Sugato Nawa

Prognostic impact of intratumoral vessel invasion in completely resected pathologic stage I non–small cell lung cancer

OBJECTIVE Intratumoral vessel invasion of non-small cell lung cancer is a readily available tumor-related factor that provides direct evidence of microscopic tumor invasion. We assessed the prognostic influence of intratumoral vessel invasion and its ability to provide a differential prediction of prognosis for completely resected pathologic stage I non-small cell lung cancer. METHODS We analyzed 258 patients with non-small cell lung cancer who underwent complete resection between January of 1996 and December of 2005 and were diagnosed with pathologic stage I disease. In addition to the conventional staging factors, intratumoral vessel invasion in the primary lesion was histologically evaluated by both hematoxylin-eosin and elastic staining. We examined the significance of intratumoral vessel invasion in prognosis and compared the outcomes between patients with and without this factor with stage IA and IB disease, respectively. RESULTS Intratumoral vessel invasion was found in 124 patients (48%). Five-year survival of patients with or without intratumoral vessel invasion was 74% and 93%, respectively. On multivariate analysis, intratumoral vessel invasion and pleural invasion were shown to be independent prognostic factors. Subgroup analyses suggested that patients with pathologic-stage IA with intratumoral vessel invasion and patients with pathologic-stage IB with both intratumoral vessel and pleural invasion had significantly worse prognosis than patients with the same pathologic stage without these factors. CONCLUSION The current study indicated that intratumoral vessel invasion and pleural invasion are independent prognostic factors. Intratumoral vessel invasion status can complement the size-dependent TNM staging system in pathologic stage I non-small cell lung cancer.

Idiopathic Renal Arteriovenous Fistula Demonstrating a Huge Aneurysm with a High Risk of Rupture : Report of a Case

This paper reports a case of an idiopathic renal arteriovenous fistula demonstrating a huge guitar-shaped aneurysm, which required a total nephrectomy. Although the patient insisted on having been asymptomatic, echocardiography and cardiac catheterization clearly revealed that the influence on hemodynamics was unexpectedly significant. Interestingly, the aneurysm was also considered to have a high risk of rupture, which was preoperatively suggested by an aneurysm wall projection discernible on both computerized tomograms and angiograms, and this suspicion was also convincingly supported by the perioperative and histopathological findings.

Endothelin-1 levels in portal venous blood in relation to hepatic tissue microcirculation disturbance and hepatic cell injury after ischemia/reperfusion.

This study was conducted to clarify the role of endothelin-1 in the portal vein after hepatic ischemia/reperfusion and to ascertain whether it is related to hepatic microcirculation disturbance. Using a canine ischemic liver model, the portal and systemic endothelin-1 levels were measured before ischemia, then after 1h and 2h of reperfusion, and comparatively evaluated with the serum levels of GOT and lactic dehydrogenase (LDH). As an indicator of liver tissue microcirculation, tissue blood flow volume (TBF) was also measured in the site subjected to ischemia. The animals were divided into: group 1, which received ischemia for 30 min; group 2, which received ischemia for 60 min; and group 3, which received a sequence repeated four times of 15 min ischemia and 10 min reperfusion. The portal endothelin-1 level became significantly elevated after reperfusion compared to that before ischemia in all groups, being significantly higher in group 2 than in the other groups. The systemic endothelin-1 level also increased after reperfusion; significantly in group 2. The portal endothelin-1 level was generally higher than the systemic level, which again was statistically significant in group 2. After 2h of reperfusion, a significant positive correlation was found between the portal endothelin-1 level and serum LDH, whereas a significant negative correlation was found between the portal endothelin-1 level and TBF. The finding that the portal endothelin-1 level became elevated after hepatic ischemia/reperfusion suggests that it probably plays an essential role in hepatic ischemia/ reperfusion injury by adversely influencing tissue microcirculation.

Bronchial arteriovenous malformation with large aneurysm, resected by video-assisted thoracic surgery.

