The role of video-assisted thoracic surgery for the treatment of lung cancer: lung lobectomy by thoracoscopy versus the standard thoracotomy approach

Our objective was to evaluate the usefulness, safety, validity and benefits of video-assisted thoracoscopic surgery (VATS) for performing pulmonary lobectomy in 24 patients with clinical NO stage I primary non-small-cell lung cancer compared with 30 patients who underwent a conventional thoracotomy. There were no significant differences in the intra-operative blood loss, duration of operation, or duration of chest tube drainage between the VATS group and the standard lobectomy group, but in this VATS' experience, patients had less postoperative pain. Numbers and distributions of dissected lymph-nodes were similar in patients whether undergoing standard thoracotomy or VATS lobectomy. We can confirm that the safety and validity of VATS are virtually identical to those of the standard thoracotomy approach in the lobectomy. However, the former technique causes less discomfort to patients and requires a shorter recovery period of laboratory data and IL-6 concentrations in thoracic drainage fluid. We conclude that VATS major lung resection is technically feasible. Stringent patient selection is important and special training is needed.

[Giant bladder stone: a case report]

An 88-year-old woman was hospitalized with the chief complaints of lower abdominal pain, miction pain and pollakisuria. Radiographs showed a giant bladder stone shadow, 12.0 x 9.0 cm in size. Cystolithotomy was performed under the diagnosis of bladder stone. The extirpated stone weighed 510 g, and measured 10.0 x 7.5 x 6.0 cm in size. The stone had four compartments of stratified lamellae composed of calcium phosphate and magnesium ammonium phosphate. The postoperative course was uneventful and the bilateral hydronephrosis improved markedly on DIP.

[Clinical evaluation of VATS lobectomy for lung cancer]

Thoracoscopic lobectomy is now recognized as a possible less invasive surgical option for stage I primary non-small cell lung cancer. We have widely used thoracoscopic procedure for surgical diagnosis of lung nodules especially in lung peripheral region as well as resection of primary lung cancer. Results of 47 thoracoscopic lobectomy during last 5 years were compared with 24 standard lobectomy under postero-lateral thoracotomy. There were no significant differences in the duration of surgery, post-operative hospital stay, intraoperative blood loss and post-operative survival. All but three patients who were diagnosed as n 2 disease or tumor with extrapulmonary extension post-operatively are surviving at the time of survey. We conclude that thoracoscopic lobectomy is safe and less invasive procedure compared to standard thoracotomy. We believe it can provide sufficient outcome for stage I non-small cell lung cancer.

Support for and observance of worksite smoking restriction policies--A study of municipal employees at a city office in Japan

BACKGROUND

While various types of smoking restrictions have been introduced in Japanese workplaces, it is not clear what restriction policies workers find acceptable. This study examined the relationship between the extent of worksite smoking restriction and worker attitudes toward these policies.

METHODS

Municipal employees randomly selected from a city office were surveyed using a self-administered questionnaire concerning support for and smokers' observance of their present smoking restriction. A total of 2857 (88. 6%) workers responded.

RESULTS

More than 60% of respondents regarded a work-area ban with a designated smoking space as the most desirable policy. Among subjects who were aware of the current policies in their workplaces, positive support was highest for a total ban (73.9%) and decreased as the extent of the restriction became milder (P for trend <0.001). In contrast, an inverse relation was found for negative support (P for trend <0.001). These trends were observed among both nonsmokers and smokers. Smokers subject to a work-area ban observed the policy more faithfully than those subject to milder policies.

CONCLUSIONS

Policies prohibiting smoking in work areas were favorably accepted by municipal employees, irrespective of smoking status. These results should encourage Japanese workplaces to adopt work-area bans, through which nonsmokers are effectively protected from environmental tobacco smoke.

A lung metastasis from giant cell tumor of bone at eight years after primary resection

We report a case of extensive pulmonary metastasis from a histologically benign giant cell tumor. A 34-year-old woman had undergone tumor resection, curettage and artificial bone grafting for giant cell tumor in the left tibia. At eight years after surgery, a chest radiograph revealed an extensive tumor shadow in the right thoracic cavity. Tumor resection with right upper and middle bilobectomy was performed. Its histological features were consistent with those of the primary tumor of the tibia. Distant metastases from a giant cell tumor of bone are rare, with only 50 reported cases. Metastasis has occurred mainly within 3 years after the primary resection. However, in 20% of reported cases, metastasis occurred after 5 years or longer. Long-term follow-up and careful observation for distant metastasis are necessary for this histologically benign disease.

