Shinpei Yoshii

Protein overexpression and gene amplification of c-erb B-2 in pulmonary carcinomas: a comparative immunohistochemical and fluorescence in situ hybridization study.

Amplification of the c-er b B-2 gene (located on 17q11.2–12) is accompanied by overexpression of its cell surface receptor product, p185ERBB2. In pulmonary carcinomas, however, there has been disagreement between the reported frequencies of gene amplification and overexpression. To clarify their relationship, the correlation between the cellular expression of p185ERBB2 and the level of c-erbB-2 gene amplification was studied. A total of 195 pulmonary carcinomas (182 primary and 13 metastatic) were examined immunohistochemically using a polyclonal antibody, which recognizes the internal domain of the human c-erbB-2 protein, and positive tumors were further examined for the gene amplification by dual-color fluorescence in situ hybridization using probes for centromere 17 and 17q11.2–12. By immunohistochemistry, distinct membrane staining was found in an adenocarcinoma, a large cell carcinoma and a metastatic carcinoma from the breast, and cytoplasmic and/or faint membranous staining was observed in 23 non-small cell lung carcinomas. It was in the two primaries and the metastatic carcinoma that more than 8-fold amplification of c-erbB-2 was found by fluorescence in situ hybridization. Especially, in the two primary carcinomas, tumor cells had amplified genes with the signals forming one or two clusters, indicating that the amplified gene was present in homogeneously staining regions. Among the 23 tumors, three tumors showed low-level amplification (less than 3-fold), which was differentiated from polysomy 17 found in the other two. In the 30 non-small cell lung carcinomas selected at random from 151 with negative immunostaining, there were five trisomy 17, but no tumors with the gene amplification. This suggests that although c-erbB-2 amplification in pulmonary carcinoma is rare, it occurs in the form of a homogeneously staining region and is thought to control the overexpression of the protein in the cell membrane. New adjuvant therapy using a humanized antibody to the oncoprotein may be beneficial to patients with these tumors.

Angiogenic strategy for human ischemic heart disease: Brief overview

In the Western World ischemic coronary disease is the leading cause of morbidity and mortality. Therapeutic approaches mostly aim to restore flow to a localized segment by angioplasty or bypass surgery. Therapeutic angiogenesis and or arteriogenesis describes a strategy where blood vessel formation is induced for the purposes of treating and/or preventing ischemic disease. At present, at least 17 clinical trials of myocardial angiogenesis have been presented involving over 900 patients. Therapeutic angiogenesis makes use of the administration of angiogenic growth factor protein or gene to promote the development of endogenous collateral vessels in ischemic myocardium. Most recently, interest has grown in the potential angiogenesis effects of cell therapy—such as autologous bone marrow cells or cultured stem cells—and there are now several groups initiating phase I/II trials in this area. (Mol Cell Biochem 264: 143–149, 2004)

Partial left ventriculectomy in a 3-year-old boy with dilated cardiomyopathy

A 3-year-old boy suffered severe heart failure 2 months after ventricular septal defect repair. The cardiothoracic ratio was 67% and the ejection fraction 13%. Echocardiography showed a dilated left ventricle and thin myocardium. After thorough study, we made a diagnosis of dilated cardiomyopathy. Because conventional therapy was unsuccessful, we conducted partial left ventriculectomy with Alfieri repair of the mitral valve. The postoperative cardiothoracic ratio was 57% at 1 year of follow-up and the ejection fraction 40%. The New York Heart Association functional class improved from IV to I. In conclusion, the role of partial left ventriculectomy is both as a bridge to transplantation and as a definitive repair in dilated cardiomyopathy during childhood.

Partial left ventriculectomy in an infant with dilated cardiomyopathy

being living autogenous tissue. Hence the potential for growth exists when the pulmonary autograft is used in the aortic position, and that is the reason the Ross operation is considered ideal for aortic valve replacements in infants and children. However, the potential for growth is lost when the pulmonary autograft is used in the mitral position because it has to be housed within the Dacron tube. On the other hand, inasmuch as the autograft is lying in the left atrium as a top hat, a partial or total preservation of the mitral valve apparatus is feasible, as was done in our patient. The autograft is a living autogenous tissue, fully flexible, and it cannot obstruct the left ventricular outflow tract because of its position inside the left atrium (Figs I and 2). The improved clinical condition of our patient, freedom from anticoagulation, absence of thromboembolism, and the maintained excellent performance of the pulmonary autograft in the mitral position 6 years later cautiously support this procedure as a viable alternative in specific clinical situations requiring replacement of the mitral valve. However, a larger The Journal of Thoracic and Cardiovascular Surgery March 1999

Left atrial dissection after aortic valve replacement

J Thorac Cardiovasc Surg 2003;126:604-605 and Yusuke Tada Hiroshi Osawa, Shinpei Yoshii, Shigeru Hosaka, Shoji Suzuki, Samuel J. K. AbrahamLeft atrial dissection after aortic valve replacement http://jtcs.ctsnetjournals.org/cgi/content/full/126/2/604 located on the World Wide Web at: The online version of this article, along with updated information and services, is

A modified infarct exclusion technique: Triple-patch technique for postinfarction ventricular septal perforation

