the Cg A protein is not detected by immunohistochemistry. The authors believe this is a first step toward better diagnosis and treatment for patients with SCLC.

Primary tracheal fibrosarcoma in a child: a case of tracheal resection under ECMO support

We report a case of severe airway obstruction due to endotracheal fibrosarcoma in a 3-year-old boy. Successful tracheal resection and reconstruction was performed under extracorporeal membrane oxygenation support. A solid, elastic hard tumor with a smooth surface was attached by a tiny stalk structure to the membranous part of the lower trachea. Histological findings of the tumor were consistent with infantile fibrosarcoma, showing proliferation of spindle cells forming interlacing patterns.

Free radical-mediated tissue injury in acute lung allograft rejection and the effect of superoxide dismutase

BACKGROUND

The role of monocytes and neutrophils is crucial during acute allograft rejection. They have the capacity to generate toxic reactive oxygen intermediates in response to specific agonists that may act as tissue destructive molecules. We examined the possibility of reactive intermediate-mediated tissue injury in acute lung allograft rejection, as well as the effect of superoxide dismutase.

METHODS

Allogenic (Brown Norway to F344) or syngenic (F344 to F344) rat left-lung transplantation was performed. Generation of reactive oxygen intermediates in peripheral blood was evaluated by the method of luminol-dependent chemiluminescence. Cell membrane phospholipid peroxidation in the graft was measured as malondialdehyde concentration. The third group of animals having allografts received bovine erythrocyte superoxide dismutase (5,000 U/kg intravenously every 12 hours after transplantation).

RESULTS

Relative chemiluminescence response in the allograft recipient to normal F344 was elevated on postoperative day 1 (257%), then decreased slightly on day 3 (156%) and was elevated again on day 7 (560%) as the process of rejection progressed. Allograft tissue malondialdehyde levels (248.37 +/- 112.35 nM/whole lung, n = 6; p < 0.05 by Student's t test) were higher than isograft levels (139.29 +/- 35.93 nM/whole lung, n = 6) on day 7. Superoxide dismutase treatment significantly ameliorated the histologic degree of rejection on day 7.

CONCLUSIONS

These results demonstrate the tissue destructive activity of reactive oxygen intermediates during lung allograft rejection. To scavenge free radicals may be a useful therapeutic modality in the management of acute lung allograft rejection.

[DT-diaphorase]

Anti-tumor quinone, including mitomycin C (MMC), needs to be activated by bioreduction to exert its cytotoxic activities. The enzymes underlying this bioreductive activation have been the subject of extensive research on Mitomycin C. Cytochrome P450 reductase, cytochrome b5 reductase, xanthine oxidase, xanthine dehydrogenase and DT-diaphorase (DTD) have been shown to be involved in the reduction of MMC. The relationship between bioreductive enzymes and the cytotoxicity of quinone, however, has not been analyzed yet. In this study, we investigated the relationship between the bioreductive enzymes and the cytotoxicity of MMC. We carried out the following experiments and the following results were obtained. I) We isolated an MMC-resistant variant. This cell showed five-fold resistance to MMC as compared with the parental cell line. DTD was deficient in this resistant cell. II) We have examined the bioreductive enzyme activities of DTD and cytochrome P450 reductase and IC50's of MMC in 13 colon and gastric carcinoma cell lines. A positive correlation was not found between the enzyme activities and MMC sensitivities, but the cells with little or no DTD activity showed higher IC50 values compared to the other cell lines. III) To elucidate directly the role of DTD in MMC sensitivity, we introduced NQO1 gene into St-4 cells. NQO1 gene encodes DTD and St-4 cells have no DTD activity. All of the transfectants showed five- to ten-fold higher sensitivity to MMC as compared to the parental St-4 cells. The above data indicate that DTD is a critical determinant of sensitivity to MMC in aerobic conditions.

