Biomedical subjects
S Akamine
Publications and source records attributed to S Akamine.
Graft damage after a single lung transplantation for pulmonary hypertension in a rat model.
The hemodynamic effect and degree of damage in grafts of single lung transplants for pulmonary hypertension were studied in rats with monocrotaline-induced pulmonary hypertension. Inbred male Lewis rats (weight 200-230 g) were divided into two groups. Group 1 (control group, n = 16) underwent isogenic left lung transplantation, while group 2 (n = 15) received an intravenous administration of monocrotaline (80 mg/kg i.v.) and underwent isogenic left single lung transplantation 3 week later. Hemodynamic evaluations were performed prior to transplantation, at 1 h postoperatively, and on days 3 and 7 after transplantation. Mean pulmonary arterial pressure (mPAP) rapidly declined after transplantation in group 2, from 39.3 +/- 8.7 mmHg to 18.5 +/- 3.0 mmHg 1 h after transplantation, and remained stable on day 7 after transplantation. No significant difference in the mPAP between the two groups was observed after transplantation. The extravascular lung water volume (ELWV: dry/wet ratio) in the right lung of group 2 significantly increased on day 3 (0.86 +/- 0.02) (P < 0.01), and subsequently decreased to control levels on day 7 (0.83 +/- 0.02). There was no significant difference in the ELWV in the grafted lungs between the two groups (0.84 +/- 0.03 vs 0.86 +/- 0.04), but there was tendency toward an increase in ELWV in group 2 on days 3 and 7. These data thus demonstrated that a hemodynamic improvement was obtained by single lung transplantation; however the degree of graft damage was remarkable in the pulmonary hypertension group.
Inhaled nitric oxide and arterial oxygen tension in patients with chronic obstructive pulmonary disease and severe pulmonary hypertension.
BACKGROUND: Inhaled nitric oxide (NO) is a selective pulmonary vasodilator which can improve gas exchange in acute lung injury. However, it is uncertain that this effect on arterial oxygenation can be generalised to all lung diseases. METHODS: The effects of inhaled NO on gas exchange were studied in nine patients with chronic obstructive pulmonary disease (COPD), 11 patients with severe pulmonary hypertension, and 14 healthy volunteers. A randomized sequence of 40 ppm of NO or air was inhaled for 20 minutes through an orofacial mask. RESULTS: Inhaled NO reduced mean (SE) transcutaneous arterial oxygen tension (TcPO2) from 9.6 (0.3) to 8.9 (0.4) kPa in healthy volunteers and from 7.4 (0.6) to 7.0 (0.5) kPa in patients with COPD. There was no change in TcPO2 in patients with severe pulmonary hypertension. During inhalation of NO and air no change occurred in transcutaneous arterial carbon dioxide tension (TcPCO2), arterial oxygen saturation (SaO2) measured by pulse oximeter, or cardiac output determined by the transthoracic impedance method. CONCLUSIONS: Inhaled NO does not improve TcPO2 nor increase cardiac output in normal subjects and patients with COPD, suggesting that inhaled NO worsens gas exchange. This could represent inhaled NO overriding hypoxic pulmonary vasoconstriction in COPD. The finding that TcPO2 also fell when normal subjects inhaled NO suggests that a similar mechanism normally contributes to optimal gas exchange. Whilst inhaled NO can improve oxygenation, this effect should not be considered to be a general response but is dependent on the type of lung disease.
[Basilar artery aneurysm associated with agenesis of unilateral internal carotid artery: two case reports].
Two patients presented with a basilar artery aneurysm associated with agenesis of the right internal carotid artery. In both cases, the right middle cerebral artery was supplied by the basilar artery via the enlarged right posterior communicating artery, and the right anterior cerebral artery was supplied by the left internal carotid artery via the anterior communicating artery. The first patient was a 65-year-old woman who suffered from a subarachnoid hemorrhage due to rupture of a basilar bifurcation aneurysm, which was demonstrated as a "de novo" aneurysm 13 years after successful clipping of the anterior communicating artery aneurysm. Delayed surgery was planned, but she died due to recurrent hemorrhage. The second patient was a 67-year-old woman who had had a history of progressive left sided weakness over the previous few years. Conventional angiography and 3 dimensional CT angiography showed a large aneurysm of the basilar artery trunk with a wide neck. Endovascular embolization was performed with mechanically detachable coils, and the aneurysm was incompletely occluded. The patient regained complete strength in the left arm after the treatment, but the follow-up angiography at 5 months disclosed recanalization of the treated aneurysm, associated with shift of the packed coils. Hemodynamic stress resulting from unique collateral circulation with agenesis of the internal carotid artery may cause a predisposition to "de novo" aneurysm formation or recanalization of an occluded aneurysm with coils.
