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Biomedical subjects

T Shirakusa

Publications and source records attributed to T Shirakusa.

At least 91 records · Page 5Linked to original sources
PubMed1998

Tracheal transplantation for carinal reconstruction in dogs.

BACKGROUND: Experimental carinal allotransplantation has been performed with tracheocarinal Y-shaped allografts in dogs. In this study we tried canine carinal reconstruction with cylindrical allografts. MATERIAL AND METHODS: Carinal reconstruction was performed with allotransplantation of cylindrical trachea in dogs, and graft healing was evaluated by bronchoscopic observation, mucosal blood flow measurement, and histologic examination. A section of the recipient carina containing five tracheal rings and two main stem bronchi was removed, and a donor trachea seven rings long was inserted between the recipient trachea and the left main stem bronchus; then side-to-end anastomosis was performed between the graft midportion and recipient right main stem bronchus (new carina). The grafts were wrapped with pedicled omentum. Fresh grafts were transplanted into one group of dogs (n=8 ), and grafts cryopreserved for 1 week were transplanted into another group (n=7). RESULTS: No anastomotic leakage occurred in any dog. Excellent healing of grafts and graft anastomoses was observed by fiberoptic bronchoscopy in six dogs (75%) in the fresh graft group and in four dogs (57%) in the cryopreserved graft group. The mucosal blood flow in the new carina decreased remarkably and, although it recovered, mucosal blood flow remained under the preoperative level on day 28 after the operation. CONCLUSION: Cylindrical tracheal allotransplantation is useful for carinal reconstruction, and the method of side-to-end anastomosis between the donor trachea and recipient bronchus is a feasible and accessible procedure in dogs.

Anastomosis, Surgical↗
PubMed1998

Immunological quantitation of DT-diaphorase in carcinoma cell lines and clinical colon cancers: advanced tumors express greater levels of DT-diaphorase.

NAD(P)H:quinone oxidoreductase (DT-diaphorase; DTD) plays a major role in activating mitomycin C (MMC) in human colon and gastric carcinoma cell lines. Thus, measurement of DTD in clinical tumor samples could be beneficial in designing adjuvant chemotherapy. We explored immunological quantitation of DTD protein using a monoclonal antibody against DTD, demonstrating a close correlation between protein expression and enzyme activity of DTD in colon and gastric carcinoma cell lines and in colorectal tumor samples. This indicates that such immunoblot analysis is a simple alternative method for quantitating DTD in clinically excised samples. In most colorectal tumor samples, the tumors expressed larger amounts of DTD than did the peripheral normal tissues, suggesting a selective toxicity of MMC toward tumor cells. Also tumors with nodal metastases showed significantly higher DTD levels than did tumors without metastasis. These results raise the possibility that DTD expression is related to tumorigenesis and malignant progression of colorectal tumors. Measurement of DTD by the immunological method described here could be beneficial in designing a rational adjuvant chemotherapy with MMC.

Adenocarcinoma↗
PubMed1998

Factors related to the relapse of bronchiolitis obliterans organizing pneumonia.

STUDY OBJECTIVE: The purpose of this study is to determine factors, including laboratory data, related to the relapse of bronchiolitis obliterans organizing pneumonia (BOOP). DESIGN: Retrospective study. SETTING AND PATIENTS: The medical files of Fukuoka University Hospital and Nishi Fukuoka Hospital patients from 1984 to 1996 were reviewed, and 18 cases of BOOP that had been diagnosed using transbronchial or open lung biopsy were selected for evaluation. MEASUREMENTS: The 18 cases were put into two groups composed of 7 patients who relapsed and 11 who did not relapse. Their clinical symptoms and laboratory data at first admission, including hemograms, blood chemistry tests, and pulmonary function tests were compared. Patients with or without associated diseases, such as collagen vascular diseases, were compared using the same parameters in order to examine the relationship between the associated diseases and BOOP relapse. RESULTS: The serum levels of total protein and albumin in patients who relapsed were significantly lower than in patients who did not relapse, respectively: 5.8 (range, 4.4 to 6.2) vs 6.3 (range, 4.5 to 6.8) g/dL, p < 0.05; and 2.9 (range, 2.5 to 3.4) vs 3.7 (range, 2.8 to 4.3) g/dL, p < 0.01. Levels of serum albumin in BOOP patients with associated diseases, however, were significantly lower than in those without associated diseases, respectively: 2.95 (range, 2.5 to 3.9) vs 3.65 (range, 2.8 to 4.3) mg/dL, p < 0.05. The fall in serum albumin levels in patients who relapsed, therefore, was probably due to associated diseases. The fact that 5 of 8 patients with associated diseases relapsed but only 2 of 10 without associated diseases relapsed suggests that a relationship exists between associated diseases and the prognosis of BOOP, although this finding was not statistically significant because of the small number of cases and the heterogeneity of the associated diseases. The most striking observation was that PaO2 levels in patients who relapsed were significantly lower than in those who did not, respectively: 55.4 (range, 39.9 to 73.2) vs 78.0 (range, 48.4 to 89.4) mm Hg, p < 0.05. However, PaO2 levels were not statistically different between patients with and without associated diseases, respectively: 66.0 (range, 45.4 to 78.8) vs 71.4 (range, 39.9 to 89.4) mm Hg. CONCLUSIONS: The severity of hypoxemia at first medical examination may be an important determinant for the subsequent BOOP relapse.

