Koichiro Shibata

Intrapleural perfusion hyperthermo-chemotherapy for malignant pleural dissemination and effusion

Taking advantage of the antitumor effect of hyperthermia, we administered intrapleural perfusion hyperthermo-chemotherapy for the treatment of malignant pleural seeding or pleural effusion. This consists of irrigating the pleural space for 2 hours with 43 degrees C saline solution containing cis-platinum using specially devised extracorporeal circuits. From January 1988 through December 1993, we performed this technique in 12 patients with malignant disseminated lesions stemming from lung cancer who also underwent surgical resection of the primary lesions and in 7 patients with malignant pleural effusions who did not undergo thoracotomy or surgical resection. There were no serious clinical complications associated with this procedure. The pharmacokinetics showed that a high concentration of cis-platinum (more than 17.6 micrograms/mL in the free form) was retained in the pleural cavity during perfusion. After this therapy, the cancer cells showed marked degeneration with fibrosis in the pleural wall. The pleural effusion was well controlled in 100% of the patients. The median survival time in the 12 patients with pleural disseminated lesions who were treated with intrapleural perfusion hyperthermo-chemotherapy was 20 months. On the other hand, the median survival time in 7 patients with similar lesions who did not receive IPHC was only 6 months. Intrapleural perfusion hyperthermo-chemotherapy seems to have considerable value as an adjuvant therapy for patients with pleural dissemination who have had their primary lesions removed.

The effects of pulsatile and non-pulsatile cardiopulmonary bypass on renal blood flow and function.

The physiologic effects of pulsatile and non-pulsatile flow in cardiopulmonary bypass were compared in terms of the relationship between different flow rates and what effects these had on pulsatile and non-pulsatile flow. Forty adult mongrel dogs were used in this study and divided into 5 groups, each comprised of 8 animals, according to the flow rate during cardiopulmonary bypass, namely; 40, 60, 80, 100, or 120 ml/kg/min. The animals were perfused with either pulsatile or non-pulsatile flow for 1 hour, given randomly at the same mean flow rate. At flow rates of 80 and 100 ml/kg/min, the mean arterial blood pressure and total peripheral vascular resistance were significantly lower in pulsatile flow than in non-pulsatile flow, and the renal blood flow was significantly greater in pulsatile flow than in non-pulsatile flow. The renal arterial-venous lactate difference was significantly less in pulsatile flow than in non-pulsatile flow at a flow rate of 80 ml/kg/min, and the renal lactate extraction was significantly higher in pulsatile flow than in non-pulsatile flow at the same flow rate. The renal excess lactate was significantly lower in pulsatile flow than in non-pulsatile flow at a flow rate of 100 ml/kg/min. There were no significant differences in these parameters between the two types of perfusion at flow rates of 40, 60 or 120 ml/kg/min. Pulsatile flow was therefore apparently advantageous, when compared to non-pulsatile flow, in terms of hemodynamics, renal circulation, and metabolism of the kidney at flow rates of 80 and 100 ml/kg/min. However, when the flow rate was 120 ml/kg/min, pulsatile flow and non-pulsatile flow had the same effects.

Primary liposarcoma of the mediastinum —A case report and review of the literature—

Liposarcoma of the mediastinum is a rare disease. A 59 year old woman was seen with the complaint of dizziness. A chest radiogram taken during the course of investigation for hypertension revealed a large mass shadow 24×18.5×12 cm located in the anterior mediastinum. The tumor of the mediastinum was diagnosed as a benign lipoma when it was first resected, but subsequently proved to be a liposarcoma when it re-appeared 2 years and 10 month later. Based on the WHO classification, the mixed type of liposarcoma was diagnosed. The salient and pathological features of mediastinal liposarcoma are reviewed and compared with those nine cases reported in Japan and fifty in North America and European countries. Treatment by simple enucleation or shelling out of the tumor should be discouraged, since this seems to be the main cause of local recurrence. Surgical wideen bloc excision is the treatment of choise.

