Surgical treatment for chronic pleural empyema

Various surgical procedures have been developed in an attempt to alleviate the significant problems caused by chronic pleural empyema. The present study evaluates our 11-year experience of employing a number of therapeutic approaches for chronic empyema. Between 1987 and 1997, 45 consecutive patients underwent treatment for chronic empyema at our hospitals. They comprised 21 patients (47%) presenting with post-tuberculosis, 11 (24%) receiving cancer therapy including pulmonary resection, and 13 (29%) with postpneumonic empyema. Omentopexy, lung resection, and thoracoscopic surgery were performed in 10 (22%), 5 (11%), and 4 (9%) patients, respectively. Poor results of treatment were observed in two of the patients with post-tuberculous empyema, and three of the patients treated for cancer died of recurrence. The other 40 patients remain symptom-free. An improvement in quality of postoperative life was revealed by the exercise test rather than by static spirometry. Optimal therapy for chronic empyema requires selection of the most appropriate first and staged procedures for each patient. Moreover, lung resection should be minimal. In a critical state, open thoracostomy must be performed as the first procedure, while omentopexy or thoracoplasty should be restricted to selected cases. Dead space and minor air leakage may safely be left behind. A video-assisted procedure can be selected for postpneumonia empyema.

Molecular and biological studies on male-sterile cytoplasm in the Cruciferae. III. Distribution of Ogura-type cytoplasm among Japanese wild radishes and Asian radish cultivars

The distribution of Ogura male-sterile cytoplasm among Japanese wild radish populations and Asian cultivated radishes was studied by means of polymerase chain reaction (PCR)-aided assays using mitochondrial atp6 and orf138 loci as molecular markers. Three separate PCR experiments were performed to amplify the target sequences in normal-type atp6, Ogura-type atp6, and Ogura-specific orf138, and the cytoplasm of each plant was classified as either normal or Ogura. Among 217 wild radish plants, 93 had both Ogura-type atp6 and orf138 (or its modified form), whereas 124 had normal-type atp6. Of the 93 plants with Ogura-type cytoplasm, only a single plant showed male sterility. A complete linkage between Ogura-type atp6 and orf138 loci was found in Japanese wild radishes, confirming our findings that Ogura-type cytoplasm is distributed widely among Japanese wild radish populations. A modified form of orf138 (orf138-S) was identified in a few wild radish populations in a limited area of Japan, and the nucleotide sequence of the orf138-S revealed a 39-bp deletion shared in common with 'Kosena' male-sterile cytoplasm. Among the 44 Asian cultivars analyzed, 40 were determined to have normal cytoplasm since all 4 plants tested in each cultivar showed the same PCR amplification profiles as that of 'Uchiki-Gensuke', a reference cultivar with normal cytoplasm. The plants with Ogura-type cytoplasm (or its modified form) were found in 1, 1, and 2 cultivars from Tibet, Japan, and Taiwan, respectively. Except for 1 cultivar from Taiwan, those with Ogura-type cytoplasm included a few plants having male sterility. The multiple and independent introduction of Ogura-type cytoplasm from the wild radish in Asia into these cultivars is suggested.

Long-term benefit of extended lymphadenectomy with gastrectomy in distally located early gastric carcinoma

BACKGROUND

Extended lymphadenectomy performed with gastrectomy has been reported to prolong survival of patients with early gastric cancer. However, some authors question the value of extensive lymphadenectomy in these patients, especially since much recent discussion of patient quality of life after gastrectomy has favored less invasive operations.

METHODS

We retrospectively analyzed 485 patients who had undergone gastrectomy for early cancer in order to evaluate the effect of extended versus limited lymphadenectomy on postoperative survival. Various prognostic factors were examined for patients whose tumors were located in the distal third of the stomach.

RESULTS

Although extended radical lymphadenectomy did not prolong postoperative survival when early gastric cancer was located in the middle or proximal third of the stomach, it did when the tumor occupied the distal third.

CONCLUSIONS

Performance of extended radical lymphadenectomy was a significant prognostic factor for early gastric cancer patients when tumors were located in the distal third of the stomach.

Infiltrating ductal carcinoma developing within cystosarcoma phyllodes--a case report

Malignancy in cystosarcoma phyllodes is uncommon and often confined to the stromal element. An extremely rare case of infiltrating ductal carcinoma developing within the stroma of cystosarcoma phyllodes is reported herein. A breast tumor with a diameter of 15 cm, which was diagnosed as cystosarcoma phyllodes, was excised from the right breast of a 47-year old woman. The histopathological examination revealed that hyperplastic ductal epithelial cells with dark cytoplasm and enlarged hyperchromatic nuclei were infiltrating the stroma. Thus, a diagnosis of ductal carcinoma within cystosarcoma was made. Subsequently, a standard radical mastectomy was performed. No recurrence or metastasis has been observed over the post-operative period of 5 years and 6 months.