Aged↗
PubMed1998

[Therapeutic strategy for pleural mesothelioma].

Generally pleural mesothelioma is divided into two histologic types: localized and diffuse. Most cases of the former are considered to be benign and the latter malignant. The treatment strategy for these tumors has been investigated, including various surgical and chemotherapeutic approaches. In spite of these efforts. no curative method for malignant mesothelioma has been established yet, although the gene therapy is expected to be the most powerful tool in the near future.

Adult↗
PubMed1998

Extended operation for T4 lung carcinoma.

The extended surgery for T4 lung carcinoma was reviewed. From literature in the last decade, the 5-year survival rate has been under 10% worldwide. However a more favorable prognosis will be expected nowadays because of the progress of perioperative intensive care and appearance of effective anticancerous agents for induction chemotherapy. We compared the results of surgery for T4 lung carcinoma from 1978 to 1989, to those from 1992 to 1997. The 3 and 5-year survivals in the former period were 6.8% respectively, however in the latter period the 3-year survival rate rose to 24.6%. In patients with T4, the prognoses are different according to the involved organs by lung carcinoma. Generally, combined resection of the trachea, carina, descending aorta and left atrium show better prognoses compared to that of the esophagus and liver. We consider that malignant pleural effusion with N2 should not be the object for panpleuropneumonectomy. In our series from 1992 to 1997 median survival time (MST) of T4 with N0 or N1 was 25.5 months, on the other hand MST with N2 or N3 was 14.2 months. Histologically patients with squamous cell carcinoma showed a better prognosis than those with adenocarcinoma. From these results, in the extended operation for T4 we may expect more favorable prognoses in cases with involvements of the trachea, carina, aorta and left atrium, and with N0 or N1, histologically squamous cell carcinoma.

Adenocarcinoma↗
PubMed1998

Inhaled nitric oxide does not increase rat pulmonary allograft rejection.

BACKGROUND: There is evidence that inducible nitric oxide (NO) may be directly related to the process of allograft rejection. Because of its strong pulmonary vasodilatory activity, inhaled NO (INO) has recently been used as a therapeutic option for allograft dysfunction after lung transplantation. The action of inducible NO and inhaled NO seems contradictory for preserving posttransplantation pulmonary allograft function. INO used for lung transplant recipients may actually enhance acute allograft rejection. We studied the effect of INO on acute allograft rejection with a rat pulmonary allograft model. METHOD: A total of 24 left lung allotransplantations were performed from Lewis donors into F344 recipients. Animals were divided into two groups and inhaled either room air alone or 20 ppm NO with room air in a closed chamber immediately after transplantation until rats were killed on days 7 and 14. During observation, NO uptake was monitored by measuring serum NO2-/NO3- level. Acute rejection was evaluated by use of a semiquantitative radiographic scoring method (aeration score: 0 to 6, opaque to normal appearance) and rejection score (0 to 4, no sign of rejection to diffuse mononuclear infiltration). RESULTS: Markedly elevated serum NO2-/NO3- levels were observed in the NO inhalation group compared with levels in the normal air inhalation control group (110.8 +/- 25.3 vs 16.3 +/- 4.0 micromol/L/ml on day 7, p < 0.01; 107.0 +/- 30.9 vs 16.8 +/- 4.8 micromol/L/ml on day 14, p < 0.01). However, no positive effect of INO on acute rejection was found histologically or radiographically. CONCLUSION: The effect of INO on acute rejection is likely so minimal as not to be clinically relevant.