High doses of digitalis increase the myocardial production of proinflammatory cytokines and worsen myocardial injury in viral myocarditis: a possible mechanism of digitalis toxicity

Results of recent studies suggest that proinflammatory cytokines cause myocardial contractile dysfunction, and that the drugs used to treat heart failure modulate the production of cytokines. This study was designed to examine the effects of digoxin in a murine model of heart failure induced by viral myocarditis. Four-week-old inbred DBA/2 mice were inoculated intraperitoneally with encephalomyocarditis virus (EMCV). Digoxin was given orally in doses of 0.1, 1 or 10 mg/kg daily from the day of virus inoculation. Interleukin (IL)-1beta, IL-6 and tumor necrosis factor (TNF)-alpha production in the heart were measured on day 5 after EMCV inoculation by enzyme-linked immunosorbent assay. The 14-day mortality tended to be increased in mice treated with 1 mg/kg, and was significantly increased in the group treated with 10 mg/kg per day. Myocardial necrosis and cellular infiltration on day 6 were significantly more severe in the high-dose digoxin group than in the control group. In the animals treated with 1 mg/kg digoxin, IL-1beta was significantly higher than in the control group. Intracardiac TNF-alpha levels were increased in a dose-dependent manner. These results suggest that digoxin worsens viral myocarditis, and that its use in high doses should be avoided in patients suffering from heart failure due to viral myocarditis.

Mast cells cause apoptosis of cardiomyocytes and proliferation of other intramyocardial cells in vitro

BACKGROUND

Mast cells are multifunctional cells containing various mediators such as cytokines, proteases, and histamine. They are found in the human heart and have been implicated in ventricular hypertrophy and heart failure. However, their roles in pathogenesis of these diseases are unknown.

METHODS AND RESULTS

Cultured cardiomyocytes from neonatal rats were incubated with mast cell granules (MCGs) for 24 hours. The highest concentration of diluted MCGs caused the death of approximately 70% of cardiomyocytes. This cell death was proved to be apoptosis, as quantified by electron microscopy and biochemical criteria. MCG-mediated cytotoxicity was prevented by pretreatment of MCGs with protease inhibitors or a neutralizing antibody against rat mast cell chymase 1 (RMCP 1). RMCP 1 by itself was proved to induce cell death of cardiomyocytes. These results suggest that RMCP 1 contained in MCGs causes the death of cardiomyocytes. In contrast, MCGs induced the proliferation of intramyocardial cells other than myocytes. RMCP 1 was also proved to induce their proliferation.

CONCLUSIONS

Mast cells cause apoptosis of cardiomyocytes and proliferation of other intramyocardial cells via the activity of RMCP 1. Our results suggest that mast cell chymase may play a role in the progression of heart failure, because loss of cardiomyocytes and proliferation of nonmyocardial cells exaggerate its pathophysiology.

FTY720, a new immunosuppressant, promotes long-term graft survival and inhibits the progression of graft coronary artery disease in a murine model of cardiac transplantation

Background-Effective immunosuppression is a critical determinant of organ and patient survival in cardiac transplantation. The present study was designed to determine the potency of FTY720, a new synthesized immunosuppressant, and examine its clinical potential as an immunosuppressant. Methods and Results-Hearts of DBA/2 mice were transplanted heterotopically in C57BL/6 mice. Recipients were treated with oral FTY720 in doses of 0.3, 1, 3, or 10 mg. kg(-1). d(-1) or with 40 mg. kg(-1). d(-1) of cyclosporin A (CsA) as a comparative treatment. The median graft survival time (MST) was significantly prolonged by treatment with FTY720 10 mg. kg(-1). d(-1). MST was not prolonged by FTY720 1 mg. kg(-1). d(-1) or CsA. However, FTY720 1 mg. kg(-1). d(-1) combined with CsA 40 mg. kg(-1). d(-1) resulted in a significant prolongation of MST. Histopathological studies performed 5 days after transplantation demonstrated remarkable suppression of inflammatory response by treatment with FTY720 10 mg. kg(-1). d(-1). Interleukin (IL)-2 and interferon (IFN)-gamma production was not suppressed; however, cytotoxic T lymphocyte activity was strongly suppressed in vitro. In addition, IL-2-stimulated T-cell proliferation and class I and class II MHC antigen expression on IFN-gamma-stimulated macrophages were strongly inhibited by FTY720. Histopathological studies 60 days after transplantation (DBA/2-B10.D2) demonstrated a beneficial effect on graft atherosclerosis. Conclusions-FTY720 promoted long-term cardiac graft survival and strongly inhibited the progression of graft atherosclerosis. These observations suggest that FTY720 has a promising clinical potential in cardiac transplantation.