[Analysis of DNA ploidy pattern and overexpression of p53 protein in cases of early gastric carcinoma with lymph node metastasis]

Twenty-one cases of surgically resected early gastric carcinoma with lymph nodal involvement (4 mucosal and 17 submucosal carcinomas) and 37 cases of that with no lymph nodal involvement (14 mucosal and 23 submucosal) were investigated by means of flow cytometry and immunohistochemical staining in order to clarify the correlation between lymph node metastasis and DNA ploidy pattern as well as overexpression of p53 protein. DNA aneuploidy was found to show a significantly higher frequency in submucosal carcinomas (60.0%) than in mucosal ones (22.2%), and also a significantly higher frequency in node positive cases (76.2%) than in node negative ones (32.4%). Meanwhile, the overexpression of p53 protein showed higher frequency in submucosal carcinomas (52.5%) than in mucosal ones (22.2%), and also higher frequency in node positive cases (47.6%) compared with that in node negative ones (40.5%). However there was no significant difference either in relation to the depth of tumor invasion or the lymph node metastasis. Thus, DNA aneuploidy showed a significant correlation to the depth of cancer invasion as well as lymph node metastasis, which was regarded as a useful indicator for the preoperative estimation of the depth of tumor invasion as well as lymph node metastasis.

[Complications of thoracoscopic surgery for spontaneous pneumothorax]

We reviewed the cases of 122 patients with primary spontaneous pneumothorax who underwent thoracoscopic surgery at our institution between 1992 and 1995. In 9 cases, thoracotomy became necessary because of severe adhesions (3 cases), large foci (3 cases), and unrecognized foci (3 cases). Complications occurred in 17 cases: collapse in 1 patient after removal of the thoracic drain, persistent air leakage (> 7 days) in 2 patients, and recurrent pneumothorax in 14 patients. There were no significant differences between the recurrent and non-recurrent cases in age, sex location of bullae, past history of pneumothorax, operating time, intraoperative blood loss, or duration of chest tube drainage after surgery. The interval between onset and consult was significantly longer in recurrent cases than in non-recurrent cases, and the number of patients who required chest tube drainage before surgery was significantly higher in recurrent cases. Reoperation was performed in 9 cases. Bullaes that were not detected during the first surgery were found in the 7 of these cases. The recurrent cases in our study were regarded as resulting from a lack of surgical skill that may improved with increasing surgical experience. The Brinkman index was significantly higher in recurrent cases. Smoking and air-leakage before surgery may be risk factors for recurrence following thoracoscopic surgery for spontaneous pneumothorax.

The influence of pyrimidine nucleoside phosphorylase activity on metastasis of breast cancer

The activity of pyrimidine nucleoside phosphorylase (PyNPase) was analyzed in thirty-six cases of resected breast cancer and 9 cases of resected benign breast tumor. PyNPase is an enzyme which converts 5'-DFUR to 5-FU in tumor tissue and has been reported to be identical to the platelet-derived endothelial cell growth factor (PD-ECGF) that has angiogenic activity. PyNPase activity was significantly elevated in cancer and metastatic lymph nodes compared to normal lesions of the same breast. PyNPase activity was higher in T2 and T3 breast cancer than of T1 breast cancer. Furthermore, cases of high PyNPase activity (>200 mu g FU/mg protein/h) were significantly more likely to develop distant metastasis (p<0.01) than those of low PyNPase activity. These results suggest an important role of PyNPase activity in the progression of breast cancer.

Video-assisted thoracoscopic lobectomy for treating lung cancer

Our objective was to evaluate the usefulness and safety of video-assisted thoracoscopic surgery (VATS) for performing pulmonary lobectomy in 11 patients with clinical NO stage I primary non-small-cell lung cancer compared with 11 patients who underwent a conventional thoracotomy. Treatment was switched to conventional thoracotomy in three VATS patients because of the involvement of interlobar nodes or incomplete lobar fissure. None of the eight VATS patients died or experienced serious complications during 12 months of follow-up. There were no significant differences in the intraoperative blood loss, duration of operation, or duration of chest tube drainage between the VATS group and the standard lobectomy group. We conclude that although VATS lobectomy appears to be safe for use in managing patients with primary lung cancer, it does not seem to offer any advantages over standard lobectomy.

