Yoshinori Hiramatsu

Influence of pH of preservation solution on lung viability.

Recently, various solutions for organ preservation have been introduced. Despite much debate regarding the composition of preservation solutions, the ideal pH of a preservation solution has not been determined. We investigated the effects of the pH of a lung preservation solution on viability using an isolated, ventilated lung perfusion model. Initially, we performed flush perfusion with solutions of five different pH groups (6.60, 7.00, 7.40, 7.80 and 8.20, measured at 10 degrees C). Lungs perfused with pH 6.60 solution had a significantly higher pulmonary vascular resistance than those perfused with pH 7.40, 7.80 and 8.20 solutions. Blood was washed out completely and uniformly with solutions of pH 7.40 and 7.80. After preservation the arterial oxygen tension was significantly greater in pH 7.40 and 7.80 groups than in pH 6.60, 7.00, or 8.20 groups. Moreover, pulmonary artery pressure, airway pressure, and wet/dry weight ratios in the pH 7.40 and 7.80 groups were lower than in the others. We conclude that for both pulmonary flush and storage preservation, solutions of pH 7.40 to pH 7.80 are optimal for lung preservation.

A prospective, multi-institutional phase II study of induction chemoradiotherapy followed by surgery in patients with non-small cell lung cancer involving the chest wall (CJLSG0801)

OBJECTIVES The standard therapy for patients with T3N0-1M0 non-small cell lung cancer (NSCLC) involving the chest wall is considered surgical resection and adjuvant therapy. However, the compliance of adjuvant therapy is relatively low, and the prognosis for those patients has been unsatisfactory. Therefore, we conducted a phase II study of induction chemoradiotherapy followed by surgery with the aim of improving the survival. PATIENTS AND METHODS This treatment strategy consisted of induction chemotherapy (two cycles of cisplatin at 80mg/m2 on Day 1 and vinorelbine at 20mg/m2 on Days 1 and 8) concurrent with radiotherapy (40Gy in 20 fractions) followed by surgery. The inclusion criteria were patients with resectable T3N0-1M0 NSCLC involving the chest wall who were 20-70 years of age. The primary end point was the 3-year survival, assuming an expected rate of 67%. RESULTS From January 2009 to November 2012, 51 eligible patients were enrolled. Induction therapy was completed as planned in 49 (96%) patients without treatment-related death, and 25 (51%) had a partial response. Complete resection combined with the involved chest wall was achieved in 46 (92%) patients, and a pathologic complete response was seen in 13 (26%) patients. Five patients experienced major postoperative complications, and 1 patient died of acute exacerbation of interstitial pneumonia. With a median follow-up period of 42 months, the 3- and 5-year overall survivals of all registered patients were 77% and 63%, respectively. There was a significant difference in the survival rate between patients with a pathologic complete response and those with a residual tumor (p=0.039). CONCLUSION The mature results of this study in a multi-institutional setting showed the treatment strategy to be safe and effective with a high rate of pathologic response for patients with NSCLC involving the chest wall.

Laparoscopic Splenectomy for the Patients with Idiopathic Thrombocytopenic Purpura.

特発性血小板減少性紫斑病 (以下, ITPと略記) の2例に対し腹腔鏡下脾摘術を施行したので報告する. 症例は63歳の男性と57歳の女性で, いずれも内科療法にて副作用の合併したITPの患者である. 手術: 体位を右斜め側臥位とし, 5本のトロッカーを挿入した. まず脾外側の腹膜を切開し, 脾結腸間膜を脾に沿って切離した. 次に胃脾間膜と膵脾間膜を脾に沿って徐々にEndo-Clip, Endo-Scissors, Endo-GIAを用いて脾臓を摘出した. 脾臓はEndo-pouchに収納し, 創を広げることなく砕いて腹腔より摘出した. 出血量は190mlと200mlで, 手術時間は3時間35分と3時間05分であった. ITPにおいて腹腔鏡下脾臓摘出術はステロイド療法に比べ, 副作用, 入院期間などはるかに優れており, 寛解率も良く, また疾患としても若い女性に多いことより美容的にも優れており, 治療方針として積極的に選択すべき方法と思われる.