Kembu Nakamoto

Human papillomavirus not found in squamous and large cell lung carcinomas by polymerase chain reaction.

BACKGROUND: Human papillomavirus (HPV) has been identified not only in anogenital carcinomas, but also in malignancies of other organs, including bronchogenic carcinomas. Previous studies reporting detection of these viruses in lung cancers used mainly in situ hybridization. The authors applied the polymerase chain reaction (PCR) for investigating the occurrence of HPV in bronchial neoplasms. METHODS: Formalin fixed, paraffin embedded tissues of 40 squamous and 7 large cell lung cancers were examined. PCR was done with consensus primers, capable of detecting HPV 6, 11, 16, 18, 31, 33, 52b, and 58. RESULTS: None of the 47 samples contained any of the examined HPV types. CONCLUSIONS: Because the squamous and large cell cancer cases were found not to be associated with HPV infection, this study does not support the potential role of these viruses in the development of lung cancers.

Operative Approaches for Left-Sided Carinoplasty

Carinoplasty was performed in 42 patients: 7 with wedge pneumonectomy, 15 with sleeve pneumonectomy, 14 with one-stoma-type carinal reconstruction, 5 with montage-type carinal reconstruction, and 1 other. Diagnoses in the 42 patients consisted of lung cancer in 31 (73.8%), tuberculous stenosis in 10 (23.8%), and tracheobronchial injury in 1 (2.4%). The thoracotomy was on the right side for lung cancer in 77.4% and on the left side for tuberculous stenosis in 80.0% (p < 0.01). Left-sided carinoplasty was performed in 14 patients using four approaches: midline thoracotomy in 1, left thoracotomy in 10, midline sternotomy and left thoracotomy in 2, and bilateral thoracotomies in 1. Left wedge or sleeve pneumonectomy, without right thoracotomy, could be done by midline sternotomy and left thoracotomy but with limited tracheal resection. Left one-stoma-type carinoplasty was undertaken, sacrificing one lobe, as an alternative to pneumonectomy, where an approach drawing the carina down to an aortopulmonary window was considered to be preferable to the drawing-up approach.

A study on optimal temperature for isolated lung preservation

Fifty-two heart-lung blocks (grafts) of New Zealand white rabbits were used for determining optimal temperature in lung preservation. Grafts were inflated with room air and preserved by simple surface cooling at arbitrarily determined temperatures for 18 hours. Graft function was assessed by nonrecirculated perfusion with autologous blood. Segmented regression models between functional parameters and preservation temperature (T) were applied for determining optimal temperature. Graft ability was also assessed from the point of view of pulmonary circulation by indocyanine green dilution rate of effluent and histological distribution of carbon particles. Significant segmented regression curves and lines between parameters of effluent oxygen tension (PO2) and wet-dry weight ratio (W/D), and T were obtained as follows: PO2 = 150/(1 + 3208.1[e-1.17T]), p less than 0.01; PO2 = -13.8T + 222.6, p less than 0.05; W/D = 5.0 + 1.5/(1 + 0.0028[e0.94T]), p less than 0.01; W/D = 0.075T + 4.52, p less than 0.05. Optimal temperature for lung preservation by topical cooling was calculated as 8 degrees to 9 degrees C from each intersecting point of regression equations. Analysis of regression curves suggested that the most common hypothermic ischemic injury during preservation by topical cooling is pulmonary vascular obstruction, which might be induced at temperatures lower than the critical temperature of 6 degrees to 7 degrees C. Indocyanine green dilution rate and histological findings supported the results of graft functional parameters.

Superselective segmentectomy for deep and small pulmonary nodules under the guidance of three-dimensional reconstructed computed tomographic angiography.

BACKGROUND Three-dimensional computed tomographic angiography (3D-CT angio) allows selective access to peripheral segments. Superselective segmentectomy (SSS) was applied to the surgical management of indeterminate small and deep pulmonary nodules. METHODS Thirty patients with indeterminate pulmonary nodules less than 25 mm in diameter and located deeper than 20 mm from the pleural surface were enrolled in this study between 2002 and 2009. All patients underwent exploratory thoracotomy. The SSS with a surgical margin from the nodule larger than the nodule diameter or 20 mm was directed toward the target pulmonary arteries by 3D-CT angio using a multidetector-row CT scanner. The SSS was evaluated for resected area, surgical margin, regional lymph nodes, morbidity, lung function, and survival rate. RESULTS Three patients received SSS at the daughter segment, 23 patients that at the subsegment, and the remaining four underwent miscellaneous SSS without major complications. Twenty patients exhibited early lung cancer, one patient stage IIA lung cancer, and the remaining nine patients had metastatic or benign tumors. Five patients with primary cancer subsequently underwent standard lobectomy. The remaining 16 patients with early lung cancer did not undergo lobectomy because of their major comorbidities or refusal of a second thoracotomy. The surgical margins were free of disease in all patients. The actual and disease-free five-year survival rates were 100% for the lung cancer patients, excluding those who subsequently underwent lobectomy. The lung function after SSS was well preserved. CONCLUSIONS Superselective segmentectomy is an applicable optional strategy for the surgical management of indeterminate small and deep pulmonary nodules.

Carcinosarcoma of the Lung

We describe a case of carcinosarcoma of the lung in a 60-year-old female who was admitted with complaints of productive cough and an abnormal shadow in the chest X-ray. Sputum cytology showed both squ

Blood coagulation and fibrinolysis after surgery for lung cancer

肺は凝固線溶能の高い臓器である.肺に外科的侵襲の加わる肺癌術後の血液凝固線溶能について検討した.術前凝固線溶能に異常を認めない手術例55例を対象とした.肺癌22例, 胃癌7例, 胆石症9例, 甲状腺癌7例, 乳癌10例である.術前と術後2, 4, 6, 10, 14, 21病日に血中フィブリノーゲン値, AT-III値, FDP 値を測定した. (1) 疾患群間の比較 : フィブリノーゲン値は肺癌群と胃癌群が他群に比べ術後4, 6病日に有意に上昇した (p<0.05).AT-III値は肺癌群が術後2病日に有意に低下した (p<0.01).FDP値は胃癌群が術後6病日に有意に上昇した (p<0.01). (2) 肺癌群での検討 : 術後2病日のAT-III値 (%) と手術時間 (分) には有意な回帰式 (Y=-0.195X+123.908R=0.854 p<0.01) が得られた.出.血量, 切除量と各測定因子問の有意な関連は認めなかった.肺癌術後はAT-III値の低下を特徴とする凝固線溶能の亢進を認めた.凝固線溶能亢進の因子として, 出血量, 切除量よりも手術時間が関与していた.

A Case Report Suggesting the Significance of Serum CEA in Evaluation of Anticancer Effects.

症例は74歳男性.1期肺腺癌術後肝転移に対し, rhG-CSF併用chemotherapy (MVP療法: CDDP 80mg/m2, VDS 3 mg/m2, MMC 3mg/m2, 2週間隔, 5クール) で画像上PR (Pertial Response) を得た.化療中のCEA値を経時的に測定した結果, 腫瘍体積と有意の相関をみた.画像上PRであったがCEA値は完全に正常化した.このことは, 縮小した塊状影が腫瘍の壊死組織である可能性を示している.本症例の血清CEA値は, 予後判定のうえで再発の指標となり, 抗腫瘍効果のマーカーとして鋭敏に反応した.血清CEA値は画像診断の限界を補う新たな化療効果判定方法になりうることが示唆された.