Tumor neutrophil elastase is closely associated with the direct extension of non-small cell lung cancer into the aorta

OBJECTIVE

Neutrophil elastase (NE) is the only neutral protease that is able to degrade insoluble elastin and other extracellular matrix constituents, and thus, may be involved in tumor invasion and metastasis. Using a highly specific and sensitive enzyme immunoassay (EIA), we recently demonstrated that immunoreactive (ir)-NE is produced by non-small cell lung cancer cell lines. We have measured the ir-NE concentration in non-small cell lung cancer tumor extracts and have evaluated its association with disease stage.

METHODS

We measured the ir-NE concentration in 144 non-small cell lung cancer tumor extracts using EIA, which permits the rapid measurement of both the free and alpha1-protease inhibitor (alpha1-PI) complexed form of ir-NE. In 15 clinical T4 (cT4) patients, we also determined the concentration of free ir-NE in tumor extracts using a kit that detects only NE complexed with alpha1-PI and subtracting that value from the total NE concentration.

RESULTS

ir-NE was detected in tumor extracts from 115 of 144 patients, ranging from 0.21 to 23.35 microg/100 mg protein. When the 144 specimens were grouped according to the clinical stage of disease, the ir-NE concentration (mean+/-SE) was significantly higher in those with cT4 disease (n=15; 7.90+/-1.88 microg/100 mg protein) than in those with cT1 (n=29; 1.27+/-0.27; p<0.001), cT2 (n=64; 1.18+/-0.17; p<0.001), or cT3 disease (n=26; 1.99+/-0.38; p<0.003). There was no significant association between the ir-NE concentration and cN-factor or any other clinical features. When the ir-NE concentration in the tumor extracts of the cT4 patients was compared with respect to the tumor invasion sites, the ir-NE level was significantly higher in those with surgical T4 (sT4) disease with aortic invasion (n=4; 17.4+/-3.10) than in those who were down-staged postoperatively (n=5; 4.9+/-1.33; p=0.005) or those with sT4 disease with involvement of other sites (n=6; 4.07+/-1.83; p=0.004). Similar results were observed for the free form of ir-NE.

CONCLUSIONS

These data suggest that NE may be involved in tumor progression of non-small cell lung cancer. Since the aorta is one of the richest sources of polymeric and insoluble elastin, this enzyme may play an active role in the direct extension of the tumor into the aorta.

Inhibition of inducible nitric oxide synthase prolongs rat lung allograft survival

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

[Video-assisted thoracic surgery for lung cancer]

Video-assisted thoracic surgery (VATS) has been applied to treat patients with various pulmonary diseases. Recent advances in video endoscopic instruments have been enabled radical resection of pulmonary malignancies as minimally invasive surgery. Forty patients with primary lung cancer underwent several types of lung resection in the past 3 years at out unit. Of these, twenty-seven anatomical pulmonary resections were performed using VATS. Peripherally located, early-stage lung cancer is thought to be a potential candidate for curative surgery with video-assisted lobectomy. Although there are some pitfalls with VATS, sufficient mediastinal lymph node dissection is thought to be possible. Additionally, intrathoracic hyperthermic chemotherapy using video-assisted thoracoscope for both pleural disseminated lesion and malignant pleural effusion is described.

The expression of MDM2 and p53 protein breast carcinoma

We studied the expression of MDM2 protein and p53 protein in 67 cases of the breast carcinoma. The result demonstrated no significant relationship between the MDM2 protein expression and any of the clinicopathological parameters except for the estrogen receptor status (p=0.033). Furthermore, in p53 protein negative cases, there was a significant relationship between MDM2 protein expression and the ER status (p=0.027). This study showed the expression of ER to be associated with MDM2 protein in p53 protein negative breast carcinoma. These results thus suggested that an investigation of both p53 and MDM2 gene alteration revealed precise information regarding breast carcinoma.