Aneurysm of the Transverse Cervical Artery Occurring in Association with a Cavernous Hemangioma as a Complication of Klippel-Trenaunay Syndrome : Report of a Case

We report herein the case of a 14-year-old girl with Klippel-Trénaunay syndrome who developed an aneurysm of the transverse cervical artery. Because it was continuing to increase in size, with an associated risk of rupture, an aneurysmectomy was performed. Pathological examination of the resected specimen revealed a cavernous hemangioma located near the aneurysm. To our knowledge no other case of an aneurysm occurring in association with a cavernous hemangioma as a complication of Klippel-Trénaunay syndrome has ever been reported.

SUCCESSFUL TREATMENT OF BRONCHIAL MUCOEPIDERMOID CARCINOMA IN AN 11-YEAR-OLD BOY BY BRONCHOPLASTY : REPORT OF A CASE

We report herein the rare case of an 11-year-old boy in whom mucoepidermoid carcinoma of the right upper lobe bronchus was successfully treated by bronchoplasty. The patient underwent bronchoscopy to investigate the cause of relapsing respiratory infections over the past 2 years, which revealed a tumor at the orifice of the right upper lobe bronchus. Thus, a right upper sleeve lobectomy was effectively carried out, preserving right pulmonary function. The tumor was observed to partially invade the bronchial wall, but not the lung parenchyma. Histological examination confirmed a diagnosis of mucoepidermoid carcinoma, classified as grade 2 by Conlans classification. The patient has been well and free of recurrence for 3 years postoperatively.

Reduction of post-ischemic lung reperfusion injury by fibrinolytic activity suppression.

BACKGROUND Although extensive studies on the detailed mechanisms of ischemia-reperfusion injury have been conducted, the implication of the fibrinolytic system has not been known. To determine the role of the fibrinolytic system in ischemia-reperfusion injury, we used tranexamic acid, a synthetic specific plasmin and tissue-type plasminogen activator inhibitor, to suppress fibrinolytic activity in a rabbit lung ischemia-reperfusion model. METHODS New Zealand White rabbits were randomly divided into two groups: a simple ischemia group and a group injected with tranexamic acid before left hilar occlusion. After 2 hours of warm ischemia, plasma was collected from pulmonary vessels. Fibrin zymography was used to ascertain fibrinolytic activity, and enzyme-linked immunosorbent assay was used to determine soluble thrombomodulin levels as a marker for endothelial cells damage. Changes in left pulmonary function including arterial oxygen tension, peak airway pressure, and pulmonary vascular resistance were recorded during reperfusion after the 2 hours of warm ischemia. RESULTS Fibrinolytic activity and soluble thrombomodulin levels increased in the vessels of the ischemic lung, indicating endothelial cell injury. The increased fibrinolytic activity and the rise in soluble thrombomodulin were suppressed by the preadministration of tranexamic acid, resulting in remarkably improved pulmonary function during reperfusion. After 2 hours of reperfusion, the wet-to-dry weight ratios and histological studies showed reduced pulmonary edema in the group that had received tranexamic acid. CONCLUSION These findings suggest that the fibrinolytic system is involved in the onset mechanism of ischemia-reperfusion injury through induced endothelial cell damage and increased vascular permeability.

Efficacy and Safety of a Percutaneous Right Ventricular Assist System

BACKGROUND Mechanical right ventricular assistance is necessary in the management of profound right ventricular failure resistant to medical therapy. Conventional right ventricular assistance requires a thoracotomy. We developed a technique for assisting the failing right ventricle without thoracotomy. METHODS We implanted the percutaneous right ventricular assist system in animals to test its feasibility and safety. A feasibility study was performed in a right ventricular failure model using 12 open chest dogs, and we examined the effects of the system hemodynamically. Next, the system was implanted into 6 goats and driven for 2 to 8 days. RESULTS Institution of the percutaneous right ventricular assist system revealed overall hemodynamic improvement on right ventricular failure in dogs. In the goat experiment, no animal died from cannula-related complications. No damage to the intracardiac structures and no pulmonary edema were seen. Plasma free hemoglobin concentration did not exceed 10 mg/dL. CONCLUSIONS The percutaneous right ventricular assist system is safe and effective in the management of right ventricular failure.

