Katsuhiko Morita

Comparison of interleukin-6, interleukin-8, and granulocyte colony–stimulating factor production by the peritoneum in laparoscopic and open surgery

AbstractsBackground: Human mesothelial cells secrete a variety of cytokines. The levels of postoperative serum inflammatory cytokines are thought to reflect the magnitude of surgical stress. Methods: Pieces of peritoneum were obtained immediately upon and 1 h after entry into the abdominal cavity in nine patients undergoing laparoscopic surgery and 11 patients undergoing open surgery. The samples were cultured and interleukin (IL)-6, IL-8, and granylocyte colony–stimulating factor (G-CSF) levels in the supernatants were measured by enzyme-linked immunosorbent assay (ELISA). Expression of IL-6, IL-8, and G-CSF mRNAs was examined by RT-PCR. Results: At 1 h after laparotomy, the amounts of IL-6 and G-CSF produced by the peritoneum were significantly greater than those obtained immediately after the procedure, but this difference was not observed with laparoscopic surgery. Reverse transcription–polymerase chain reaction (RT-PCR), which showed an increase in the expression of cytokine mRNAs at 1 h after laparotomy, was compatible with these results. Conclusion: The lower levels of cytokine production by the peritoneum suggest that laparoscopic surgery is associated with lower degree of surgical stress.

Interleukin-6 production in lung tissue after transthoracic esophagectomy

BACKGROUND The mechanisms of the reported high increase in interleukin-6 (IL-6) levels after esophagectomy are unclear. We investigated the influence of an intrathoracic procedure, esophagectomy, on IL-6 production in lung tissue. STUDY DESIGN Fourteen paired lung tissue samples were obtained from patients before and after they underwent transthoracic esophagectomy for esophageal cancer. IL-6 levels in the lung were measured with enzyme-linked immunosorbent assay, and IL-6 mRNA expression was determined with real-time quantitative reverse transcription-polymerase chain reaction. Immunohistochemical staining was used to localize IL-6, and circulating levels were also measured. RESULTS IL-6 protein and mRNA were significantly increased in lung tissue after this intrathoracic procedure (p < 0.05). Peak levels of plasma IL-6 after surgery were correlated with IL-6 levels in lung tissues obtained after the procedure (p < 0.05). Immunohistochemical staining revealed IL-6 production from alveolar and bronchial epithelial cells but not from alveolar macrophages. CONCLUSIONS Transthoracic esophagectomy causes an increase in IL-6 production from airway epithelial cells, secondary to increased expression of IL-6 mRNA. Local response of lung tissue may be one source of increased serum IL-6 after this procedure.

Comparison of 21-gauge and 22-gauge Needles for Endobronchial Ultrasound-Guided Transbronchial Needle Aspiration of Mediastinal and Hilar Lymph Nodes.

Background:Although endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) using a 22-gauge needle has emerged as an accurate, minimally invasive, and safe technique for accessing undiagnosed mediastinal adenopathy, particularly in patients with lung cancer, the small sample size obtained by a conventional needle may limit the accuracy of the result. Objectives:We evaluated the safety and efficacy of obtaining specimens using 21-gauge needles, comparing diagnostic yield with conventional 22-gauge needles. Methods:Participants consisted of 56 consecutive patients with mediastinal lesions referred to our institution for diagnostic EBUS-TBNA. The 21-gauge needle group (21 G) included 24 patients with 6 nonmalignancies and the 22-gauge needle group (22 G) included 32 patients with 9 nonmalignancies. Final diagnosis was based on cytology, histology, surgical results, appropriate clinical pictures on examination, and/or clinical follow-up. Results:Comparing 21 G and 22 G, inadequate material rates were 0% versus 3.1% in cytology, and 4.2% versus 18.8% in histology, respectively. Accuracy in cytology, histology, and combined cytology and/or histology were 91.7% versus 65.6% (P=0.02), 95.8% versus 81.3% (P=0.11), and 100% versus 84.4% (P=0.04), respectively. After limiting cases to suspected malignancies, sensitivity in cytology, histology, and combined cytology and/or histology were 88.9% versus 52.2% (P=0.01), 100% versus 82.6% (P=0.09), and 100% versus 87.0% (P=0.17), respectively. Conclusions:Increasing sample volume using a 21-gauge needle rather than a 22-gauge needle might improve diagnostic yield in EBUS-TBNA. This study revealed the benefits of using a 21-gauge needle for cytological and histologic diagnostic yields.