Administration, Inhalation↗
PubMed1998

Exogenous thrombospondin stimulates the proliferation of non-thrombospondin-producing cells.

The effects of thrombospondin (TSP) on the proliferation of two different human carcinoma cell lines (KIM-1 and CW-2) were investigated. The characterization of these two carcinoma cells by immunohistochemistry using anti-TSP antibody and anti-TSP-receptor antibody showed that the KIM-1 had TSP-receptors and TSP, while the CW-2 had only TSP-receptors. The addition of exogenous TSP (10 or 20 microg/ml) to culture medium stimulated the cell proliferation of CW-2 but not that of KIM-1. The cell count for CW-2 was increased dosage-dependently from 10.3 0.6x104/ml at zero TSP concentration to 12.9 0.6x104/ml at 10 microg/ml TSP concentration and to 14.7 0. 4x104/ml at 20 microg/ml TSP (each p<0.0001). In conclusion, though TSP promoted the proliferation of non-TSP-producing cells, it did not promote proliferation of TSP-producing cells. Therefore, it is predicted that TSP was already at saturated activity concentration in the TSP-producing cell line (KIM-1).

Blotting, Western↗
PubMed1998

[A case of lymphocytic interstitial pneumonia].

A 56-year-old female was admitted on November 1995 to our hospital because of the abnormal shadow on her chest X-ray. Although the chest X ray film revealed diffuse reticulonodular shadows in the bilateral lung fields and right hilar lymphadenopathy, she had not any complaints. Furthermore, mediastinal lymphadenopathy and polyclonal hypergammaglobulinemia were noted. For a further examination, transcutaneous thoracoscopic lung biopsy was performed on August 1996. The lung specimens showed a interstitial infiltration of small lymphocytes exclusively around bronchioles. And the diagnosis of lymphocytic interstitial pneumonia (LIP) was made. She had been suffered from bronchial asthma for 27 years. This is the first report of LIP accompanied with bronchial asthma. Its relationship between LIP and bronchial asthma remains unclear. In the 2 years of follow-up, she remained asymptomatic with unchanged chest radiogram. And her pulmonary function was preserved for the 2 years. But lymphocytic interstitial pneumonia may induce malignant lymphoproliferative disease potentially, we should carefully follow up.

Asthma↗
PubMed1998

[Results of surgical treatment of T3 lung carcinoma according to the combined resection of involved organs].

A new TNM staging system was decided last year by UICC, consequently T3N0M0 was transferred from stage IIIA to stage IIB. Although T3 is defined to include tumors with direct invasion to adjacent organs. Those are chest wall, parietal pleura, diaphragma and pericardium, however results of surgical treatment according to the combined resection of involved organs described above have not been investigated yet enough. Eighty-nine cases with T3 from 1996 were divided into two groups, patients from 1986 to 1990 and from 1994 to 1998. In the former phase 46 cases were resected and its 5-year survival rate was 15.6%. Better prognosis with significant difference was shown in patients between N0 (5-year survival: 25.1%) and N1 + N2 (5-year survival: 4.0%). In the latter phase 43 cases underwent surgery and its 3-year survival was 24.0%. In the prognoses according to the involved adjacent organs, patients with combined resection of parietal pleura showed the best survival in comparison with patients of chest wall resection and pericardial resection, but there was no significant difference in these 3 groups. Two patients with combined resection of diaphragma are well alive.

Adult↗
PubMed1997

Carinal resection and reconstruction for recurrent lung cancer.

A patient with a recurrent tumor in the trachea adjacent to the right main bronchus was treated by surgical resection 19 months after undergoing surgery for the primary cancer. The patient had previously undergone right upper lobectomy for T1N0M0 stage I squamous cell carcinoma. A carinal resection was performed which included 4 rings of the trachea, 2 rings of the right main bronchus, and 1 ring of the left main bronchus. Reconstruction consisted of an end-to-end anastomosis of the trachea and left main bronchus, and an end-to-side anastomosis of the right and left main bronchi. The postoperative course was uneventful, and at present the patient is healthy 12 months following reoperation.

Aged↗
PubMed1997

Free radical-mediated tissue injury in acute lung allograft rejection and the effect of superoxide dismutase.

