Ken-ichi Togashi

Limited Resection for Noninvasive Bronchioloalveolar Carcinoma Diagnosed by Intraoperative Pathologic Examination

BACKGROUND The establishment of limited resection procedures for non-small cell lung cancer is expected. Many groups have suggested noninvasive bronchioloalveolar carcinoma (BAC) to be a potential indication for limited resection. METHODS We designed a prospective phase II study evaluating limited resection for noninvasive BAC diagnosed by intraoperative pathologic examination. From 1999 to 2007, limited resection was the procedure in 46 patients (16 men and 30 women; median age, 69 years; range, 49 to 83) who were diagnosed intraoperatively as having noninvasive BAC. The first end point was the predictive value of the intraoperative pathologic examination for noninvasive BAC diagnosis. The second end point was overall survival, disease-free survival, and cancer-specific survival, calculated using the Kaplan-Meier method. RESULTS We performed wedge resections for 44 patients and segmentectomy for 2 patients. Permanent pathologic examination revealed 3 patients had primary lung adenocarcinomas other than noninvasive BAC. The predictive value of intraoperative pathologic examination for noninvasive BAC diagnosis was 94%. During a median 51-month follow-up, there were only 2 cancer unrelated deaths. The 5-year overall survival rate and the disease-free survival rate were 93%, and the 5-year cancer-specific survival rate was 100%. CONCLUSIONS The results of our prospective phase II study indicate that limited resection, mainly by wedge resection, is a potentially curative surgical procedure and may be an acceptable alternative to lobectomy for patients with noninvasive BAC. Furthermore, an intraoperative pathologic diagnosis of noninvasive BAC is strongly predictive and allows for an intraoperative decision to perform a limited resection in these patients.

Field survey of sex-reversals in the medaka, Oryzias latipes: genotypic sexing of wild populations.

Abstract The medaka, Oryzias latipes, has an XX/XY sex determination mechanism. A Y-linked DM domain gene, DMY, has been isolated by positional cloning as a prime candidate for the sex-determining gene. Furthermore, the crucial role of DMY during male development was established by studying two wild-derived XY female mutants. In this study, to find new DMY and sex-determination related gene mutations, we conducted a broad survey of the genotypic sex (DMY-negative or DMY-positive) of wild fish. We examined 2274 wild-caught fish from 40 localities throughout Japan, and 730 fish from 69 wild stocks from Japan, Korea, China, and Taiwan. The phenotypic sex type agreed with the genotypic sex of most fish, while 26 DMY-positive (XY) females and 15 DMY-negative (XX) males were found from 13 and 8 localities, respectively. Sixteen XY sex-reversals from 11 localities were mated with XY males of inbred strains, and the genotypic and phenotypic sexes of the F1 progeny were analyzed. All these XY sex-reversals produced XY females in the F1 generation, and all F1 XY females had the maternal Y chromosome. These results show that DMY is a common sex-determining gene in wild populations of O. latipes and that all XY sex-reversals investigated had a DMY or DMY-linked gene mutation.

Successful Surgical Management of Complete Tracheal Disruption due to Penetrating Injury

Successful management of penetrating injury to the trachea is rare, especially in Japan. A 32-year-old female attempted suicide by stabbing herself in the throat with a knife, and at operation the trachea was found to be completely disrupted. A median sternotomy made possible end-to-end anastomosis of the trachea. All other important organs including the great vessels, esophagus, and lungs were intact, but the pleura was open on the right side. The patient was managed under heavy sedation and with controlled ventilation for more than a week postoperatively, because of her suspected mental condition. She was extubated on postoperative day 13 and transferred to a mental hospital on day 16. We concluded that early diagnosis and surgical repair were important for the successful management of this patient with tracheal disruption.

RAPID RESTORATION OF INJURED KIDNEY AFTER IMMEDIATE REMOVAL OF OPPOSITE NORMAL KIDNEY In Comparison with Delayed Contralateral Nephrectomy

The difference in restoration of injured kidneys according to the time of contralateral nephrectomy was investigated in rats. When the opposite normal kidney was removed immediately or when both kidneys were rendered ischemic totally, the function of the injured kidney or kidneys was rapidly restored and showed almost normal level of blood urea nitrogen as well as normal histology one week after the ischemic damage. But delayed contralateral nephrectomy slowed down the speed of recovery, and the injured kidney did not function completely and showed severe inflammatory reaction in histology four weeks after the injury. It was discussed that retention of some factors like renal hypertrophy factor would cause rapid restoration of the damaged kidney.

Mechanism of Inducing Autologous Antibody Formation in Nephrotoxic Serum Nephritis

The role of the heterologous antibody fixed in the kidney was evaluated by means of transplantation of a nephritic kidney to a normal recipient in the rat. An Intravenous Injection of 0.5 ml of nephrotoxic serum could not induce distinct changes in the heterologous phase, but it could cause mild or moderate changes in the autologous phase. Titration of rat antibody to rabbit IgG according to passive hemagglutination test showed that rabbit IgG fixed in the transplant could Induce autologous antibody formation with a similar intensity to nephrotoxic serum given intravenously, indicating that fixed antigen played the most Important role In autologous antibody formation and other factors, such as the kidney‐fixing rabbit IgG remained in circulation or fixed In other tissues and the gamma‐globulin other than anti‐kidney antibody, might be less important. It was unclear which antibody, fixed or dissociated from the transplant, played the more important role in stimulating antibody formation.

Minute lesions of alveolar damage in lungs of patients with stable idiopathic pulmonary fibrosis.

To investigate the mechanisms underlying the acute exacerbation of idiopathic pulmonary fibrosis, and in particular the role of minute lesions of alveolar damage.