Detection of antibodies against porcine parvovirus in swine sera by enzyme-linked immunosorbent assay

An enzyme-linked immunosorbent assay (ELISA) was developed for detection of antibody against porcine parvovirus in swine sera. The antigen used for the assay was partially-purified virus treated with fluorocarbon and shown to contain 7 proteins by sodium dodecylsulfate-polyacrylamide gel electrophoresis. Of these proteins 83-, 64- and 60-K proteins reacted in Western immunoblotting with swine serum after infection with porcine parvovirus. Antibody responses were demonstrated by ELISA in pigs subcutaneously-infected with porcine parvovirus as by hemagglutination-inhibition (HI) test and Western immunoblotting reaction with the 83-, 64- and 60-K viral proteins. The results of ELISA on random swine-serum samples were well-correlated with those of the HI test. These findings indicate the usefulness of the ELISA as a serological tool for porcine parvovirus infection.

Comparative measurement of equine influenza virus antibodies in horse sera by single radial hemolysis, neutralization, and hemagglutination inhibition tests

Single radial hemolysis (SRH), neutralization (NT), and hemagglutination inhibition (HI) tests were carried out on sera from horses immunized against the Prague and Miami strains of equine influenza virus. The HI and NT tests demonstrated good sensitivity; the sensitivity of the SRH test was somewhat lower. The NT titers of individual sera were correlated very closely with the HI titers, although the NT titers were higher. SRH zone diameters of individual sera also showed significant correlation with the NT and NI titers. The SRH test appears to be suitable for large-scale serological surveys and offers the advantages of rapidity and simplicity.

The ubiquitous transcription factor NF-Y positively regulates the transcription of human p27Kip1 through a CCAAT box located in the 5-upstream region of the p27Kip1 gene

Abnormally low levels of the cyclin-dependent kinase inhibitor p27Kip1 are found frequently in human carcinomas, and these levels correlate directly with both histological aggressiveness and patient mortality. p27Kip1 is haplo-insufficient for tumor suppression. Thus, p27Kip1 may be a useful molecule for the development of cancer therapies. To know the possible mechanisms underlying transcriptional control, we previously cloned the promoter region of human p27Kip1 gene. We report here the characterization of the 5'-regulatory region of the human p27Kip1 gene. Promoter analysis using 5'-deletion mutants revealed that a 39-bp region between -549 and -511 was required for maximal promoter activity. Point mutation analysis revealed that a CCAAT box within this region was essential for promoter activity. Gel shift assays and cotransfection experiments using a dominant negative form of the NF-Y transcription factor showed that NF-Y directly regulates p27Kip1 transcription through this CCAAT box. This finding might provide a clue to approach the mechanism of tumorigenesis.

Complete caudate lobectomy: its definition, indications, and surgical approaches

There are three ways to approach and resect the caudate lobe of the liver, that is; and isolated caudate lobectomy, a combined resection of the liver overlying the caudate lobe, and a transhepatic anterior approach by splitting parenchyma of the liver. We had two patients with neoplasms originating in the caudate lobe who underwent a complete caudate lobectomy. Both patients have been doing well without liver dysfunction. Although after the transhepatic anterior approach we anticipated an adverse effect from splitting the parenchyma of the liver, the postoperative course was uneventful and similar to that of the right side approach.

[Receptive systems for drugs in salivary gland cells]

Investigators have demonstrated many types of receptors or acceptors for endogenous substances in salivary glands. These suggest that salivary glands contain receptive systems for many drugs. These receptors can be classified into three types based on the property of saliva secretion: (1) receptors involved in fluid secretion, (2) receptors involved in exocytosis for the protein secretion, (3) receptors involved in both types of secretion. The receptors involved in fluid secretion include the group of alpha 1B, M3, NK-1 receptors coupled with IP3; the group of beta 2 and VIP receptors coupled with cAMP; and the group of P2Z and P2U receptors coupled with the ATP-gated calcium channel. Whereas alpha 1A, beta 1, VIP, M3, insulin and H2 receptors mediate exocytosis via the cAMP-proteinkinase A pathway. Moreover, the another pathway of diacylglycerol-proteinkinase C has also been demonstrated to be involved in the exocytosis occurring via NK-1 and M3 receptors. Thus, salivary gland cells have many kinds of drug-receptor system. These receptors are all positive to fluid and/or protein exocytosis. Recently our study on the inhibitory regulation of saliva secretion have suggested the existence of GABA and the GABA-synthetic/metabolic pathway, GABA(A) receptors and benzodiazepine (BDZ) receptors of both central and peripheral types, and furthermore, the coupling of GABA(A) and the central type of BDZ receptors. These receptors are involved in decreasing fluid secretion and amylase release elicited by secretagogues. In the future, mechanisms of the intracellular transduction elicited by BDZ or GABA must be clarified.

