Yukihito Saito

Prognostic significance of p53, Ki-67, VEGF and Glut-1 in resected stage I adenocarcinoma of the lung

OBJECTIVES The purpose of this study was to evaluate the prognostic significance of various biological factors in patients with resected stage I adenocarcinoma. METHODS We immunohistochemically examined 47 specimens of surgically resected adenocarcinomas to evaluate the expression of the biological markers p53, Ki-67, vascular endothelial growth factor (VEGF) and glucose transporter-1 (Glut-1). Angiogenesis grade and tumor vessel invasion was also investigated. Actuarial survival was analyzed by the Kaplan-Meier method. Clinical variables and biological markers were analyzed using the Coxs proportional hazards model for multivariate analysis to identify independent prognostic factors. RESULTS The overall survival rate for the whole series was 85.1% at 3 years and 71.9% at 5 years, with a median survival time of 73 months. Differentiation, Ki-67, Glut-1, VEGF, tumor vessel invasion and microvessel density (MVD) were significant prognostic factors by univariate analysis, with Glut-1 expression the most important prognostic factor for survival (P<0.0001). After multivariate analysis, only Glut-1 expression remained as a prognostic factor for survival. CONCLUSION Glut-1 expression can be a predictor for prognosis in patients with resected stage I adenocarcinoma of the lung.

New Tubular Bioabsorbable Knitted Airway Stent: Feasibility Assessment for Delivery and Deployment in a Dog Model

PURPOSE The aim of this study was to determine whether it is possible to deliver and deploy a new device, a poly-L-lactic acid (PLLA) tubular knitted airway stent, under bronchoscopic guidance in a dog model. DESCRIPTION The delivery system consisted of a flexible balloon catheter (controlled radial expansion balloon dilator, M00558440, Boston Scientific Corporation, MA, USA) preloaded with a stent. A delivery catheter preloaded with a stent was advanced to a target point in the trachea under bronchoscopic guidance. Once the stent was positioned, the balloon was inflated for sixty seconds. The stent was in full contact with the tracheal wall upon deflation of the balloon. EVALUATION The stents were successfully delivered into the tracheal lumen and successfully deployed in all dogs. CONCLUSIONS This is the first study to prove the feasibility of delivering and deploying the PLLA stents in a dog model, using a balloon expansion technique. Further investigation with large numbers of subjects and long-term follow-up will be necessary to assess the utility of the bioabsorbable knitted tubular stent before clinical applications begin.

A new bioabsorbable sleeve for staple-line reinforcement: report of a clinical experience.

AbstractPurpose. The most frequent and troublesome complication after resection of an emphysematous lung is persistent air leakage. This report describes our recent experience of using sleeves made of polyglycolic acid to reinforce staple-lines to reduce air leaks after resection of emphysematous lung. Methods. We used bioabsorbable sleeves made of polyglycolic acid (PGA) for staple-line reinforcement during lung resections in 25 patients with emphysema. Results. Immediately after stapling, no air leaks were detected in 20 patients (80%), although prolonged air leaks lasting for more than 7 days were observed in three patients (12.5%). Conclusion. PGA sleeves do not constitute a foreign body that stays in the host lung, and they require no rinsing at the time of clinical use. Therefore, the PGA sleeve could be a promising new material instead of non-absorbable materials and xenomaterials for staple-line reinforcement.

Fate of fibrin sealant in pericardial space

BACKGROUND Although fibrin sealant (Beriplast, Aventis Behring, Marburg, Germany) has been widely used as a supplementary measure for hemostasis during cardiac surgery in Europe and is becoming popular in the United States, the pharmocokinetics of fibrin sealant applied in pericardial space has not been elucidated. METHODS A small incision was made on the epicardial surface of the left ventricle of a rat, and the incision was sutured. Total 0.2 ml of fibrin sealant containing iodine 125 (125I)-labeled fibrinogen, aprotinin, blood coagulation factor XIII and thrombin was applied to the area around the suture line. RESULTS Distributions of 125I-labeled fibrinogen in the heart on postoperative days 1, 3, 7, and 14 were 48.2% +/- 1.8%, 20.7% +/- 2.2%, 0.15% +/- 0.02%, and 0.01% +/- 0.02%, respectively. The radioactivity was negligible in the blood, liver, spleen, and kidney except for the thyroid in which the radioactivity increased to 7.9% +/- 0.7% and 4.3% +/- 0.4%, respectively, on postoperative days 7 and 14. Iodine 125-labeled fibrinogen concentrations of the heart and other organs showed a similar change in the time course of distribution. Dense and thick fibrin network, observed on postoperative day 1, had dissipated and was thinner with collagen formation by postoperative day 7. CONCLUSIONS Fibrin sealant applied to the pericardial cavity regresses rapidly and plays an important role in wound healing.

Three-step management of pneumothorax: time for a re-think on initial management

Pneumothorax is a common disease worldwide, but surprisingly, its initial management remains controversial. There are some published guidelines for the management of spontaneous pneumothorax. However, they differ in some respects, particularly in initial management. In published trials, the objective of treatment has not been clarified and it is not possible to compare the treatment strategies between different trials because of inappropriate evaluations of the air leak. Therefore, there is a need to outline the optimal management strategy for pneumothorax. In this report, we systematically review published randomized controlled trials of the different treatments of primary spontaneous pneumothorax, point out controversial issues and finally propose a three-step strategy for the management of pneumothorax. There are three important characteristics of pneumothorax: potentially lethal respiratory dysfunction; air leak, which is the obvious cause of the disease; frequent recurrence. These three characteristics correspond to the three steps. The central idea of the strategy is that the lung should not be expanded rapidly, unless absolutely necessary. The primary objective of both simple aspiration and chest drainage should be the recovery of acute respiratory dysfunction or the avoidance of respiratory dysfunction and subsequent complications. We believe that this management strategy is simple and clinically relevant and not dependent on the classification of pneumothorax.