Bronchial arteriovenous malformation with a large aneurysm appearing as a mass shadow in the right hilum on chest imaging was successfully extirpated thoracoscopically without any lung resection. Preoperative angiography showed tortuous, enlarged right bronchial arteries with an aneurysm connecting to the pulmonary artery, which could not be totally embolized via the transcatheter approach because of the length of the abnormal bronchial artery and possibility of embolotherapy-induced pulmonary infarction. Histological examination revealed defects of the media and internal elastic lamina of the resected bronchial arteries and aneurysm. The patient was free of hemoptysis and other airway symptoms 4 years after surgery.

Hemodynamic effects of pumpless extracorporeal membrane oxygenation (ECMO) support for chronically pressure-overloaded right heart failure in a canine experimental model

PurposeThis study was done to evaluate the hemodynamic effects of a pumpless implantable extracorporeal membrane oxygenation (ECMO) circuit between the right ventricle (RV) and left atrium (LA) in a chronic canine model with an RV pressure overload.MethodWe created a model of right-sided heart failure by pulmonary artery banding in ten dogs for a duration of more than 3 months. After demonstrating that the RV pressure increased, a bypass circuit was created between the RV and LA with an in-line oxygenator. Both the hemodynamics and gas exchange were measured.ResultsThe effects of a pulmonary bypass in nine dogs were studied. Approximately half of the RV output was passively shunted through the bypass circuit, and a marked reduction in the RV pressure and recovery from right heart failure were observed. After a complete ligation of the main pulmonary artery, five of the nine dogs survived more than 6 h. The RV pressure did not change significantly, but the cardiac output and blood pressure gradually decreased. The blood gas state was sufficiently maintained throughout the experiment.ConclusionThe present study indicates the hemodynamic benefit of a partial pumpless ECMO system in dogs with chronically pressure-overloaded right heart failure; however, the experimental preparation of the total pumpless ECMO circuit proved to be unstable.

Three major coronary artery-to-left ventricular shunts: Report of three cases and review of literature

Among the congenital coronary artery fistulas, diffuse fistulation into the left ventricular chamber, usually expressed in terms of a coronary artery-left ventricular shunt, is not as rare today as was previously thought. However, the origin of such a shunt from all three major coronary arteries is rare. This paper reports three cases of such an occurrence and presents the clinical features and management of this rare anomaly by analyzing 31 cases, including 28 from the literature.

Congenital Coronary Artery Fistulae Arising from Bilateral Coronary Arteries and Emptying into Both Pulmonary Artery and Left Ventricle: A Rare Presentation

Congenital coronary artery fistulae rarely empty into both the pulmonary artery and the left ventricle. To our knowledge, there have been only two such cases reported in the literature. This paper presents a third case. The pattern of drainage into the left ventricle in the present case was, however, quite different from that observed in the previous reports.

The presentation of a double aortic arch in adulthood in association with congestive heart failure attributed to a previously silent aortic regurgitation

This paper describes an adult case of a double aortic arch (DAA; Edwards type IA). The patient had been asymptomatic for DAA but presented difficulty in swallowing in association with congestive heart failure, which she experienced as the result of attending to her sick husband while she apparently suffered from a silent aortic regurgitation. The symptoms disappeared and the patient recovered from heart failure following medical treatment. The patient soon discontinued the outpatient treatment and, after 2 years, the identical symptoms recurred under similar circumstances. In this paper we demonstrate that an asymptomatic case of DAA has the potential to clinically manifest itself.

An unusual complication of a myocardial electrode—Apatite mantle on the platinum-iridium spurs

SummaryA case of a high excitation threshold that occurred 2 years 5 months after the initial implantation of pacemaker electrodes is described in a girl 4 years 3 months of age. This complication was considered to be due to calcification of the platinumiridium electrode spurs. The calcified material was shown to be a kind of apatite using the X-ray powder diffraction method. This complication is rare, but it must be kept in mind since battery longevity has markedly improved in recent years.

A new method for continuous pericardiocentesis--percutaneous pericardial drainage via a sheath-introducer.

A technique of percutaneous pericardial drainage (PPD) utilizing a catheter introducer system, is described herein. This technique combines the accuracy of the surgical method with the simplicity of the ‘blind’ method, and has been clinically applied with safety and success.