Bronchoscopic evaluation of bronchial healing after carinal reconstruction.
Bronchoscopic evaluation of the anastomoses created by carinal reconstruction was carried out over a period of 7 weeks in 6 patients who had undergone carinal and lobar resections for lung cancer, and 4 who had undergone carinal resection without pulmonary resection for carinal tumors. The techniques of reconstruction included end-to-end and end-to-side tracheobronchial anastomoses with omental, fat, or pleural wrapping. Bronchial healing at the anastomosis was evaluated using a bronchial healing score (BHS) based on the bronchoscopic findings. The degree of healing was scored on a 0 to 4 scale, with 0 indicating normal mucosa; 1, edema or reddening; 2, mucosal color changes; 3, ulceration; and 4, diffuse ulceration. One postoperative death occurred as a result of anastomotic leakage. The remaining nine patients were divided into three groups according to the bronchoscopic findings on postoperative day (POD) 7: group A (n = 3) had mild ischemia at the anastomosis, group B (n = 3) had moderate ischemia at the anastomosis, and group C (n = 3) had severe ischemia at the anastomosis. Bronchial healing of the anastomosis improved over a 7-week period in groups A and B, but was delayed in group C. These findings led to the conclusion that wound healing of the anastomosis following carinal reconstruction requires more than 7 weeks due to the consequent devascularization resulting from the extended bronchial resection and lymph node dissection.
[Suspension of ventilation during extracorporeal membrane oxygenation with veno-venous by pass in dogs].
We studied whether extracorporeal membrane oxygenation with a veno-venous bypass would allow withdrawal of mechanical ventilation. Three mongrel dogs were anesthetized with intravenous pentobarbital. A Swan-Ganz catheter was placed via the left jugular vein into the main pulmonary artery, and an extra-long total volume catheter was placed in the right femoral artery. The animals were placed in the lateral position, and cannulas (15 Fr.) were placed in the inferior vena cava and the superior vena cava via the right jugular vein and the right femoral vein. These cannulas were connected to a pump and a membrane oxygenator. When the pump flow was almost the same as the previous cardiac output, the partial pressure of oxygen in the pulmonary artery, was high enough to allow ventilation to be suspended. All dogs survived. This suggests that extracorporeal membrane oxygenation with a veno-venous bypass can allow mechanical ventilation to be suspended during tracheocarinal operations such as tracheocarcinal resection.
Pathologic examination of discordant lung xenotransplantation in the rat.
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Effect of gammahydroxybutyrate on donor lung function after long-term hypothermic storage using low potassium University of Wisconsin solution.
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Significance of Flow Cytometric DNA Analysis from Freshly Aspirated Samples.
The procedure of aspiration biopsy cytology by fine needle aspiration (ABC) is as option in establishing definitive diagnoses for breast cancers. In this series, a needle size of 21G was considered most suitable for ABC as well as flow cytometric DNA analysis. Histograms from fresh samples aspirated by fine needle clearly delineated a sharp peak in G&sup0;G(1) phases and also a better CV was obtained than with paraffin-embedded preparations. In addition, fresh samples gave more reliable DI and suggested the value of measuring nuclear DNA contents. It is believed that the prognoses of breast cancers are closely associated with DNA ploidy patterns. In this sense, flow cytometric DNA analysis of fresh samples of ABC is regarded as important in clinical use.
Successful utilization of a video-assisted thoracic approach to repair Morgagni's hernia: report of a case.
We describe herein the successful utilization of a video-assisted thoracic surgical approach to repair Morgagni's hernia. The patient was a 62-year-old woman in whom a routine chest X-ray had revealed an asymptomatic mass, which was presumed to be a pericardial lipoma or Morgagni's hernia. The video-assisted thoracic surgical approach was combined with a right submammary minithoracotomy to successfully repair the hernia without performing a laparotomy. The patient's postoperative course was uneventful and she was discharged 14 days after surgery. Thus, we believe that video-assisted thoracic surgery may be a useful and effective method for repairing Morgagni's hernia.
Results of carinal resection for bronchogenic carcinoma.
