Tsugio Furukawa

Langerhans cells and prognosis in patients with gastric carcinoma

Infitration of Langerhans cells (LC) and macrophages into tumor tissues was investigated using immunohistochemical methods, anti‐S‐100 protein and anti‐lysozyme antibodies in 174 cases of gastric carcinoma. Varying population densities of S‐100‐positive LC were noted in tumor tissues; lysozyme‐positive macrophages, however, were found in almost equal quantities. LC were mainly interspersed among the tumor cells, whereas macrophages were present in the stroma and around the necrotic foci. Although the survival time of patients with Stage I, II or IV gastric carcinoma did not relate to the density of LC, survival time in Stage III patients correlated well with the density of LC. In patients with a marked infiltration of LC, survival time was longer than in cases of only a slight infiltration (P < 0.001). Therefore, LC in immunological defense mechanisms of the host against the tumor may be clinically effective in a certain phase of tumor development.

Arterial Hypoxemia in Patients With Hepatic Cirrhosis

Pulmonary function tests were studied in 105 patients with cirrhosis of the liver who had no clinical or radiographical evidence of cardiopulmonary disease. Spirometric data such as VC, FRC, RV, TLC, RV/TLC and FEV1.0% were within normal limits in all subjects. However, flow-volume curve and closing volume curve were abnormal in the majority. In flow-volume curve, &OV0312;25, was decreased and the &OV0312;50/&OV0312;25 value was increased; on the other hand, closing volume was markedly increased and FRC-CC value was reduced in the patients with hepatic cirrhosis. The closing capacity tended to exceed the FRC in the patients with arterial hypoxemia, indicating the presence of airway closure and gas trapping during resting ventilation. Therefore, ventilation-perfusion imbalance may be an important cause of arterial hypoxemia in patients with cirrhosis of the liver.

Mechanisms involved in acute lung edema induced in dogs by oleic acid

We investigated mechanisms related to the development of acute lung edema, as induced by oleic acid in adult mongrel dogs. The intravenous injection of oleic acid (0.04 ml/kg) was considered to induce a permeability edema, as an enhancement of transvascular protein clearance was observed after the injection. The effects of oleic acid injection on systemic blood pressure (SBP), pulmonary arterial pressure (PAP), pulmonary arterial wedge pressure (PAWP), cardiac output (CO) and airway pressure (AWP) were measured. A significant decrease in CO and increase in AWP were evident after the injection, but there were no changes in SBP, PAP and PAWP. Treatment of the animals with prostaglandin I2 (PGI2) did not alter the induction of edema by oleic acid. However, the decrease in CO and increase in AWP were normalized by treatment with PGI2. Blood platelet count was not affected by oleic acid given in a dose of 0.04 ml/kg. To determine the direct effect of oleic acid on the vascular endothelium, the agent was injected through a catheter placed in the pulmonary artery. Electron microscopic examination revealed severe vacuolation on the endothelium of the pulmonary artery after only 1 min of exposure to oleic acid. Increased permeation of Evans blue into the subendothelial tissue was also observed with oleic acid treatment, compared with findings in the controls. These results indicate that the lung edema induced by oleic acid is due to an increased protein clearance, probably through a direct toxic effect on the vascular endothelium rather than an indirect toxic effect of chemical mediators released from the aggregated platelets.

Effect of decreased plasma colloid osmotic pressure on development of pulmonary edema in dogs

The effect of decreased plasma colloid osmotic pressure on the development of pulmonary edema was studied in anesthetized dogs. Lung lymph flow was used as a sensitive and reliable indicator of fluid filtration rate in the lung. When plasma colloid osmotic pressure alone was reduced by slow infusion of saline, and hydrostatic pressure in the pulmonary vascular bed was maintained at normal level by exsanguination, lung lymph flow increased almost linearly with the reduction in colloid osmotic pressure, but was not increased more than five fold of the control, despite a reduction of 80% in the plasma colloid osmotic pressure. Furthermore, there was no evidence of fluid in the tracheal aspirations and no gross evidence of pulmonary edema. In contrast, both decrease in colloid osmotic pressure and increase in pulmonary capillary hydrostatic pressure produced a marked increase in lung lymph flow. This flow varied linearly with the level of the pulmonary artery wedge-plasma colloid osmotic pressure difference and approached twelve fold of the control, when the plasma colloid osmotic pressure was reduced by 73% and the pulmonary artery wedge pressure was elevated by 20 mmHg from the baseline. Our data indicate that decreased colloid osmotic pressure is not associated with the development of pulmonary edema, when there is no increase in pulmonary vascular hydrostatic pressure.

Pulmonary Interstitial Edema in Experimental Cirrhosis of the Liver in Rats

To determine whether interstitial pulmonary edema occurs or not in experimental cirrhotic rats, male Sprague-Dawley rats were given carbon tetrachloride subcutaneously in order to induce liver cirrhosis. The percent lung water content of the cirrhotic rats increased to 79.1 +/- 0.7% compared to 77.4 +/- 0.9% in control rats (p less than 0.001). Microscopically, 8 of 10 cirrhotic rats show the pulmonary interstitial thickening with lymphocytic infiltration. Moreover, perivascular edema with dilatation of lymphatics was frequently recognized. This suggested that fluid retention of pulmonary interstitial tissue would occur in the cirrhotic rats, and then perivascular edema would compress the small airways of the lung in cirrhotic rats.

