Makoto Sugita

Left sleeve pneumonectomy performed through a clamshell incision with extracorporeal membrane oxygenation for bronchogenic carcinoma: report of two cases.

We report herein the cases of two patients with bronchial gland carcinomas in the left main bronchus who were successfully treated by left sleeve pneumonectomy performed through a clamshell incision. Adequate oxygenation during pathological examination of tumor invasion at the bronchial stumps and the tracheobronchial anastomoses was achieved by extracorporeal membrane oxygenation (ECMO) in both patients. Tracheobronchial anastomosis was relatively easy to perform in the excellent operative field achieved by this method. The postoperative courses of both patients were uneventful, although they developed temporary pulmonary edema that was effectively controlled by mechanical ventilation and appropriate diuresis. The procedure presented in this paper is considered to be a safe and effective method of performing left sleeve pneumonectomy.

Difference in the effects of low temperatures on the tension of human pulmonary artery and vein ring segments.

Background: Although limited data suggest that pulmonary flushing with organ preservation solutions should not be performed at too low temperatures, the influence of temperature on pulmonary vascular tone is unclear. Objective: The purpose of this study was to examine the effect of low temperatures of the tension of human pulmonary artery and vein ring segments and the vascular resistance of perfused rat lungs. Methods: 5 sets of human pulmonary artery and vein ring segments were suspended from a force displacement transducer at 37, 24 and 8°C, and the effect of 30 mM K+ on the tension was monitored. The effect of 30 mM K+ on vascular resistance was also examined at low temperatures in 5 perfused rat lungs. Results: Pulmonary artery segments dilated at 24°C, and more significant vasodilatation was observed at 8°C. In contrast, there was a significant constriction of pulmonary veins at 8°C. Vasoconstriction induced by 30 mM K+ at 37°C was significantly inhibited at low temperatures in both pulmonary arteries and veins. In rat lungs, perfusion at 8°C caused a significant increase in pulmonary vascular resistance, even though no further increase was observed in the presence of 30 mM K+. Conclusions: Our data indicate that pulmonary arteries dilate and the veins constrict at 8°C and may increase pulmonary vascular resistance. We conclude that the different effect of low temperatures between pulmonary arteries and veins may explain why pulmonary vascular flushing with organ preservation solutions at room temperature is more satisfactory.

Sleeve Superior Segmentectomy of the Right Lower Lobe for Endobronchial Neurinoma

A 30-year-old woman was found to have an obstructive intrapulmonary tumor at the right intermediate bronchus which caused atelectases of both right middle and lower lobes. The diagnosis of endobronchial neurinoma was made by bronchofiberscopic biopsy. Since the tumor was benign, we considered an operative procedure which would enable both complete resection of the tumor and preservation of the pulmonary function. By utilizing the techniques of sleeve superior segmentectomy of the right lower lobe and telescoping bronchial anastomosis, both objectives were achieved.

Effects of EP4 solution and LPD solution vs Euro-Collins solution on Na+/K+-ATPase activity in rat alveolar type II cells and human alveolar epithelial cell line A549 cells

BACKGROUNDnIntact alveolar epithelial Na(+)/K(+)- adenosinetriphosphatase (ATPase) function is important in preventing alveolar fluid accumulation after lung transplantation. We examined whether the type of preservation solution used influences Na(+)/K(+)-ATPase activity in alveolar epithelial cells.nnnMETHODSnRat alveolar type II cells were preserved with EP4, low-potassium dextran (LPD), or Euro-Collins solution at 7 degrees C for 5 and 20 hours. To assess cell toxicity, we measured cell viability and lactate dehydrogenase release. Na(+)/K(+)-ATPase activity was measured as ouabain-sensitive ATPase hydrolysis. We also examined the effect of terbutaline (10(-3) mol/liter) and dibutyryl cyclic adenosine monophosphate (dbcAMP) (10(-3) mol/liter) on Na(+)/K(+)-ATPase activity in A549 cells preserved for 5 hours.nnnRESULTSnAll solutions caused significant damage of rat alveolar type II cells at 20 hours. However, Na(+)/K(+)-ATPase activity was preserved at normal levels with EP4 and LPD over 20 hours. Terbutaline and dbcAMP significantly increased Na(+)/K(+)-ATPase activity in A549 cells preserved with EP4 and LPD solutions for 5 hours. However, we observed no activation in the cells preserved with Euro-Collins solution. We found no significant difference in intracellular cAMP levels after terbutaline challenge among the types of preservation solution.nnnCONCLUSIONSnWe conclude that extracellular-type solutions such as EP4 and LPD may be preferable for maintaining not only the basal activity but also the ability to activate Na(+)/K(+)-ATPase in response to beta-adrenergic agonists, in alveolar epithelial cells.

Effects of intraalveolar oxygen concentration on alveolar fluid absorption and metabolism in isolated rat lungs

We evaluated the effects of intraalveolar oxygen concentration on alveolar fluid absorption and metabolism in isolated rat lungs. Alveolar fluid absorption was determined by measuring increase in albumin concentration in the instillate solution during 2 h of incubation. Oxidative phosphorylation was assessed by gas analysis of the solution. Glycolysis was assessed by determining glucose escape and lactate release in the solution. We found that alveolar fluid absorption did not change under hyperoxic and hypoxic experimental environments (range 100-10% oxygen). Glycolysis was reduced under hyperoxia and stimulated under hypoxia, however, lung ATP content did not change. When oxidative phosphorylation was inhibited by NaCN, both alveolar fluid absorption and lung ATP content were reduced. Our data indicate that isolated rat lungs maintain optimal energy production for alveolar fluid absorption by stimulating glycolysis, even though glycolysis alone is not enough. We conclude that alveolar fluid absorption determined in isolated rat lungs is not influenced by intraalveolar oxygen concentration in the range above 10% oxygen.