Fifteen patients underwent carinal resection for lung cancer during the years of 1957 through 1993. All were males with ages ranging from 40 to 81 (mean 60.1) years old. Cell Types of the cancer were squamous cell carcinoma in 12 cases, adenocarcinoma in 2 and small cell carcinoma in one. In 14 of 15 cases there was cancerous invasion into the tracheal carina (T4) and one had no involvement of the carina (T3). Four patients had no lymph node metastasis (N0), 2 had hilar node metastasis (N1), 8 had ipsilateral mediastinal node metastasis (N2) and one had contralateral mediastinal node metastasis (N3). Operative procedures for carino-plasty were sleeve pneumonectomy in 3 cases, pneumonectomy with wedge resection of the carina in 3, sleeve resection of the carina followed by reconstruction of the carina (Montage type) in 8, and carinal resection with reconstruction of the one-stoma type in one. Two patients died within one month due to pneumonia or renal failure (13.3%). Postoperative complications occurred in 14 cases and bronchorrhea (n = 8), anastomotic stenosis (n = 5) and pneumonia (n = 4) were frequent. Excluding 2 operative deaths, 8 cases died from 2 to 37 months after operation (mean 13.1 months) and 5 are alive from 10 to 24 months without recurrences. Patients with squamous cell carcinoma with N0 or N1 had better prognosis.
[Surgical treatment for acute pulmonary thromboembolism occurring 9 months after an operation for lung cancer].
Successful surgery for pulmonary thromboembolism is reported, with emphasis on the indication and the necessity of cardiopulmonary bypass. Surgical treatment is indicated for patients with localized large thromboemboli not amenable to medical management. Surgery is also an option for patients in whom medical treatment is not effective. In the present case, the etiology was unknown and there was no history of deep vein thrombophlebitis of the legs, which suggested that the cause was an embolus from a lung tumor that had already been treated surgically. Histological examination revealed a fresh blood thrombus, 9 months after pulmonary resection. This patient had syncope at the onset of the pulmonary thromboembolism (major vessel type) without circulatory collapse.
Anal metastasis from carcinoma of the lung: report of a case.
We report herein the case of a 75-year-old man who developed anal canal metastasis from squamous cell carcinoma of the lung. Initially, he underwent a right middle and lower lobectomy combined with left atrial wall resection under cardiopulmonary bypass. He presented 3 months later with an anal polyp which had prolapsed and bled, for which he underwent a transanal polypectomy. Histologically, the polyp was classified as squamous cell carcinoma and considered to be a metastasis from the primary lung cancer. He is presently well with no signs of recurrence 9 months after his initial operation. To our knowledge, there has been no other case of anal metastasis from lung cancer ever reported.
Monitoring canine lung allograft rejection using Ia antigen expression by bronchoalveolar lymphocytes.
The expression of Ia antigens by lymphocytes in bronchoalveolar lavage (BAL) was evaluated after canine lung allotransplantation with immunosuppression using FK-506. The expression of Ia antigens labeled using an OKIa-1 monoclonal antibody from Ortho Diagnostic Systems was measured by flow cytometry. Twenty-three adult mongrel dogs underwent left lung allotransplantation and were treated with FK-506 at a dose of 0.1 mg/kg/day intramuscularly until death. Allograft rejection was evaluated microscopically. The percentage of OKIa-1-positive cells among the BAL lymphocytes was 34.8% +/- 8.9% (mean +/- SD) from the allografted lungs showing no rejection, whereas it was 68.8% +/- 16.2% from the allografted lungs which showed rejection (P < 0.01). When a diagnosis of rejection was made prior to pathologic examination by an OKIa-1-positive lymphocyte percentage of 42% or more, the sensitivity, specificity, and accuracy of diagnosis were 100%, 87.5%, and 94.1%, respectively. Subsequently, pulse steroid therapy was attempted in those dogs with a high rate of OKIa-1-positive lymphocytes in the BAL. In 3 of 4 dogs showing histological signs of rejection, a decrease in the rate of OKIa-1-positive cells among the BAL lymphocytes corresponded to an improvement in pathologic diagnosis. In two dogs with bacterial pneumonia and pulmonary vein thrombosis, densities indistinguishable from those of rejection were seen on chest roentgenograms, but in these dogs the rate of OKIa-1-positive BAL lymphocytes was 42% or less. In conclusion, Ia antigen expression by BAL lymphocytes could be useful for monitoring rejection in lung allotransplantation.
Management of anastomotic complications after sleeve lobectomy for lung cancer.