Mesenteric paraganglioma : Report of a case

We report a rare case of a solitary primary paraganglioma arising in the mesentery, found in a 72-year-old woman who presented with abdominal pain and a palpable abdominal mass. This extra-abdominal paraganglioma developed from paraganglionic cells that travelled by vertebral migration from the root of the superior mesenteric artery. Extra-adrenal paraganglia extend anywhere from the neck down to the base of the pelvis. Ultrasonography, computed tomography (CT), and angiography showed a solid and cystic heterogeneously enhanced mass, which was fed by the superior mesenteric artery, without distant metastasis. Exploratory laparotomy revealed a large, dark, brownish-red mass in the mesentery of the ileum, which was distinct from the ileum. The mass consisted of peripherally solid areas with central hemorrhage and cystic degeneration. It was diagnosed as a paraganglioma histologically. The patient is free from recurrence of paraganglioma after 1 year of follow up. To our knowledge, this represents only the seventh case of a paraganglioma arising in the mesentery.

Effects of moderate hypothermia on proinflammatory cytokine production in a rat model of caerulein-induced pancreatitis.

Introduction Proinflammatory cytokines act as mediators of the local and systemic manifestations of acute pancreatitis (AP). Aims To investigate whether moderate hypothermia (MH) (32°C) can reduce the severity of AP by inhibiting cytokine production in a rat model of caerulein-induced pancreatitis. Methodology Rats were divided into three groups: control rats (Group I), AP rats treated with normothermia (38°C) (Group II), and AP rats treated with MH (Group III). AP was induced by intramuscular injection of caerulein and intraperitoneal infusion of lipopolysaccharide. MH was induced 4 hours after the first caerulein injection. Serum interleukin (IL)-1&bgr;, tumor necrosis factor (TNF)-&agr;, IL-6, amylase, and lipase levels were determined 8 hours after the first injection. The pancreas and lung were examined histologically. Results MH in comparison with normothermia significantly reduced serum levels of IL-1&bgr;, TNF-&agr;, IL-6, amylase, and lipase. Histologically, the MH group showed less vacuolization of the acinar cells and cellular infiltration into the interacinar areas of the pancreas than were shown in the normothermia group, but these effects were not evident in the lung. Conclusion Our results suggest that MH may be clinically applicable for reducing the severity of AP.

The usefulness of endobronchial ultrasonography-guided transbronchial needle aspiration at the lobar, segmental, or subsegmental bronchus smaller than a convex-type bronchoscope.

Background:Endobronchial ultrasonography–guided transbronchial needle aspiration (EBUS-TBNA) is a standard procedure for approaching the lesion adjacent to extrapulmonary bronchus. We started to use wedge insertion of a convex endobronchial ultrasound bronchoscope into bronchi narrower than the diameter of the bronchoscope itself to perform EBUS-TBNA. Our objective was to investigate the bronchus in which EBUS-TBNA was possible and safe. Methods:In this prospective study, we examined 15 lesions that were adjacent to lobar, segmental, or subsegmental bronchi narrower than the 6.9 mm external diameter of the convex scope. The cross-sectional area and maximum, minimum, and mean internal diameters of the airway lumen adjacent to the lesion were calculated using the measurement software. We investigated the airway branch in which EBUS-TBNA was possible, the narrowest airway diameter adjacent to the lesion for which insertion and diagnosis could be performed, the feasibility of puncture, and techniques for ensuring procedural success. Results:The mean cross-sectional area of the lumen for the 13 lesions that could be punctured was ≥15.9 mm2 and the mean internal diameter was ≥4.5 mm. Cytologic or histologic diagnosis by EBUS-TBNA was possible in 11 of the 15 cases. In 2 of the 4 undiagnosed lesions, the mean internal diameter was <4.5 mm, and the convex scope was unable to reach the lesion. There was no occurrence of complications in any case. Conclusions:EBUS-TBNA can be performed by inserting a 6.9 mm EBUS bronchoscope into airways with a mean diameter ≥4.5 mm as measured on computed tomography before bronchoscopy.