Lung volume reduction surgery results in pulmonary emphysema. Changes in pulmonary function

From December 1993 to August 1998, we conducted 57 lung volume reduction surgeries on patients with severe pulmonary emphysema but without giant bullae. Of these, 26 underwent unilateral lung volume reduction surgery and 31 bilateral surgery. We analyzed the results of thoracoscopic lung volume reduction surgery (unilateral: 25; bilateral: 16) and volume reduction surgery by median sternotomy (unilateral: 1; bilateral: 15). Bilateral surgery via thoracoscope and median sternotomy significantly improved symptoms and pulmonary functions; mean improvement in forced expiratory volume in 1 second was 42.4% for bilateral thoracoscopic volume reduction surgery and 60.0% for median sternotomy. Unilateral volume reduction surgery produced a mean improvement in forced expiratory volume in 1 second of 28.9%. No significant complications were seen with either procedure. Reevaluation at 1 and 2 years after lung volume reduction surgery showed improvement to be well maintained.

Efficacy of disinfectants and heat against Escherichia coli O157:H7

The bactericidal activity of disinfectants and hot water against ten Escherichia coli O157:H7 strains, which were isolated from faeces of patients with enterohaemorrhagic E. coli infection, were evaluated and showed different DNA patterns. After exposure to 0.1% benzalkonium chloride, 0.1% chlorhexidine gluconate containing a nonionic surfactant, and 80% (v/v) ethanol, 99.99% of viable bacterial cells were killed at 20 degrees C within 15 s irrespective of the presence or absence of 0.1% albumin. On the other hand, after exposure to hot water, 99.99% of the bacterial cells were killed within 15 s at 70 degrees C. These results suggest that benzalkonium chloride, chlorhexidine gluconate containing a nonionic surfactant, ethanol, and hot water at 70 degrees C or more are effective for disinfection of E. coli O157:H7 in hospitals.

Effects of extracellular ions on the reactivation of human spermatozoa preserved in electrolyte-free solution

It has previously been reported that human spermatozoa preserved in an electrolyte-free solution can survive for several weeks at 4 degrees C. However, the motility of spermatozoa after preservation cannot be restored when incubated at 37 degrees C, unless reactivated by extracellular alkalisation. Under weak acidic conditions, the reactivation is induced by > or = 10 mmol l-1 Na+ and inhibited by a Na(+)-H+ antiporter inhibitor. The addition of > or = 0.1 mmol l-1 K+ also induces the reactivation. In the present study, the reactivation was induced by > or = 0.1 mmol l-1 Rb+ or > or = 1 mmol l-1 Cs+ at an acidic pH. The maximum motility rate with K+, Rb+ or Cs+ was obtained at 10-20 mmol l-1 and inhibited by 10(-5)-10(-2) mol l-1 ouabain in a dose-dependent manner, while ouabain had no effect on the Na(+)-induced reactivation. The addition of K+ further increased sperm motility reactivated by Na+, which was also inhibited by ouabain. The addition of Ca2+ did not induce the reactivation or increase sperm motility reactivated by Na+ or K+. It was concluded that activation of the ouabain-sensitive Na(+)-K(+)-ATPase and Na(+)-H+ exchange mechanism has an important role in sperm motility.