Management of a complicated pulmonary fistula caused by lung cancer using a fibrin glue-soaked polyglycolic acid sheet covered with an intercostal muscle flap

Pulmonary fistulas caused by tumours are very fragile and difficult to suture directly. It is impossible to close pulmonary fistulas with tissue sealants when massive air leakage occurs in the low pressure of the respiratory tract. A 73-year-old man with a pneumothorax caused by lung cancer had suffered a persistent massive air leakage for more than one month. We used a fibrin glue-soaked polyglycolic acid (PGA) sheet for sealing the complicated fistula. In addition, the visceral pleura of the fistula was wrapped with the pedicle of an intercostal muscle (ICM) flap to prevent massive air leakage. The pneumothorax did not reappear after surgery. Thus, a fibrin glue-soaked PGA sheet covered with an ICM flap was effective for sealing an intractable air-leaking fistula caused by lung cancer.

Reperfusion injury induced by augumented oxygen uptake in the initial reperfusion period: Possible efficacy of extreme hemodilution

This study was designed to investigate the relationship between myocardial oxygen consumption and oxygen-induced myocardial injury. Dog hearts were exposed to 40 min normothermic ischemia and then reperfused for 10 min with three oxygenated perfusates containing different hemoglobin concentrations and with moderate hemodilution. The experimental groups consist of a moderate hemodilution group (Group M) receiving 8 g/dl of hemoglobin, an extreme hemodilution group (Group E) given 4 g/dl of hemoglobin, and a hemoglobin-free autologous plasma group (Group F). Hearts in the non-ischemic control group (Group C) were also perfused with moderate hemodilution throughout. In Group C, Group M and Group E, the O2 tension of perfusates was maintained at about 100 mmHg and in Group F, at over 300 mmHg. Oxygen extraction at 5 min after reperfusion in Group C was 14%, in Group M and Group E less than 10%, but in Group F 70%. Oxygen consumption in Group F was more than twice that in Group E and surpassed that in Group C. Group M also showed a significant increase in oxygen consumption compared with Group E at 5 min after reperfusion. Among the ischemic groups, Group E showed improvement of left ventricular function almost comparable to Group C accompanied by a rapid decrease in myocardial lactate, improved preservation of myocardial adenine nucleotides and prevention of myocardial lipid peroxidation. In contrast, Group F showed persistently higher values of lipid peroxides and lactate, the poorest recovery of adenine nucleotides, and impairment of left ventricular function.(ABSTRACT TRUNCATED AT 250 WORDS)

The covering with forceps-assisted polymeric biodegradable sheet and endostapling method: a simplified technique for wide coverage and reinforcement of staple-line in video-assisted thoracoscopic bullectomy for spontaneous pneumothorax

Primary spontaneous pneumothorax is one of the most common diseases. To prevent recurrent pneumothorax after video-assisted thoracoscopic surgery, various methods of pleural covering with biodegradable polymers have been devised. In addition, using fibrin sealant should be avoided as far as possible because of its infectious aspect. Thus, we devised the covering with forceps-assisted polymeric biodegradable sheet and endostapling method in response to these demands. With this novel technique, we used non-woven polyglycolic acid (PGA) NEOVEIL® sheet (Gunze, Ayabe, Japan). A 5-mm cut was made in the center of the PGA sheet, which was then guided over the apical bulla with a lung forceps. The bulla was then pulled through the cut hole with the lung forceps, in a manner similar to the way a cape is worn through the head. To avoid stapling failure caused by wrinkling of the PGA sheet, we moistened the sheet with a few drops of saline before endostapling. The diseased lung tissue was resected by endostapling across the PGA sheet. After firing the endostapler, we could perform a sealing test by inflating the lung to detect persistent air leaks. This is a simple and reliable technique of staple-line reinforcement without fibrin glue.

Operative aneurysmectomy and middle lobectomy for asymptomatic bronchial artery aneurysm in young patient

A 33-year-old woman was admitted for investigation of a round right hilar shadow on chest X-ray. A bronchial arteriogram revealed it was a bronchial artery aneurysm. She had no symptoms such as bloody sputum or hemoptysis. Although bronchial arterial embolization (BAE) is a good procedure for controlling hemoptysis, sometimes hemostasis is unsuccessful or bleeding recurs after BAE. Our patient underwent an operative aneurysmectomy and middle lobectomy to eliminate aneurysmal rupture instead of BAE.

Coexistence of catamenial pneumothorax and catamenial hemoptysis in a patient with pulmonary hemangiomatosis-like foci: A case report

Catamenial pneumothorax and catamenial hemoptysis are syndromes specific to women of reproductive age. Thoracic endometriosis syndrome most commonly presents as catamenial pneumothorax and very rarely as catamenial hemoptysis. Thoracic endometriosis syndrome is not the only cause of catamenial pneumothorax and hemoptysis. Some cases of catamenial pneumothorax and more than half of patients with hemoptysis lack evidence of ectopic endometrial tissue. Coexistence of catamenial pneumothorax and hemoptysis is extremely rare, and only one patient has been reported in the English literature. We report a case of catamenial pneumothorax and hemoptysis presenting with pulmonary capillary hemangiomatosis-like foci instead of ectopic endometrial implants.