Endocytoscopy and narrow band imaging for superficial extension of squamous cell carcinoma.

60-year-old man presented with cough. Chest Acomputed tomography revealed a nodule in right S2 (Fig 1A). By conventional bronchoscopy, the orifice of B2 was obstructed with tumor (squamous cell carcinoma; Fig 1B). Tumor extension was assessed in greater detail using autofluorescence imaging, narrow-band imaging and ultra-high-magnification bronchoscopy (endocytoscopy; ECS) [1]. Autofluorescence imaging revealed magenta-colored epithelium at the orifice of the upper lobe bronchus (Fig 1C). Several dotted vessels were detected with narrow-band imaging at the same lesion (Fig 1D). Sleeve upper lobectomy was performed according to these bronchoscopic findings. ECS with methylene blue staining was performed in the resected bronchus intraoperatively. On these images of the bronchial epithelium, one could

A CHEST WALL ABSCESS DEVELOPING 11 YEARS AFTER AN INTERCOSTAL MUSCLE FLAP POSTERO-LATERAL THORACOTOMY

38歳，男性．11年前に気管支壁発生神経鞘腫にて後側方切開，第5肋間開胸で，中間幹環状切除，肋間筋弁による吻合部被覆術を行った．2006年10月頃から微熱と前回の術創部に一致した疼痛を自覚，胸部CTで肋骨融解像を伴う胸壁の腫瘤様陰影を認めた．同部位に対するCTガイド下経皮針生検では肉芽腫と診断されたが，後日，深部の穿刺液から黄色ブドウ球菌を検出した．胸壁膿瘍と診断したが胸壁腫瘍も完全には否定出来ず，2007年2月手術を施行した．右第6肋骨床に沿う膿瘍形成があり胸腔とは交通がなく，術創の晩期膿瘍と最終診断し，掻爬・ドレナージを行い治癒せしめた．悪性腫瘍との鑑別が困難な胸壁膿瘍の報告は少なくないが術後11年を経た晩期創部感染は過去に報告はない．病因論的観点から若干の考察を加え報告する．

A Case of Simultaneous Presence of Malignant Lyniphoma and Adenocarcinoma of the Stomach

胃悪性リンパ腫と早期胃癌の共存例は非常にまれである. 病理組織学的に興味が持たれ, 文献的考察を加え報告する. 症例は63歳の男性, 慢性肝炎 (HCV+), 胃潰瘍で, 内科治療中であった. 胃内視鏡生検にて胃幽門部にIIc (adenocarcinoma), 胃体上部に悪性リンパ腫を診断され, 胃全摘術を施行した. 切除標本の全割病理組織学的検索では胃悪性リンパ腫は表層型で, 胃全体に散布しており6病変認められた. しかも, そのうちの2病変に相接してtubular adenomaの存在もみられた. 深達度はsmでLSG分類ではdiffuse lymphoma, medium sized cell type, B cellであった. 一方, 胃癌は幽門部後壁小彎側に存在しIIc, 深達度はm, 組織型は中分化腺癌 (tub2) であった. 胃粘膜よりHelicobacter pyloriが証明された. リンパ節転移はなく, 両者は全く別々に離れ存在していた.