Anatomical location of enterochromaffin-like (ECL) cells, parietal cells, and chief cells in the stomach demonstrated by immunocytochemistry and electron microscopy

Enterochromaffin-like (ECL) cells are included in the endocrine cells present in the gastric oxyntic mucosa, and have been attracting attention as histamine-secreting cells contributing to gastric secretion. However, the anatomical location of ECL cells in relation to parietal cells and chief cells has not yet been sufficiently investigated. To elucidate this location of ECL cells, we performed an immunocytochemical study using anti-histamine antibody and electron microscopic examination of guinea pig gastric mucosa. ECL cells were located near the basement membranes in the gastric oxyntic region, and were in contact with both chief cells and parietal cells in the same glandular epithelium. The ratio of ECL cells in contact with chief cells was clearly greater than that in contact with parietal cells. An omega-shaped morphology, indicating emiocytosis, was found in ECL cells by electron microscopy. These findings suggest that ECL cells have a paracrine effect on chief cells and parietal cells, and may have an important physiological role in pepsinogen secretion.

Mucosal immunity and inflammation. I. Mucosal dendritic cells: their specialized role in initiating T cell responses

Dendritic cells (DCs) are the most competent antigen-presenting cells known for the induction of primary T cell responses. Functional studies of tissue-resident DCs have been impaired by the rarity of these cells in any given organ. Recent development of isolation procedures allowing extraction of highly purified fresh DC populations has made it possible to study mucosal DCs in distinct mucosa-associated lymphoid tissues. Here, we discuss several recent studies by us and others that describe the tissue-specific phenotype and function of mucosal DCs and speculate on the mechanism by which the resident DCs regulate tissue-specific T cell responses.

Epitope-specific cytotoxic T lymphocyte induction by minigene DNA immunization

Plasmid DNA vaccines encoding full-length antigen often induce both potent antibody and cytotoxic T lymphocyte (CTL) responses. Here, we examine strategies to exclusively elicit epitope-specific CTL responses using DNA constructs expressing a minimal class I MHC-restricted epitope of the nucleoprotein (NP) of influenza virus. The effects of the addition of an ER leader sequence or cytokine combination on minigene-induced CTL responses in vivo were assessed following both delivery by needle injection into skeletal muscle and by gene gun bombardment into skin epidermis. Our data indicate that the leader sequence enhanced the magnitude of the CTL responses, whereas co-injection of the cytokine genes IL-12 and GM-CSF had a minimal effect. An antibody response against NP was not observed in any of the mice receiving the minigene constructs.

Pimobendan inhibits the production of proinflammatory cytokines and gene expression of inducible nitric oxide synthase in a murine model of viral myocarditis

OBJECTIVES

This study was designed to examine the effects of pimobendan in a murine model of viral myocarditis in relation to proinflammatory cytokine production and nitric oxide (NO) synthesis by inducible NO synthase (iNOS) in the heart.

BACKGROUND

Pimobendan has been recently confirmed to improve both acute and chronic heart failure. Since the modulation of myocardial necrosis and contractile dysfunction by various proinflammatory cytokines may be partially mediated by the production of nitric oxide, the effects of pimobendan on the production ofproinflammatory cytokines and NO were investigated in an animal model of viral myocarditis involving heart failure.

METHODS

DBA/2 mice were inoculated with the encephalomyocarditis virus. To observe its effect on survival up to 14 days, pimobendan (0.1 mg/kg or 1 mg/kg) or vehicles were given from the day of virus inoculation (day 0) orally once daily. The effects of pimobendan on histological changes, cytokine production, NO production and iNOS gene expression in the heart were studied in mice treated either with pimobendan, 1 mg/kg or with vehicles only, and sacrificed seven days after virus inoculation.

RESULTS

The survival of mice improved in a dose-dependent fashion such that a significant difference (p < 0.02) was found between the higher-dose pimobendan group (20 of 30 [66.7%]) and the control group (11 of 30 [36.7%]). Histological scores for cellular infiltration (1.1+/-0.1 vs. 2.0+/-0.0, p < 0.001), intracardiac tumor necrosis factor (TNF)-alpha (18.2+/-1.8 vs. 35.8+/-4.2 pg/mg heart, p < 0.001) and interleukin (IL)-1beta (9.3 +/-1.2 vs. 26.6+/-7.1 pg/mg heart, p < 0.01) were significantly lower in the mice given pimobendan versus those of the control mice. Interleukin-6 levels (7.1+/-0.8 vs. 9.2+/-1.9 pg/mg heart) were also lower in the mice treated with pimobendan. Furthermore, intracardiac NO production was significantly (p < 0.001) less in the pimobendan group (0.165+/-0.004 nmol/mg heart) than in the control group (0.291+/-0.051 nmol/mg heart), and intracardiac iNOS gene expression in the mice given pimobendan was 74% lower than it was in the control animals (p < 0.01).