BACKGROUND: The role of monocytes and neutrophils is crucial during acute allograft rejection. They have the capacity to generate toxic reactive oxygen intermediates in response to specific agonists that may act as tissue destructive molecules. We examined the possibility of reactive intermediate-mediated tissue injury in acute lung allograft rejection, as well as the effect of superoxide dismutase. METHODS: Allogenic (Brown Norway to F344) or syngenic (F344 to F344) rat left-lung transplantation was performed. Generation of reactive oxygen intermediates in peripheral blood was evaluated by the method of luminol-dependent chemiluminescence. Cell membrane phospholipid peroxidation in the graft was measured as malondialdehyde concentration. The third group of animals having allografts received bovine erythrocyte superoxide dismutase (5,000 U/kg intravenously every 12 hours after transplantation). RESULTS: Relative chemiluminescence response in the allograft recipient to normal F344 was elevated on postoperative day 1 (257%), then decreased slightly on day 3 (156%) and was elevated again on day 7 (560%) as the process of rejection progressed. Allograft tissue malondialdehyde levels (248.37 +/- 112.35 nM/whole lung, n = 6; p < 0.05 by Student's t test) were higher than isograft levels (139.29 +/- 35.93 nM/whole lung, n = 6) on day 7. Superoxide dismutase treatment significantly ameliorated the histologic degree of rejection on day 7. CONCLUSIONS: These results demonstrate the tissue destructive activity of reactive oxygen intermediates during lung allograft rejection. To scavenge free radicals may be a useful therapeutic modality in the management of acute lung allograft rejection.

Acute Disease↗
PubMed1997

Is video-assisted thoracoscopic surgery suitable for resection of primary lung cancer?

We investigated the validity of thoracoscopic surgery-in patients with primary lung cancer undergoing lobectomy. 14 primary lung cancer patients treated by typical VATS lobectomy and one by anatomical segmentectomy, were compared with 56 patients with Stage-I lung cancer undergoing standard lobectomy (control group), the results focusing on the lymph-nodes dissected. All 14 lobectomy patients showed primary lesions of size less than 3 cm. Following classification of the lymph-nodes into groups I (hilar lymph node) and II (mediastinal lymph node), we compared results according to the sites of the lobectomies conducted. Numbers of dissected lymph-nodes were similar in patients whether undergoing standard thoracotomy or VATS lobectomy. We also investigated what histological types of cancer should be treated by VATS lobectomy by comparing preoperative and operative staging in the control group. The results showed that in most patients with squamous-cell carcinoma judged as T1 N0 M0 the staging corresponded, the other patients actually being in N1 (Stage II). Of Patients with adenocarcinoma of T1 N0 M0, however, 14% had lymph-node metastasis even into the superior mediastinum, i.e., Stage III. The overall findings suggest at present that VATS lobectomy should be applied preferably to patients with a histological typing such as squamous cell carcinoma or alveolar cell carcinoma of relatively early stage, i.e. preoperative Stage I.

Adenocarcinoma↗
PubMed1997

Inhibition of inducible nitric oxide synthase prolongs rat lung allograft survival.

Nitric oxide (NO) has been demonstrated to be an important immunoregulation molecule in the process of cellular immunologic interactions. Our recent results demonstrated that NO is produced in association with acute allograft rejection and NO inhibition may suppress rejection histologically. This data provides direct evidence of NO in allograft rejection and the immunosuppressive potential of NO inhibitors. In this paper, the effect of NO inhibition on allograft survival was evaluated to investigate the capacity of NO inhibitors as immunosuppressive agents. Seventeen rat left lung transplants from BN donors to F344 recipients were accepted for this study. After surgery, recipients were randomized into two groups and received either aminoguanidine (AG), a highly selective NO synthase inhibitor, 200 mg/kg, intra-peritoneal every 6h (n = 13) or normal saline treatment (n = 4). No production was determined from the recipient's serum nitrite and nitrate levels. Graft survival was monitored via semi-quantitative radiographic aeration scores (AS: 0 = opaque lung to 6 = normal appearing lung). The nitrite and nitrate levels were clearly detectable before the radiographic finding associated with rejection became obvious. Production of NO was significantly inhibited by AG treatment. AG treatment prolonged allograft survival radiographically (12.0 days and 6.0 days for treated and untreated groups respectively, p = 0.0001). These data suggest that the inducible NO is produced in association with acute lung allograft rejection and may serve as a sensitive rejection marker. NO inhibition significantly prolonged rat lung allograft survival but failed to induce immunological tolerance.

Animals↗
PubMed1997

Primary tracheal fibrosarcoma in a child: a case of tracheal resection under ECMO support.