A case of dobutamine-induced coronary arterial spasm with ST-segment elevation

A 55-year-old Japanese woman demonstrated ST-segment elevation in leads I, aVL, and V3-V6 with chest pain both in an ergometer exercise test and on dobutamine stress echocardiography. Although the baseline coronary arteriogram revealed no organic stenosis, total occlusion of the distal portion of the posterolateral branch of the left circumflex artery was observed during dobutamine infusion with ST-segment elevation and chest pain. This is a rare case of documented dobutamine-induced coronary arterial spasm.

Specific and non-specific immunologic mechanisms of tumor growth facilitation

Specific and non-specific mechanisms of tumor growth facilitation were studied using methylcholanthrene (MCA)-induced fibrosarcomas in C3H/HeJ mice. In early and late stages of tumor growth, mice possessed non-specific, tumor-facilitating cells detected by local adoptive transfer assay (LATA). These cells appeared to be macrophages; they were radioresistant (700 rads), phagocytic, and adherent to plastic. Specific tumor facilitation was induced by treatment either with crude 3M KCl extracts, or with an acidic pIEF fraction (pI 3.5). After treatment with this material, animals displayed facilitated outgrowth of only MCA-F, but not the antigenically distinct MCA-D or MCA-C tumors. Thus in addition to non-specific stimuli, which accelerate neoplastic growth, tumors bear tumor-specific transplantation antigens (TSTA), which induce specific facilitation.

Administration of subtumor regression dosage of TNF-alpha to mice with pre-existing parental tumors augments the vaccination effect of TNF gene-modified tumor through the induction of MHC class I molecule

One obstacle in treating pre-existing parental tumors by vaccination with cytokine gene-modified tumor cells is the impaired expression of immune-related molecules such as MHC class I. In this study, to enhance MHC class I expression on pre-inoculated parental tumors, low dose TNF (300 U, 500 U, 1000 U), that is, TNF at levels shown to cause neither tumor regression nor any severe adverse reaction, was systemically injected into parental tumors bearing mice before vaccination with TNF gene-modified Meth-A cells or B-16 cells. Since the class I expression was confirmed to continue for at least 24 h following administration of TNF, TNF was administered 6 h before vaccination. Complete regression of relatively large parental tumors (M0) (8.0-10.0 mm in diameter) was observed in five of eight mice treated with 1000 U TNF, partial regression was observed in mice treated with 500 U, and a lesser yet significant regression was observed in mice treated with only 300 U. Contrarily, in the mice which had received vaccination without the TNF pretreatment, no complete regression was observed. This effect was inhibited with the anti-class I antibody or anti-CD8 antibody. Growth of a re-established, B16 tumor was significantly suppressed with a combination of TNF preadministration and vaccination of TNF gene-modified B16. These results indicate that pre-administration of low-dose TNF may be promising for enhancing vaccination effects of TNF gene-modified tumor cells.

Glutamatergic neuromuscular transmission in the heart of the isopod crustacean Ligia exotica

Neuromuscular transmission between the cardiac ganglion (CG) and the myocardium was examined in the adult heart of the isopod crustacean Ligia exotica. Intracellular injection of neurobiotin into the CG neurones revealed that all six CG neurones send their axons onto the cardiac muscle, where they form axon terminals bearing varicosities. All the CG neurones and their processes exhibited glutamate-like immunoreactivity. The cardiac muscle showed depolarizing membrane potential responses to glutamate applied focally to sites close to axon terminals bearing varicosities. Both the glutamate-induced response and the excitatory junctional potential (EJP) showed desensitization in response to the repeated application of glutamate. Under voltage-clamp conditions, the cardiac muscle produced inward current responses to focally applied glutamate. The reversal potential for the glutamate-induced current estimated from extrapolation of the linear current/voltage relationship was similar to that of the excitatory junctional current evoked by ganglionic nerve stimulation. Both the glutamate-induced response and the EJP were blocked by a glutamate-specific antagonist, Joro spider toxin. These results led us to conclude that the CG neurones of Ligia exotica are glutamatergic motoneurones.