Postinfarction ventricular septal perforation (VSP) remains an important complication of myocardial infarction. The prevalence is approximately 1% to 2% among patients withacutemyocardialinfarction,anditisoftenfatalunless surgical treatment is performed. Despite numerous improvements in surgical technique, the mortality remains about 19% to 40%. 1 Perioperative low-output syndrome and residual shunt are associated with a poor outcome. We operated on 4 patients with our simple technique that minimizes residual shunting. Materials and Methods OPERATIVE TECHNIQUE. Cardiopulmonary bypass was established, and myocardial revascularization if necessary was performed on the beating heart before repair of the VSP. The heart was then arrested with a cardioplegic solution, and repair was done through a longitudinal left ventriculotomy in the infarcted area, about 1 to 2 cm away from the left anterior descending coronary artery. First, a tailored small bovine pericardial patch was used to close the VSP directly with a running 3-0 polypropylene suture. Then two bovine pericardial patches were cut into rectangular shapes. One pericardial patch was sutured to the noninfarcted endocardium around the ventricular septal side, and the other patch was sutured to the noninfarcted endocardium of the anterolateral ventricular wall, both with running 3-0 polypropylene sutures. These two patches were then cut and sewn to determine the ideal size and shape of the pouch fitting the left ventricular cavity to make an infarct exclusion. After the VSP patch and endoventricular pouch were sutured, fibrin glue was applied to fill the cavity between the patches. The ventriculotomy was closed in two layers with two polytetrafluoroethylene felt strips and 2-0 polypropylene sutures (Figure 1). PATIENTS. Between 1996 and 2006, a total of 10 patients underwent VSP repair. Through 2003, we performed VSP repair by the David‐Komeda method in 6 patients. Since 2004, the new triplepatch technique has been used for all patients. STATISTICAL ANALYSIS. Preoperative and postoperative variables were compared between the two operative groups with the Mann‐Whitney U test.

Prevention of surgical site infection by antibiotic spraying in the operative field during cardiac surgery.

OBJECTIVE Despite the many procedures introduced to prevent surgical site infection during cardiothoracic surgery, serious infections still occur. We attempted to reduce surgical site infection by spraying antibiotic solution in the operative field--a procedure since introduced at 4 other Japanese institutions. METHODS In the latter half of 1990, we began spraying an antibiotic solution of cefazolin (1g) and gentamicin (40 mg)/40 ml of saline placed in a 50 ml syringe and dispensed through an 18 G needle bent at 60 to 80 degrees to clean the wound during surgery. RESULT No deep surgical site infections or deaths due to infection have occurred among the 502 patients undergoing cardiothoracic surgery under cardiopulmonary bypass at our hospital. This method was used in over 2,100 cases of similar procedures at 4 other institutions. There were 3 deaths due to severe surgical site infection (0.11%). At one institution treating over 1,000 cases a year, the incidence of death due to surgical site infection decreased significantly after this method was introduced. CONCLUSION These preliminary experiences show that spraying antibiotic solution in the operative field reduces the risk of surgical site infection in cardiothoracic surgery.

Cimetidine reduces impairment of cellular immunity after cardiac operations with cardiopulmonary bypass

OBJECTIVE Depressive effects of cardiopulmonary bypass on cell-mediated immune responses may lead to postoperative infectious complications. We previously reported that cimetidine reduced postbypass depression of the cytotoxic activity of natural killer cells. This study evaluated cimetidine as an agent to preserve cellular immunity after cardiac operations. METHODS In a prospective randomized study, 20 patients were divided into two groups of equal size. Cimetidine-group patients received 400 mg of cimetidine intravenously before bypass and a 33 mg/hr intravenous infusion of cimetidine after the operation, continuing until the fifth postoperative day. Control-group patients received conventional perioperative therapy. Lymphocyte subsets, natural killer cell activity, percentage of CD56+CD16+ (percentage of natural killer cells), and percentage of CD11b+CD8+ (percentage of suppressor T lymphocytes) were measured perioperatively. RESULTS Although temporary postoperative reductions in percentages of CD3+, CD4+, and CD56+CD16+ cells were observed in both groups, CD8+ percentages on postoperative day 1 and CD11b+CD8+ percentages on postoperative days 1 and 3 in the cimetidine group were significantly lower compared with those in the control group (p = 0.01,p = 0.004, andp = 0.02, respectively). Temporary postoperative reduction of natural killer cell activity was also observed in both groups, but the natural killer cell activity on postoperative day 1 in the cimetidine group (17.1%) was significantly higher (p = 0.02) than that in the control group (8.20%). CONCLUSIONS Cimetidine counteracts depressive effects of cardiopulmonary bypass on cell-mediated immunity and may possibly reduce postoperative susceptibility to infection.

Early and Late Outcomes of Aortic Valve Replacement Using Bioprosthetic Versus Mechanical Valve in Elderly Patients: A Propensity Analysis.

There is still controversy on the use of mechanical valves to treat elderly patients with a small aortic annulus who require aortic valve replacement (AVR). We compared our results in elderly patients who underwent AVR with a bioprosthetic or mechanical valve. Propensity matching adjusted for baseline differences in this study.

Alternative Technique for Implanting an Implantable Cardioverter Defibrillator in Infants

We applied a new implanting technique for an implantable cardioverter defibrillator (ICD) in a 4-month-old girl with repeated ventricular fibrillation (Vf) due to long QT syndrome. This technique consisted of placement of an oval patch lead on the outer surface of the pericardium in the left pleural cavity. This was useful in preventing the complications of the conventional epicardial patch leads (ie, crinkling of the lead and constrictive pericarditis). This patch should be contemplated as an alternative option for implanting ICD in infants.