Thymoma: Clinicopathologic features, therapy, and prognosis

We have treated 40 patients with thymoma. All the 18 with benign thymoma were treated with resection alone and none had a tumor recurrence or died from disease-related causes. Postoperative survival in this group ranged from 2 months to 14 years. Of the 22 patients with malignant thymoma, 2 underwent total resection, 10 partial resection and 10 were non-resectable. Fifteen of the 20 patients with non-resectable and partially excised thymomas were given radiotherapy. The cumulative 5- and 10-year survival rate of irradiation treated patients was 45.6%, and 34.4%, respectively. Of 6 non-irradiated patients, only one who underwent complete excision of tumors survived for more than 10 years, and 5 died within 3 years after treatment. Based on our findings we suggest that all patients with malignant thymoma, irrespective of the extent of surgical treatment, should be given postoperative irradiation.

Relationship between postoperative hypoxemia and the operative site.

The effect of the site of operation on postoperative hypoxemia was studied in 104 patients undergoing thoraco-abdominal, thoracic, upper abdominal, lower abdominal, extra-abdominal and non-thoracic operations. The degree of postoperative hypoxemia was the most extensive in patients undergoing thoraco-abdominal, moderate in thoracic and upper abdominal operations, and minimal in lower abdominal and other operations. On the other hand, the duration of hypoxemia also differed with the surgical procedures. Arterial oxygen tension returned to almost control values by the 3rd postoperative day in cases of lower abdominal and extremity operations and by the 7th postoperative day in those undergoing thoracic and upper abdominal surgery. Postoperative hypoxemia, however, remained throughout the fourteen day study period, in patients undergoing thoraco-abdominal operation. True shunt was measured in 27 patients with thoraco-abdominal, thoracic and upper abdominal operations. An increase in true shunt was evident postoperatively in the entire group of patients. The increase was significantly larger and longer lasting in cases of thoraco-abdominal incision than that in cases of thoracic and upper abdominal incision alone. Differences in postoperative true shunt between cases of thoracic and upper abdominal incisions were nil.

Effect of free fatty acid on pulmonary transvascular fluid and protein exchange

SummaryWe demonstrated the effect of infusion of oleic acid, a common free fatty acid, on pulmonary vascular permeability in anesthetized dogs prepared with a lung lymph fistula. Infusion of oleic acid caused significant increases in lung lymph flow with no change in L/P protein ratio, resulting in significant increases in transvascular protein clearance. Pulmonary arterial and pulmonary arterial wedge pressures increased significantly from baseline but their elevation was slight. Cardiac output decreased significantly after oleic acid infusion. In contrast to the effects of oleic acid, left artrial hypertension caused increases in lung lymph flow that were associated with decreases in the L/P protein ratio. Lung water content was increased after oleic acid infusion, despite little effect on pulmonary vascular pressures. These findings indicate that oleic acid produced endothelial lung injury and increased pulmonary vascular permeability.

Abnormalities in maximum flow volume curve and closing volume in patients with hepatic cirrhosis

Pulmonary functions were measured in 53 patients with hepatic cirrhosis in whom there was no clinical or radiographic evidence of pulmonary involvement. Spirometric tests such as total lung capacity, vital capacity, functional residual capacity, residual volume and forced expiratory volume during one second were within normal ranges, in all subjects. Flow volume curve and closing volume tests, however, were abnormal in the majority. The maximal expiratory flow at 50 per cent of vital capacity was not altered but the maximal expiratory flow at 25 percent of vital capacity was decreased significantly in patients with hepatic cirrhosis. The closing volume in patients with hepatic cirrhosis was also significantly increased. The abnormalities in flow volume curve and closing volume curve were also demonstrated in non-smokers, and at any age, in cases of hepatic cirrhosis. These results suggested that the narrowing or closure in small airways may occur in patients with hepatic cirrhosis. These changes may be due to mechanical compression of small airways by interstitial edema which was induced by presence in the circulating blood of vasoactive substances and endotoxins.

A Case of Synchronous Quadruple Lung Cancer.

癌病巣のみられた同時性肺多発癌の1例を経験した. 患者は50才, 男性で血痰を主訴として来院. 気管支鏡検査を施行したところ, 右B1, 右B3, 右下葉支入口部および左B1+2にそれぞれ連続性のない4ヵ所に腫瘍を認め, 生検の結果はすべて扁平上皮癌であった. 肺機能上すべて外科的に切除することは不可能であり治療の選択にあたっては外科的切除との組み合わせも考慮したが, 最終的にはレーザーおよび放射線治療を行い, さらにCDDP, CBDCA, VP-16による化学療法を追加した. 退院後3ヵ月おきに気管支鏡にてFollowを行っているが, 治療開始後2年を経過した現在再発を認めていない.