Successful lung transplantation in a case with diffuse pulmonary arteriovenous malformations and hereditary hemorrhagic telangiectasia

Diffuse pulmonary arteriovenous malformations (AVMs) are associated with a poor prognosis and the therapeutic strategy remains controversial. We describe a pediatric patient with diffuse pulmonary AVMs associated with hereditary hemorrhagic telangiectasia (HHT), who presented with two cerebral AVMs in the parietal and occipital lobes as well. Of note, successful bilateral lung transplantation not only improved the hypoxemia but also resulted in size reduction of the cerebral AVMs. Although it is essential to consider involvements other than pulmonary AVMs, especially brain AVMs, to decide the indication, lung transplantation can be a viable therapeutic option for patients with diffuse pulmonary AVMs and HHT.

Myocardial infarct size by serum troponin T and myosin light chain 1 concentration

The late troponin T (TnT) peak concentration, which is known to be independent of reperfusion of the infarcted zone in acute myocardial infarction (MI), has been suggested to be correlated with clinical estimates of cardiac function and myocardial infarct size. To refine the clinical application of the late TnT peak in infarct sizing, and to examine differences in this estimation in different infarct sites, we measured the serum concentrations of TnT and myosin light chain 1 (MLC1), and compared these values with left ventricular ejection fraction (LVEF) obtained from left ventriculography, and extent score (ES) and severity score (SS) obtained from 201Tl scintigraphy in patients with anterior and inferior myocardial infarction. The late TnT peak concentration was strongly correlated with the MLC1 peak value in patients with anterior MI (r = 0.67, p < 0.05) and in those with inferior MI (r = 0.92, p < 0.0005). Furthermore, there were strong linear correlations between the late TnT peak values and all of the clinical data (LVEF; r = -0.79, p < 0.01, ES; r = 0.75, p < 0.05, SS; r = 0.75, p < 0.05, respectively) in patients with anterior MI. However, these correlations were weak in patients with inferior MI. Similar correlations were observed between MLC1 and the clinical data. Thus, TnT and MLC1 have similar kinetics in the serum at the late phase and can be used to estimate the size of anterior infarct.

Evaluation of an enzyme-linked immunosorbent assay for the detection of transmissible gastroenteritis virus antibodies

An enzyme-linked immunosorbent assay (ELISA) using a detergent-solubilized antigen of purified virus was developed for detection of antibody against porcine transmissible gastroenteritis (TGE) virus in swine serum. The ELISA demonstrated antibody responses in pigs immunized intramuscularly with the attenuated TO-163 strain of TGE virus and in pigs orally infected with the virulent Shizuoka strain of the virus. The results of the ELISA were well correlated with those of the neutralization test. These results indicate the usefulness of the ELISA as a serological tool for TGE virus antibody.

In Situ Tissue Engineering of the Bile Duct Using Polypropylene Mesh-Collagen Tubes

Multiple attempts have been made to replace biliary defects with a variety of materials. Recently, successful biliary reconstruction using the Gore-Tex vascular graft has been reported experimentally and clinically We designed a new artificial bile duct consisting of collagen sponge and polypropylene mesh. We presently evaluated the feasibility of using this prosthesis as a scaffold for bile duct tissue regeneration in a canine model. Our prosthesis, a sponge made from porcine dermal collagen, is reinforced with a polypropylene mesh cylinder. We used the prosthesis to reconstruct the middle portion of the common bile duct in seven beagle dogs to evaluate its efficacy. While one dog died of biliary stricture 8 months after operation, six survived without problems to scheduled time points for tissue evaluation at 1 to 12 months. All prostheses had become completely incorporated into the host. A confluent epithelial lining was observed within 3 months. In cholangiograms the prosthesis displayed long-term patency in the six dogs and provided satisfactory bile drainage for up to 12 months. Our graft thus shows promise for repair of biliary defects and should lead to development of a new treatment for biliary reconstruction.

Regeneration of hypogastric nerve using a polyglycolic acid (PGA)-collagen nerve conduit filled with collagen sponge proved electrophysiologically in a canine model

The hypogastric nerve (HGN) is a sympathetic nerve in the peritoneal cavity and controls urinary and seminal functions. In this study, the regeneration of HGN was determined by using a new type of an artificial nerve conduit, polyglycolic acid (PGA)-collagen nerve conduit filled with collagen sponge in two dogs. A PGA-collagen nerve conduit (diameter=2 mm) was interposed in a 10 mm gap of the right HGN. The regeneration of the HGN was evaluated electrophysiologically 8 months after the operation. The intraluminal pressure of spermatic duct and the bladder neck were elevated 80 mmHg and 25 mmHg respectively by the stimulation across the regenerated HGN. The prostate contraction was also elicited. The responses diminished after the excision of the regenerated portion of HGN. These results proved the regeneration of HGN and this nerve conduit will be great help for patients who suffer from urinary and seminal disturbances.