Ken-ichiro Minami

Prognostic significance of p53, Ki-67, VEGF and Glut-1 in resected stage I adenocarcinoma of the lung

OBJECTIVES The purpose of this study was to evaluate the prognostic significance of various biological factors in patients with resected stage I adenocarcinoma. METHODS We immunohistochemically examined 47 specimens of surgically resected adenocarcinomas to evaluate the expression of the biological markers p53, Ki-67, vascular endothelial growth factor (VEGF) and glucose transporter-1 (Glut-1). Angiogenesis grade and tumor vessel invasion was also investigated. Actuarial survival was analyzed by the Kaplan-Meier method. Clinical variables and biological markers were analyzed using the Coxs proportional hazards model for multivariate analysis to identify independent prognostic factors. RESULTS The overall survival rate for the whole series was 85.1% at 3 years and 71.9% at 5 years, with a median survival time of 73 months. Differentiation, Ki-67, Glut-1, VEGF, tumor vessel invasion and microvessel density (MVD) were significant prognostic factors by univariate analysis, with Glut-1 expression the most important prognostic factor for survival (P<0.0001). After multivariate analysis, only Glut-1 expression remained as a prognostic factor for survival. CONCLUSION Glut-1 expression can be a predictor for prognosis in patients with resected stage I adenocarcinoma of the lung.

New Tubular Bioabsorbable Knitted Airway Stent: Feasibility Assessment for Delivery and Deployment in a Dog Model

PURPOSE The aim of this study was to determine whether it is possible to deliver and deploy a new device, a poly-L-lactic acid (PLLA) tubular knitted airway stent, under bronchoscopic guidance in a dog model. DESCRIPTION The delivery system consisted of a flexible balloon catheter (controlled radial expansion balloon dilator, M00558440, Boston Scientific Corporation, MA, USA) preloaded with a stent. A delivery catheter preloaded with a stent was advanced to a target point in the trachea under bronchoscopic guidance. Once the stent was positioned, the balloon was inflated for sixty seconds. The stent was in full contact with the tracheal wall upon deflation of the balloon. EVALUATION The stents were successfully delivered into the tracheal lumen and successfully deployed in all dogs. CONCLUSIONS This is the first study to prove the feasibility of delivering and deploying the PLLA stents in a dog model, using a balloon expansion technique. Further investigation with large numbers of subjects and long-term follow-up will be necessary to assess the utility of the bioabsorbable knitted tubular stent before clinical applications begin.

A new bioabsorbable sleeve for staple-line reinforcement: report of a clinical experience.

AbstractPurpose. The most frequent and troublesome complication after resection of an emphysematous lung is persistent air leakage. This report describes our recent experience of using sleeves made of polyglycolic acid to reinforce staple-lines to reduce air leaks after resection of emphysematous lung. Methods. We used bioabsorbable sleeves made of polyglycolic acid (PGA) for staple-line reinforcement during lung resections in 25 patients with emphysema. Results. Immediately after stapling, no air leaks were detected in 20 patients (80%), although prolonged air leaks lasting for more than 7 days were observed in three patients (12.5%). Conclusion. PGA sleeves do not constitute a foreign body that stays in the host lung, and they require no rinsing at the time of clinical use. Therefore, the PGA sleeve could be a promising new material instead of non-absorbable materials and xenomaterials for staple-line reinforcement.

Coexistence of catamenial pneumothorax and catamenial hemoptysis in a patient with pulmonary hemangiomatosis-like foci: A case report

Catamenial pneumothorax and catamenial hemoptysis are syndromes specific to women of reproductive age. Thoracic endometriosis syndrome most commonly presents as catamenial pneumothorax and very rarely as catamenial hemoptysis. Thoracic endometriosis syndrome is not the only cause of catamenial pneumothorax and hemoptysis. Some cases of catamenial pneumothorax and more than half of patients with hemoptysis lack evidence of ectopic endometrial tissue. Coexistence of catamenial pneumothorax and hemoptysis is extremely rare, and only one patient has been reported in the English literature. We report a case of catamenial pneumothorax and hemoptysis presenting with pulmonary capillary hemangiomatosis-like foci instead of ectopic endometrial implants.

A new method for establishing an intrapulmonary tumor in the rabbit.

