Evaluation of the Malignant Grade of Thymic Epithelial Tumors According to the Epithelial Subclassification

(Received for publication on June 15, 1998; accepted on May 27, 1999)     

A case of enucleation for multiple renal cell carcinomas in unilateral kidney with microwave tissue coagulator

A 67-year-old man, who had undergone left nephroureterectomy for ureteral tumor (transitional cell carcinoma, G1) eight years previously, was found to have two renal tumors in the residual right kidney by the follow-up computed tomography (CT). We performed non-ischemic enucleation for multiple tumors at the upper and lower pole in the unilateral kidney using a microwave tissue coagulator (MTC). We confirmed by means of ultrasonography during operation the absence of any other satellite tumors. The operation time was 154 minutes and bleeding during operation was 267 ml. There was no difference between creatinine before (0.73 mg/dl) and after (0.79 mg/dl) operation. On the follow-up CT, there was a low density area after enucleation. This area gradually decreased and disappeared on enhanced CT 18 months after operation. We enucleated multiple renal cell carcinomas using MTC without reduction of renal function or remarkable side effects. These results suggested that non-ischemic enucleation using MTC would be useful for multiple renal cell carcinoma in the unilateral kidney.     

Result of surgical treatment to early stage peripheral non-small cell lung cancer

In the lung cancer, the announcement of the definition, the clinical behavior and the treatment result of the central early stage lung cancer, especially in situ lung cancer, have been seen. However, the definition and a clinicopathological concept of the peripheral lung cancer are still uncertain. The so-called small lung cancer of the tumor diameter 20 mm or less are peripheral lung adenocarcinoma. These patients' prognosis is excellent better, in contradiction to the prognosis of the patients with positive for pleural involvement or vessels invasion is worse. We studied the clinicopathological features, the Noguchi's classification, and prognosis of the 101 patients with small lung adenocarcinoma which were performed the operation, and refere about the selection of the operation method including the VATS and the limited operation.     

Usefulness of cord-blood harvesting for autologous transfusion in surgical newborns with antenatal diagnosis of congenital anomalies

BACKGROUND/PURPOSE: The risks of homologous transfusion and the effectiveness of predeposit autologous transfusion have been described. The authors examined the clinical usefulness of cord-blood harvesting for autologous transfusion in newborns who had congenital anomalies antenatally diagnosed that would require surgical intervention at or near the time of delivery. METHODS: Of 112 cases of antenatal diagnosis of congenital anomalies, 50 mothers gave informed consent and enrolled in this study. Cord-blood was withdrawn immediately after clamping of the umbilical cord and was used for autologous transfusion in newborns within the first 3 days postpartum. RESULTS: A mean of 72 +/- 54 mL of cord-blood was harvested (27 +/- 18 mL/kg). While preserving cord-blood for 3 days at 4 degrees C, no signs of clot formation or hemolysis were observed. The harvested cord-blood included plasma-free Hb ranging from 1 to 68 (13 +/- 18) mg/dL and thrombin-antithrombin III complex ranging from 2 to 273 (18 +/- 50) ng/mL. Bacteriologic examination of the stored cord-blood showed negative cultures, except for samples from 3 newborns after vaginal delivery. A mean of 46 +/- 34 mL of cord-blood was used in 26 patients for autologous transfusion. No significant complications related to cord-blood transfusion were recognized clinically. CONCLUSIONS: Autologous cord-blood transfusion has the potential to be a useful alternative to homologous transfusion in newborns requiring surgery. Adequate collection and storage techniques for cord-blood must be developed. J Pediatr Surg 36:851-854.     

Restriction of T cell receptor variable region in lymph nodes of adult T cell leukemia/lymphoma

Adult T cell leukemia/lymphoma (ATLL) is a mature T cell malignancy, especially derived from the CD4 positive T cell. To characterize the T cell, we examined the representation of T cell antigen receptor variable region, using the monoclonal antibodies [β V 5 (a), β V 5 (b), β V 6 (a), β V 8 (a), β V 12 (a), α V 2 (a), α-β V (a)]. Clinicopathologically we classified the lymph nodes of patients with ATLL into three states (1) human T cell leukemia virus type I (HTLV-I) associated lymphadenitis, reactive state; (2) incipient ATLL, early or pre-neoplastic state; and (3) ATLL, neoplastic state. The lymph nodes of all three states were composed of unvarying CD4 positive T cells. Most of the lymph nodes with ATLL consistently presented α V 2 antigen, but no others. In HTLV-I associated lymphadenitis, only a few cells reacted for α V 2, as in non-specific lymphadenitis without ATLL features. One of three cases with incipient ATLL presented α V 2. The selective expression of T cell antigen receptor V region might be associated with the presence of HTLV-I encoded superantigen, similar to human immunodeficiency virus (HIV).     