One hundred twelve patients (102 male and 10 female) underwent sleeve lobectomy for lung cancer from January 1969 to December 1991. Bronchopleural fistula occurred in 6 (5.6%), bronchovascular fistula in 2 (1.8%), pulmonary arterial occlusion in 2 (1.9%), anastomotic stricture or stenosis in 7 (6.3%), and local recurrence in 7 patients (6.3%). Early repair of bronchopleural fistula combined with an omentopexy achieved permanent closure of the fistula. Two patients who underwent a completion pneumonectomy for a pulmonary arterial occlusion died of respiratory failure. Two patients experienced uncontrollable bleeding into the bronchial tree through a bronchovascular fistula and sudden death. Completion pneumonectomy is indicated for a stricture due to scar formation. If pneumonectomy is precluded by poor pulmonary reserve, endoscopic excision using biopsy forceps is an alternative. Endoscopic resection is the treatment of choice for suture granulomas. Complications associated with bronchial or vascular anastomoses are serious and frequently fatal.
DNA stemline heterogeneity of non-small cell lung carcinomas and differences in DNA ploidy between carcinomas and metastatic nodes.
Nuclear DNA contents were measured using a flow cytometry technique in non-small cell lung carcinomas and differences in ploidy patterns were compared between primary lung carcinomas and metastatic lymph nodes. Negative node lung cancer revealed diploidy in 82.6% of the 224 non-small cell lung cancers, in contrast with 19.5% in positive node lung cancer. In multi-stemline cells, a high incidence of nodal involvement was seen when compared with single stemline cells. The more the DNA indices increased, the more the lymph nodes were seen to be extensively involved. Furthermore, intratumoral heterogeneity was evaluated in terms of n-categories. In conclusion, it is suggested that nodal metastasis may be caused by tumor cells with high DNA indices in lung carcinomas, in particular for multi-stemline cells.
Efficacy of a rinse solution for the prevention of reperfusion injury in canine preserved lungs.
To evaluate the efficacy of a perflurocarbon emulsion (Fluosol: FC-43) for protecting preserved lungs from ischemic reperfusion injuries, we employed an isolated canine left lung reperfusion model. The left lung from 15 mongrel dogs was flushed and preserved in Euro-Collins solution for 24 hrs at 4 degrees C. The preserved lungs were rinsed through the pulmonary artery with a perflurocarbon emulsion (perfluorotributylamine: FC-43) or Carolina rinse solution II (CRS-II) and then reperfused with whole blood for 120 minutes. The lungs were divided into three groups; lungs reperfused without rinse (Group 1: n = 5), and lungs rinsed with oxygenated FC-43 (Group 2: n = 6) or CRS-II (Group 3: n = 4). Reperfusion was with whole blood warmed to 37 degrees C. The pulmonary vascular resistance was lower in the lungs in Group 1 than in those in Groups 2 and 3 (84.2 +/- 33.3 v.s. 322.3 +/- 190.5 and 474.1 +/- 219.0 mmHg/L/min, p < 0.01). There was no significant difference in the PaO2 among the 3 groups at the end of reperfusion. The extravascular lung water (dry/wet ratio) was lower in the lungs in Group 2 than Groups 1 and 3 (90.5 +/- 0.7% v.s. 86.8 +/- 2.1% and 92.1 +/- 2.1% p < 0.01). These data demonstrated that pulmonary function and structure were maintained well in lungs reperfused with FC-43. We conclude that a perfluorocarbon emulsion (FC-43) is useful for protecting ischemic canine lungs from reperfusion injury, but Carolina rinse solution II is not effective for minimizing reperfusion injury in canine lungs.
[Segmentectomy and bronchoplasty for early stage squamous cell carcinoma of the segmental bronchus].
Five cases with hilar type early stage squamous cell carcinoma of the segmental bronchi underwent segmentectomy and bronchoplasty. All were males and the ages with sixties. Locations of early stage lung cancer were the apical bronchus of the right lower lobe (B6) in one patient, the intermediate-lower lobe bronchus in one, the anterior bronchus of the left upper lobe (B3) in two and the lower division bronchus (B4+5) in one. All were diagnosed as early stage squamous cell carcinoma by preoperative bronchoscopic examination. The segments resected were the right S6 in two, left S1+2+3 in one, left S4+5 in one and left S3 in one. There was no postoperative complications related to bronchial anastomosis. One patient died of secondary primary lung cancer 3 years after operation. While, four patients are alive and well one, 6, 12 and 46 months after surgery. Sleeve segmentectomy for the patients with early stage squamous cell carcinoma of the segmental bronchus is a curative operation with preserving pulmonary function.