OBJECTIVES Local treatments against malignant intrapulmonary tumors, such as radiotherapy, photodynamic therapy, and laser ablation therapy, are sometimes used in preference to surgery or chemotherapy. The efficacy of such treatments is dependent not only on the pathological type of the primary tumor, but also on loco-regional settings such as location of the lesion and relationship between the tumor and surrounding organs as well as tissues. Therefore, in order to evaluate the efficacy of a newly developed local treatment, it is essential to have a model in which a tumor can be established at an intended location. In this study, we developed a model for the establishment of an intrapulmonary tumor, using the rabbit. METHODS After induction of general anaesthesia, a catheter was inserted via the airway into the lung of a Japanese white rabbit, under X-ray guidance. The lung was then inoculated with a collagen gel matrix containing a suspension of VX2 cells derived from rabbit skin squamous cell carcinoma. Subsequent tumor growth was evaluated with X-ray imaging and pathological examination. RESULTS Growth of a solitary tumor at the target site was pathologically confirmed in 9 of 12 rabbits that were inoculated with 1 x 10(8) cells. In addition, tumor growth could be followed in 8 of 9 rabbits by chest X-ray examination. That is, a solitary intrapulmonary tumor could be established in 8 of 12 animals (67%). CONCLUSION The rabbit model reported here enables establishment of a solitary intrapulmonary tumor and thus can provide a suitable experimental setting for evaluation of local treatments of intrapulmonary tumors.

Preoperative steroid therapy stabilizes postoperative respiratory conditions in myasthenia gravis

ObjectiveWe reviewed our experience from 1990 to 2005 to examine whether control of myasthenia gravis (MG) with steroid therapy before surgery could stabilize postoperative respiratory conditions, compared with the nonsteroid treatment.MethodsRecords of 43 consecutive patients with MG who underwent extended thymectomy at Kansai Medical University Hospital were retrospectively reviewed. Two groups, a steroid group (n = 28) and a nonsteroid group (n = 15) were compared.ResultsIn the steroid group, steroid doses ranged from 10 to 100 mg every other day, or 40–60 mg daily. The patients showed significantly less thymus hyperplasia in the pathological findings (P = 0.023). Whereas 3 of 28 (7%) in the steroid group suffered respiratory insufficiency within 3 days of surgery, 5 of 15 (33%) in the nonsteroid group exhibited the same problem (P = 0.030). Univariate analysis showed that steroid treatment was the only significant factor (P = 0.041) affecting respiratory insufficiency. Patients in the steroid group achieved palliation of MG more quickly after surgery than patients in the nonsteroid group (86% vs. 57% within 6 months, P = 0.059; 84% vs. 42% within 1 year, P = 0.042).ConclusionThe control of myasthenia gravis with steroid therapy before surgery seems to stabilize postoperative respiratory status without having adverse effects on surgical infection.

Efficacy and long-term clinical outcome of bronchial occlusion with endobronchial Watanabe spigots for persistent air leaks

BACKGROUND We reviewed our clinical experience and examined the efficacy and long-term outcome of bronchial occlusion with endobronchial Watanabe spigots (EWSs). METHODS We retrospectively reviewed the clinical charts of patients who had undergone endoscopic bronchial occlusion with EWSs between July 2002 and July 2004. The affected bronchi were identified by chest computed tomography, pleurography, and balloon occlusion test. RESULTS Of the 21 patients, 18 had underlying pulmonary complications, including chronic obstructive lung disease (n=14), cancer (n=4), pneumoconiosis (n=3), and pneumonia (n=1). Six (29%) achieved complete resolution and 12 (57%) experienced a reduction in air leaks after the first EWS insertion. Of the 12 patients with reduced air leaks, 10 subsequently underwent chemical pleurodesis and 5 (24%) achieved complete resolution after the procedure. A second EWS insertion procedure was performed for 8 patients: 2 achieved complete resolution and 5 achieved a further reduction in air leaks with complete resolution after chemical pleurodesis. Eighteen of the 21 patients were followed up at an outpatient clinic after discharge: 13 for more than 12 months and 4 for more than 84 months. During the follow-up period, most patients did not show any obvious pulmonary complications. CONCLUSIONS We showed that bronchial occlusion with EWSs was effective in stopping or reducing air leaks and that 86% of our patients finally achieved complete resolution, some when the occlusion was combined with chemical pleurodesis. The rate of complications was acceptable, even after long-term placement.