Takuo Kusano

Thoracotomy in Patients with Liver Cirrhosis

Of 1030 patients requiring thoracotomy over a 7-year period, 11 had cirrhosis of the liver. The disease was severe (Child class C) in four patients, two of whom had recent variceal bleeding. Control patients with normal liver function recovered from post-thoracotomy hepatic disturbance within a week, but the cirrhotic patients required 2-3 weeks to regain baseline function. Although there were no perioperative deaths among the cirrhotic patients, management of significant pleural effusions required diuretics and plasma or albumin supplementation. Presence of cirrhosis, even advanced disease, need not contraindicate thoracotomy with skilled postoperative management, but the poor overall prognosis in Child class C cirrhosis calls for careful assessment of surgical indication.

Expression of Bc1-2 Protein in Non-small Cell Lung Carcinoma.

原発性非小細胞肺癌におけるBcl-2 (B cell lymphoma/leukemia2) 遺伝子蛋白の発現について免疫組織学的に検討した.Bcl-2の発現は, 腺癌7/107例 (6.5%), 扁平上皮癌17/58例 (29.3%), 腺扁平上皮癌0/23例 (0%), 大細胞癌1/11例 (9.1%), 腺様嚢胞癌1/1例 (100%) に認められ, 扁平上皮癌は腺癌, 腺扁平上皮癌に比べ有意に高発現を示した (P<0.001, P<0.005).また臨床病理学的諸因子では, 腫瘍の局在が肺門型の群 (hilar v.s.peripheral, P<0.05), 進行病期の早い群 (I+II v.s.III+IV, P<0.05) に有意に高率に発現し, 発現陽性群は陰性群に比し予後良好の傾向があった (P<0.1).また進行病期I-II期の扁平上皮癌の検討でも陽性群は陰性群に比し有意に予後良好であった (P<0.04).肺癌におけるBcl-2蛋白の発現は, 癌進展の比較的初期に関わり, 扁平上皮癌の予後因子である可能性が示唆された.

Malignant fibrous histiocytoma in the thoracic region —A clinico-pathologic investigation

Seven cases of malignant fibrous histiocytoma (MFH); 3 originating in the thoracic region, one which was considered to arise from the lung parenchyma, and 4 which were metastatic to the lungs, are presented herein. Six of these patients underwent surgical excision and analysis under light and electron microscopy revealed the lesions of MFH to be composed of two cell types; a fibroblast-like cell and a histiocyte-like cell. The latter showed histologically characteristic growth in a so-called storiform pattern. In all patients adjuvant chemotherapy was performed, although in only one patient did it prove temporarily effective. Despite the fact that the prognosis of MFH in the thoracic region is poor, the suggested therapy for longer survival is resection with postoperative combination chemotherapy including the use of sensitive anticancerous agents.