Noboru Tanio

CHANGES IN LUNG LOBAR VOLUME AND BRONCHIAL DEFORMITY AFTER RIGHT UPPER LOBECTOMY

To explore the anatomical repositioning of the middle lobe following right upper (RU) lobectomy, we measured the lobar volumes of the lung and the branching angles of the airway, and defined their changes after RU lobectomy in a rabbit model. Groups A1 (n=10) and A2 (n=10) were control groups and groups B1 (n=10) and B2 (n=10) underwent RU lobectomy. Casting material was introduced into the airway and a heart-lung bloc was removed form the thoracic cavity in all groups. In groups A1 and B1, the volume of each lobe of the bilateral lungs was measured, while in groups A2 and B2, bronchial casts were made and the branching angles of the airway were measured. The volume ratio of the right upper lobe (RUL) to the total lung was 12.0 ± 0.4% in group A1; however, after RU lobectomy, the volume ratio of the right middle lobe (RML) to the total lung increased from 8.7 ± 0.6% in group A1 to 13.5 ± 0.8% in group B1. The volume of the left lung also increased from 43.0 ± 0.5% in group A1 to 48.8 ± 1.1% in group B1. The angle between the truncus intermedius and the RML bronchus was significantly smaller in group B2, at 109.0 ± 3.5°, than in group A2, in which it was 138.5 ± 1.7°. The angle between the RML bronchus and the coronal plane was 57.5 ± 2.5° in group A2 and 33.5 ± 3.3° in group B2. Our method of measuring the bronchial branching angle subsequent to RU lobectomy proved useful to illustrate postoperative positional changes and expansion of the remaining lobes.

Platelets as participants in hyperacute guinea pig-to-rat lung xenorejection

It is well known that xenotransplantation leads to immediate graft dysfunction. This study was designed to specifically examine the role of platelets in mediating lung hyperacute xenorejection (HXR) in a guinea pig-to-rat model. A total of 18 lungs were perfused with blood using an ex vivo apparatus. The animals were divided into the following four groups: a CE group comprising circuit only with rat blood; a SYN group comprising rat lungs and blood; a XE group comprising guinea pig lungs and rat blood; and an SH group comprising guinea pig lungs and rat blood with sarpogrelate hydrochloride, a suppresser of platelet aggregation. The platelet and serotonin in the blood were lower and the wet/dry weight ratio of the lung (W/D) in the XE group were higher than those in the SYN group after perfusion. The platelet count was higher, but the serotonin and W/D were lower in the SH group than in the XE group. These results suggest that platelets strongly affect HXR. Thus, the administration of drugs to suppress platelet aggregation would reduce xenotransplanted lung edema.

Pulmonary adenocarcinoma metastatic to the gingiva

Abstract Gingival metastasis from lung cancer is very uncommon. We report a case of distant metastasis of pulmonary adenocarcinoma in the mandibular gingiva. A 54-year-old man was admitted to our hospital on September 1, 1997 with hemoptysis. Right upper lobectomy with mediastinal lymph node dissection was performed on September 16. On the 14th postoperative day, the patient complained of a gingival swelling. In the lower right premolar area, a wide pedunculated mass was seen on the mandibular gingiva. Excisional biopsy of the tumor was performed, and histopathological examination revealed that the tumor was a metastatic lesion from the pulmonary adenocarcinoma. The patient received 46.8 Gy of linac irradiation to the tumor area and the entire oral condition improved markedly. However, bilateral adrenal gland metastases were recognized, and left inguinal lymph node metastasis was detected 2 months after lung resection. He developed tumor metastases to multiple organs and died of respiratory failure on December 12, 1997.

Growth inhibitory factor of human alveolar macrophage

The effect of human lung conditioned medium (HLCM) on the DNA synthesis in cultured human alveolar macrophages (HAM) was evaluated. The medium from human lung cultured for 3 days (3d-HLCM) promoted the DNA synthesis as well as the recombinant human GM-CSF does. On the other hand, that cultured for six days (6d-HLCM) did not promote the DNA synthesis but strongly suppressed GM-CSF induced DNA synthesis in HAM. This growth inhibitory effect was also observed when several macrophage like cell lines were cultured with 6d-HLCM. Partial purification of an inhibitory factor on gel permeation HPLC revealed two distinct peaks of activity with molecular weights of 38 kd and 110 kd.

Analysis of Urinary Fibronectin (UFN) using Human Lung Cancer Cells Transplanted into Nude Mice.

血漿や結合組織など生体内に広く存在するフィブロネクチン (FN) は癌患者尿中に多量に出現し, この尿中FN (UFN) は癌化, 癌細胞増殖, 宿主正常細胞の反応, 転移など様々な過程との関連が示唆されている. 今回我々はこれらの過程のうち, 生体内における癌細胞増殖とUFNとの関連を明らかにする目的で, マウスと交叉反応を示さないUFN測定キットを用い, ヒト肺癌細胞担癌マウスのUFNを測定した. その結果, 非担癌マウス, 癌細胞移植後腫瘍形成前, 腫瘍形成後の3群間でUFNは有意に増加した. また腫瘍形成後の腫瘍推定重量とUFNに相関がみられた. 病理学的に皮下腫瘍は癌細胞で構成され, FN染色陽性であった. 明らかな転移病巣はみられなかった. 癌化や転移, 宿主反応の影響を除外した生体モデルにおいてUFNが上昇したことより, 腫瘍細胞に由来するFNが尿中へ排泄され, UFNとして測定されていることが強く示唆された.

Exploratory Thoracotomy for Pulmonary Nodules.

術前に確定診断を得られなかった肺腫瘤陰影の特徴を明らかにするため, 当教室における開胸生検例を検討した. 過去5年間の肺疾患手術204例のうち, 腫瘤陰影に対して開胸生検を施行した20例 (9.8%) を対象とした. 男性14例, 女性6例, 13～78歳, 腫瘤径は13～55mmであり, 画像診断に気管支鏡所見や病理診断などを加えて得られた臨床診断は,「悪性疑い」10例,「良悪性判定不能」10例であった. 開胸時の所見と術中迅速診から, 肺癌には肺葉切除術+縦隔リンパ節郭清, 良性疾患には核出術や肺部分切除術を中心とする術式を選択した. 術後病理診断は腺癌10例, 良性腫瘍5例, 結核腫5例であった. 術前「悪性疑い」10例のうち良性疾患は3例 (いずれも結核腫) であった. また「良悪性判定不能」10例のうち3例が腺癌であった. 術前に確定診断を得られなかった肺腫瘤陰影に対し, 積極的に胸腔鏡あるいは開胸による生検を行うことは意義のあることと考えられた.