Microchimeric cells from the peripheral blood associated with cardiac grafts are bone marrow derived, long-lived and maintain acquired tolerance to minor histocompatibility antigen H-Y.

Background. Although it has been well established that themicrochimerism occurs in the peripheral blood of the recipients after varioussettings in both clinical and experimental organ transplantation,nevertheless, their roles in inducing and maintaining acquired transplantationtolerance are controversial. Furthermore, regarding the cell lineages,kinetics, and functions of the cells that constitute the microchimerism afterorgan transplantation, solid information is notavailable. Methods. Using rat heterotopic heart isografts from bone marrowchimeras between cross-sex and applying polymerase chain reaction withspecific primers to rat sex determining region of Y chromosome, a relationshipbetween a state of microchimerism and induction as well as maintenance ofacquired tolerance to H-Y antigen wereexamined. Results. Microchimeric cells of the peripheral blood (MCPB) aftercardiac grafting contain bone marrow-derived and radiation-sensitive cells.Furthermore, removal of the primary cardiac grafts revealed that microchimericcells in the peripheral blood are long-lived cells, i.e., more than 6 months.When the female rats that had contained long-lasting MCPB, were innoculatedwith syngeneic male dendritic cells, failure to sensitize female toward malespecific antigen H-Y was found tooccur. Conclusions. Thus it was suggested that radiation-sensitive, bone marrowderived, long-lived MCPB play a significant role in maintaining acquiredtransplantation tolerance to minor histocompatibility antigenH-Y.

Thermotolerance in regional hyperthermia in vivo : an experimental study using the MH134 tumor

In the clinical application of hyperthermia, determining the thermotolerance that influences the anti-tumor effect is an important problem. The purpose of this study was to investigate the methods of induction and disappearance of thermotolerancein vivo. After transplanting MH134 cancer cells into the paws of C3H mice, local hyperthermia with warm water was administered, and the movement of thermotolerancein vivo studied in terms of the heating intervals and tumor growth times. When the first heating was applied on the 8th day after transplantation, thermotolerance appeared within 1 hour, increasing gradually to reach a maximum at 18 hours, after which it decreased gradually and disappeared after 48 hours. When the first heating was applied on the 13th day after transplantation, which fell during the rapid tumor proliferation period, the movement of thermotolerance presented a similar pattern of appearance and disappearance. The results of this study made it clear that there was no difference in the movement of thermotolerance between the two periods even though each had a different rate of tumor proliferation.In the clinical application of hyperthermia, determining the thermotolerance that influences the anti-tumor effect is an important problem. The purpose of this study was to investigate the methods of induction and disappearance of thermotolerance in vivo. After transplanting MH134 cancer cells into the paws of C3H mice, local hyperthermia with warm water was administered, and the movement of thermotolerance in vivo studied in terms of the heating intervals and tumor growth times. When the first heating was applied on the 8th day after transplantation, thermotolerance appeared within 1 hour, increasing gradually to reach a maximum at 18 hours, after which it decreased gradually and disappeared after 48 hours. When the first heating was applied on the 13th day after transplantation, which fell during the rapid tumor proliferation period, the movement of thermotolerance presented a similar pattern of appearance and disappearance. The results of this study made it clear that there was no difference in the movement of thermotolerance between the two periods even though each had a different rate of tumor proliferation.

An experience using spiral vein graft as arterial substitute

In two patients with aneurysmal changes due to arteriosclerosis in the axillary and the subclavian artery respectively, spiral vein grafts were used as a substitute for vascular reconstruction. After resection of the aneurysm, these vein grafts resulted in an excellent adaptation to the recipient vessel. Complicated techniques were not required and the construction time was minimal. Such an approach may be used even in adjacent sites to a joint.