Antimetastatic Effect by Anti-adhesion Therapy with Cell-adhesive Peptide of Fibronectin in Combination with Anticancer Drugs

We have investigated the therapeutic effect of CH-271 fusion polypeptide containing both cell-binding domain (C-274) and heparin-binding domain (H-271) of fibronectin in combination with anticancer drugs such as doxorubicin (DOX) or mitomycin C (MMC) on tumor metastasis of different types of tumors. CH-271 fusion polypeptide alone significantly inhibited both liver and lung metastasis when it was co-injected with L5178Y-ML25 T-lymphoma, RAW117-H10 B-lymphoma or B16-BL6 melanoma cells, and spontaneous lung metastasis of B16-BL6 melanoma cells when administered i.v. seven times before or after surgical excision of the primary tumors. Combined treatments with CH-271 and either DOX or MMC significantly inhibited liver and lung metastasis of lymphoma or melanoma cells respectively, as compared with either treatment alone or the untreated control. Administrations of CH-271 and DOX in combination substantially prolonged the survival time of mice injected i.v. with L5178Y-ML25 cells. CH-271 or DOX was effective for inhibiting the invasion of LS178Y-ML25 cells into Matrigel in a concentration-dependent manner. Our previous study has shown that CH-271-mediated inhibition of tumor invasion may be due in part to the anti-cell adhesive property without affecting the cell growth, whereas the anti-invasive effect of DOX was established to have resulted from the growth inhibition of tumor cells. Moreover, the combination of CH-271 with DOX provided a more effective inhibition of tumor invasion into Matrigel than did either alone. Thus, we have demonstrated that the combination of anti-cell adhesive CH-271 and anticancer drugs such as DOX or MMC, i.e. anti-adhesion therapy and chemotherapy, is a new approach that offers enhanced (additive) inhibitory effects on tumor metastasis and invasion.     

Expression of secretory leukocyte protease inhibitor in women with endometriosis

OBJECTIVE: To explore endometriosis-related molecules in patients with use of differential display analysis. DESIGN: Prospective study. SETTING: Nagoya City University Medical School, Nagoya, Japan. PATIENT(S): Women with endometriosis (n = 27) and without endometriosis (n = 21). INTERVENTION(S): Surgery was scheduled in the proliferative or secretory phase of the menstrual cycle. MAIN OUTCOME MEASURE(S): Differentially expressed products of endometrioma samples were sequenced at nucleotides. One of the candidate genes, secretory leukocyte protease inhibitor (SLPI) gene, was analyzed with use of in situ hybridization and Northern blot analyses. Distribution of SLPI was determined by immunohistochemistry, and the amount of SLPI in the peritoneal fluid and serum was measured by ELISA. RESULT(S): Distinct expression of SLPI messenger RNA could be detected in the endometrial-type epithelium of extrauterine endometriotic tissues and in the eutopic endometrium of women with endometriosis. SLPI was localized in the endometrial-type epithelium of endometriomas immunohistochemically. The amount of SLPI in the peritoneal fluid was markedly elevated in the endometriosis group (91.6+/-6.6 ng/mL compared with 68.4+/-5.3 ng/mL in the controls). CONCLUSION(S): Secretory leukocyte protease inhibitor may be involved in the pathogenesis of endometriosis.     

The clinical picture of terminally ill patients with lung cancer

An investigation has been made with regard to the clinical picture of 87 terminally ill patients with lung cancer. It has yielded the following points. 1) Seven patients had been informed of their diagnosis. 2) Intravenous hyperalimentation was administered in 78 cases (90%), oxygen therapy in 68 cases (78%), and morphine in 35 cases (40%). 3) The most frequent cause of death in these patients was respiratory failure, due to progress of cancer, then infection, pleural, or pericardial effusion, or interstitial pneumonitis. 4) Psychic disturbances involved anxiety over breathing, depression, and delirium. In only 12% of the patients did the mental condition seem normal until death. 5) To deal with the dying patient's needs, it is necessary to establish proper treatment for the control of sensory dyspnea and for psychosocial support by a psychiatrist and other professionals for members of the family.     

Fetal pancreas transplantation in miniature swine. I. Developmental characteristics of fetal pig pancreases

The genetically defined miniature pig developed by Sachs et al. was selected as a large animal model to test the feasibility of fetal pancreas transplants for reversal of insulin-dependent diabetes. In order to test our approach, the first key was to characterize the development of the pig pancreas tissues throughout fetal life. Pancreas samples were obtained from 102 farm pig fetuses ranging in age from 35-110 days and from 39 minipig fetuses removed by Caesarean section from 5 timed-pregnant sows between 33 and 73 days after conception. The development of the endocrine and exocrine pancreases were examined by immunobiochemical assays of insulin, chymotrypsinogen, and trypsinogen. Light and electron microscopic examination of pancreases from the critical fetal ages (35-55 days) were used to confirm the above results. Insulin was already present at day 33 and increased rapidly till birth (day 114: 2.2 U/pancreas). Chymotrypsinogen activity was first detected at day 43 and trypsinogen activity at days 49-50. Enzyme content increased rapidly till days 65-70 and then more gradually until birth. Morphological development of exocrine cell granules conformed to the above results. The results clearly demonstrated in the pancreas of a larger mammal, the pig, that the endocrine elements mature prior to the exocrine system. Thus, as we found in rats, pig fetal pancreas also has this advantage as a donor tissue for transplantation. An appropriate fetal age for pig donors is estimated to be between 45 and 50 days.