We report a case of severe airway obstruction due to endotracheal fibrosarcoma in a 3-year-old boy. Successful tracheal resection and reconstruction was performed under extracorporeal membrane oxygenation support. A solid, elastic hard tumor with a smooth surface was attached by a tiny stalk structure to the membranous part of the lower trachea. Histological findings of the tumor were consistent with infantile fibrosarcoma, showing proliferation of spindle cells forming interlacing patterns.

Airway Obstruction↗
PubMed1997

Tumor neutrophil elastase is closely associated with the direct extension of non-small cell lung cancer into the aorta.

OBJECTIVE: Neutrophil elastase (NE) is the only neutral protease that is able to degrade insoluble elastin and other extracellular matrix constituents, and thus, may be involved in tumor invasion and metastasis. Using a highly specific and sensitive enzyme immunoassay (EIA), we recently demonstrated that immunoreactive (ir)-NE is produced by non-small cell lung cancer cell lines. We have measured the ir-NE concentration in non-small cell lung cancer tumor extracts and have evaluated its association with disease stage. METHODS: We measured the ir-NE concentration in 144 non-small cell lung cancer tumor extracts using EIA, which permits the rapid measurement of both the free and alpha1-protease inhibitor (alpha1-PI) complexed form of ir-NE. In 15 clinical T4 (cT4) patients, we also determined the concentration of free ir-NE in tumor extracts using a kit that detects only NE complexed with alpha1-PI and subtracting that value from the total NE concentration. RESULTS: ir-NE was detected in tumor extracts from 115 of 144 patients, ranging from 0.21 to 23.35 microg/100 mg protein. When the 144 specimens were grouped according to the clinical stage of disease, the ir-NE concentration (mean+/-SE) was significantly higher in those with cT4 disease (n=15; 7.90+/-1.88 microg/100 mg protein) than in those with cT1 (n=29; 1.27+/-0.27; p<0.001), cT2 (n=64; 1.18+/-0.17; p<0.001), or cT3 disease (n=26; 1.99+/-0.38; p<0.003). There was no significant association between the ir-NE concentration and cN-factor or any other clinical features. When the ir-NE concentration in the tumor extracts of the cT4 patients was compared with respect to the tumor invasion sites, the ir-NE level was significantly higher in those with surgical T4 (sT4) disease with aortic invasion (n=4; 17.4+/-3.10) than in those who were down-staged postoperatively (n=5; 4.9+/-1.33; p=0.005) or those with sT4 disease with involvement of other sites (n=6; 4.07+/-1.83; p=0.004). Similar results were observed for the free form of ir-NE. CONCLUSIONS: These data suggest that NE may be involved in tumor progression of non-small cell lung cancer. Since the aorta is one of the richest sources of polymeric and insoluble elastin, this enzyme may play an active role in the direct extension of the tumor into the aorta.

Adult↗
PubMed1997

[Video-assisted thoracic surgery for lung cancer].

Video-assisted thoracic surgery (VATS) has been applied to treat patients with various pulmonary diseases. Recent advances in video endoscopic instruments have been enabled radical resection of pulmonary malignancies as minimally invasive surgery. Forty patients with primary lung cancer underwent several types of lung resection in the past 3 years at out unit. Of these, twenty-seven anatomical pulmonary resections were performed using VATS. Peripherally located, early-stage lung cancer is thought to be a potential candidate for curative surgery with video-assisted lobectomy. Although there are some pitfalls with VATS, sufficient mediastinal lymph node dissection is thought to be possible. Additionally, intrathoracic hyperthermic chemotherapy using video-assisted thoracoscope for both pleural disseminated lesion and malignant pleural effusion is described.

Cisplatin↗
PubMed1997

Video-assisted thoracoscopic lobectomy for treating lung cancer.

Our objective was to evaluate the usefulness and safety of video-assisted thoracoscopic surgery (VATS) for performing pulmonary lobectomy in 11 patients with clinical NO stage I primary non-small-cell lung cancer compared with 11 patients who underwent a conventional thoracotomy. Treatment was switched to conventional thoracotomy in three VATS patients because of the involvement of interlobar nodes or incomplete lobar fissure. None of the eight VATS patients died or experienced serious complications during 12 months of follow-up. There were no significant differences in the intraoperative blood loss, duration of operation, or duration of chest tube drainage between the VATS group and the standard lobectomy group. We conclude that although VATS lobectomy appears to be safe for use in managing patients with primary lung cancer, it does not seem to offer any advantages over standard lobectomy.

Adenocarcinoma↗