CONCLUSIONS

These findings suggest that the beneficial effects of pimobendan in viral myocarditis are partially mediated by the inhibition of both proinflammatory cytokine production and NO synthesis by iNOS.

Recurrence after thoracoscopic surgery for spontaneous pneumothorax

AIM

The purpose of this study was to examine the cause and risk of recurrence after thoracoscopic surgery for spontaneous pneumothorax.

METHODS

A total of 204 patients under 60 years of age who underwent axillary thoracotomy and 139 patients who underwent thoracoscopic surgery were compared. In addition, among the patients who underwent thoracoscopic surgery, recurrent and non recurrent cases were reviewed and compared.

RESULTS

Postoperative recurrence rate was significantly higher among the thoracoscopic surgery group. There were some significant differences between the recurrent and non recurrent cases in the Brinkman index, the duration from the onset of pneumothorax to the initial consultation, and the number of patients who had past history of pneumothorax. The recurrence rate was higher in patients with an air leak in the chest drainage tube before operation than in patients without an air leak.

CONCLUSIONS

Appropriate training under supervision of experienced surgeons is necessary for minimizing complications and procedure failures. A history of heavy smoking or an air leak in the chest drainage tube before surgery may be an index of recurrence after surgery.

Closure of mouth of bladder diverticulum via endoscopic transvesico-transurethral approach

We successfully treated bladder diverticula in two patients using the endoscopic transvesico-transurethral approach. The mouth of the diverticulum was closed in two layers under pneumobladder, using two percutaneous ports placed into the bladder as well as the urethral route. This operation was performed 2 to 3 months after the bladder outlet obstruction was relieved by transurethral resection or incision of the prostate. The patients were able to void with a minimum of residual urine. The endoscopic transvesico-transurethral approach provided satisfactory vision.

Aeqand other factors in a60Co beam for a spherical or cylindrical minimal phantom and for an ionization chamber with a known Awallcorrection factor

Three types of tissue-air ratio (TAR) are summarized. These TARS differ in their definition of the in-air absorbed dose. The first defines it as the absorbed dose at the centre of a spherical or cylindrical minimal water phantom in free space. The second defines it as the maximum primary absorbed dose in a semi-infinite water phantom. The third defines it as the absorbed dose in an imaginary infinitesimal mass of water within the cavity of a chamber in free space, where the absorbed dose is averaged within the cavity. It is concluded that the 60Co TAR data compiled by Godden and the 60Co TAR data of Johns and Cunningham should be reviewed. Aeq and other factors are evaluated for spherical and cylindrical minimal water phantoms in a 60Co gamma-ray beam. A method of obtaining Aeq and other factors for an ionization chamber with a known Awall correction factor is also reported. The work indicates some discrepancies with previously published material.

Gastric epithelial cells stimulate Helicobacter pylori growth

Helicobacter pylori infects only human gastric epithelium, causes gastritis, and is strongly associated with gastroduodenal ulceration and gastric cancer. Colonization of the stomach with H. pylori is accompanied in the acute stage by an increased number of neutrophils in the lamina propria, indicative of gastric inflammation. It is interesting that H. pylori colonizes specifically human gastric-type epithelial cells. We studied whether the presence of gastric epithelial cells influenced H. pylori growth. H. pylori (NCTC 11637) was cultured on Skirrow agar with 7% horse blood. Kato-III cells, a human gastric cancer cell line, were cultured with RPMI 1640 plus 10% fetal bovine serum (FBS). Kato-III cells (10(5)/ml) were cultured with/ without H. pylori (10(8) cfu/ml) with RPMI 1640 + 1% FBS for 3 days. The number of Kato-III cells was counted with a hemacytometer. H. pylori with/without Kato-III cells was cultured with RPMI 1640 + 10% FBS for 2 hours, and plated on Skirrow agar. After 3 days we counted the number of H. pylori colonies. To detect the H. pylori colonies, we used a colony hybridization method. DNA of colonies was transferred to positively charged nylon membrane and hybridized by PCR with Hpl (5'-CTG-GAG-AGA-CTA-AGC-CCT-CC-3') and Hp2 (5'-ATT-ACT-GAC-GCT-GAT-TGT-GC-3')-amplified primers. We previously reported that the number of Kato-III cells was significantly decreased by co-incubation with H. pylori. The number of H. pylori colonies was significantly increased by coincubation with Kato-III cells. We conclude that the presence of human gastric epithelial cells is important for the growth of H. pylori.

[Eradication rate and side effect from a point of view of Helicobacter pylori eradication of peptic ulcer disease in dual therapy or new triple therapy]

Eradication rate of Helicobacter pylori in dual therapy (omeprazole/amoxicillin) are reported in the range of 28-91%, side effect such as loose stool and skin reaction are reported 3.9-16.8%. In our study, eradication rate in dual therapy is 69.6% (lansoprazole/amoxicillin) and 74.0% (lansoprazole/clarithromycin). In triple therapy, eradication rate is 93.8% (lansoprazole/amoxicillin/clarithromycin), 94.4% (lansoprazole/amoxicillin/metronidazole) and 100.0% (lansoprazole/clarithromycin/metronidazole). There is no difference eradication rate between 1 week (89.2%) and 2 weeks (92.9%) regimen. In general, eradication rate of new triple therapy is effective in the range of 80-100%, and side effect are reported in 1.7-49%. However, Suzuki et al reported side effect decreased in new triple therapy adding mucosal protective agent.

[Tubeless cutaneous ureterostomy through a single stoma with new extraperitoneal ureteral route up to stoma]

Tubeless cutaneous ureterostomy through a single stoma has been said to be difficult to establish in patients with normal ureters or normal ureters combined with thick fatty abdominal wall, because of the poor blood supply at the end of the ureters. The technical improvements observed were as follows: 1) The peritoneal fold and the upward traction of the gonadal vessels decrease the ureteral tension and keep the blood supply to the ureters in the extraperitoneal approach. 2) The gonadal vessels and its surrounding tissue, covering the subcutaneous fatty tissue, help the ureteral adhesion at the anastomotic site. 3) Full diminution of the skin defect caused by flap formation, decreases the horizontal tension of the side-to-side anastomized ureters. Sixteen patients with normal ureters underwent this procedure. In a short-term (4-37 months) observation, 4 of the patients, including one with thick abdominal fat, showed unilateral hydronephrosis and 2 patients unilateral non-function kidney. The remaining 10 patients had no complications. Moreover, all the patients have kept their ureterostomies tubeless and their serum blood urea nitrogen and creatinine levels were within normal limits except for one patient. It is reasonably concluded that the new method will result in success clinically even in patients with normal ureters and thick abdominal fatty tissue.

Characteristics of60Co gamma -ray SPR (scatter-primary ratio), SF (scatter factor), beta (dose-kerma ratio), and dmax(depth of maximum dose)

For 60Co gamma-rays, using zero-area tissue-maximum ratio (TMR) and revised scatter-maximum ratio (SMR) data, we investigate how the scatter-primary ratio (SPR), the scatter factor (SF), and the dose-kerma ratio (beta) change with field size and depth. We also investigate how the depth of maximum absorbed dose (dmax) changes with field size in three ways: the first uses zero-area primary plus scatter absorbed dose data, the second uses integrated primary absorbed dose data, and the third uses integrated primary plus scatter absorbed dose data. The investigated characteristics are also compared with reported ones.

Protective role of melatonin and the pineal gland in modulating water immersion restraint stress ulcer in rats

We investigated the protective effect of melatonin on stress-induced gastric lesions in rats. Fasted rats were subjected to water immersion restraint stress for 4 h and the percentage of corpus mucosa containing hemorrhagic lesions was determined. Thirty minutes before restraint stress, melatonin or vehicle was administered i.p. In another experiment, pinealectomy was performed 1 week before water immersion restraint stress. Administration of melatonin at 1 and 5 mg/kg significantly decreased gastric lesions by 46 and 74%, respectively. In contrast, pinealectomy significantly enlarged the lesion area, although this effect was counteracted by melatonin at a dose of 1 mg/kg i.p. However, this protective effect of melatonin was abolished by i.p. pretreatment with indomethacin at 5 mg/kg. These results suggest that melatonin has gastroprotective properties against stress-induced gastric injury in rats and that the pineal gland contributes to gastric protection via prostaglandin-dependent mechanisms.