The monocyte tumor necrosis factor-alpha production in patients with acute leukemia in complete remission

Tumor necrosis factor-α (TNF-α) production by unstimulated and lipopolysaccharide (LPS)-stimulated peripheral monocytes has been studied in 17 acute myeioid leukemia (AML) patients, 54 AML patients in complete remission (AML-CR), 9 acute lymphoblastic leukemia (ALL) patients and 13 ALL patients in complete remission (ALL-CR). TNF-α production by the unstimulated monocytes in ALL patients (n - 6, mean: 6.6 ± 4.9 u/ml) was higher than that of normal controls (n = 13, 0.9 ± 0.7 u/ml), AML patients (n = 14, 2.0 ± 2.1 u/ml) and AMLCR patients (n = 21,1.4 ± 1.2 u/ml). TNF-α production by the LPS-stimulated monocytes of the AML-CR patients (n = 54,12.4 ± 13.4 u/ml) was significantly higher than that of the normal controls (n = 21, 3.5 ± 2.5 u/ml) and the AML patients (n = 17, 2.6 ± 2.4 u/ml),p < 0.01, but there were not any significant differences among the AML-CR patients and the ALL patients or the ALL-CR patients. We separated the AML-CR patients into 3 groups, depending on the length of their remission, and found that AML-CR patients with longer than 6 months (M) but less than 60 M (n = 21,15.7 ± 16.9 u/ml) and the patients with a remission longer than 60 M (n = 11,18.2 ± 15.9 u/ml) had significantly higher TNF-α production than that of the controls.     

Synbiotic Therapy Reduces the Pathological Gram-Negative Rods Caused by an Increased Acetic Acid Concentration in the Gut

Background

The mechanisms for the improvement of the gut flora and the intestinal environment by synbiotic therapy are unclear.

Aims

This study evaluated the changes in the gut flora and the intestinal environment after synbiotic therapy, and tried to clarify the mechanisms by which synbiotic therapy reduces pathological bacteria in the gut.

Methods

A total of 47 enteral feeding patients with long-term mechanical ventilation support were enrolled in the study. Patients were randomly assigned to synbiotic and control groups, at a two to one ratio. Patients in the synbiotic group were administrated Lactobacillus, Bifidobacterium, and galactooligosaccharides as synbiotics for 8 weeks.

Results

The characteristics of the patients were not significantly different between the control (n = 16) and synbiotic (n = 31) groups. In the synbiotic group, the counts of Bifidobacterium and Lactobacillus in the gut increased significantly to 100 times the initial level following synbiotic treatment. The acetic acid concentration increased (71.1 ± 15.9 vs. 46.8 ± 24.1 μmol/g) and pH decreased in the gut in comparison with the control group. The concentration of acetic acid in the gut increased in proportion to the Bifidobacterium counts. The counts of pathological gram-negative rod decreased significantly to one-tenth of the initial level in inverse proportion to the Bifidobacterium counts. Furthermore, the amount of Pseudomonas aeruginosa in the lower respiratory tract decreased significantly after synbiotic therapy compared to the controls.

Conclusion

Synbiotic therapy reduces the pathological Gram-negative rods by increasing the acetic acid concentration in association with an increased counts of Bifidobacterium.     

Histology is a Prognostic Indicator After Pulmonary Metastasectomy from Renal Cell Carcinoma

Objectives

There are only a few detailed reports concerning the prognosticators following surgical resection of pulmonary metastases (PMs) from renal cell carcinoma (RCC). We investigated the prognosis of patients with RCC PMs undergoing pulmonary metastasectomy and identified prognostic factors in a multi-institutional retrospective study.

Methods

We retrospectively evaluated 84 patients who underwent resection of PMs from RCC between 1993 and 2014. We assessed the clinicopathological characteristics, focusing on the histological findings of PMs. We classified the histology into three types: pure clear cell carcinoma (N = 68), clear cell carcinoma combined with other histology type (N = 8), and non-clear cell carcinoma (N = 8). We examined the relationship between these histological types and the prognosis of patients with PMs from RCC.

Results

Complete resection was achieved in 78 patients (93%). The 5-year overall survival rate after metastasectomy was 59.7%. In multivariate analysis, three factors were found to be independent favorable prognostic factors of overall survival after lung metastasectomy [tumor size <2 cm, hazard ratio (HR) = 0.31, 95% confidence interval (CI) 0.13–0.78, P = 0.012; clear cell type, HR = 0.37, 95% CI 0.16–0.83, P = 0.025; and complete resection, HR = 0.27, 95% CI 0.10–0.78, P = 0.015].

Conclusions

This study indicates that a histological finding of the clear cell type is a significant favorable prognostic factor in addition to complete resection and a tumor size <2 cm. Histological evaluation of PM lesions is important for predicting survival after metastasectomy.

     

A proposal for management after lung resection, using a flexible silastic drain

We advocate a technique using a small silastic flexible drain for air leaks after pulmonary resection. Patients undergoing lung resection by video-assisted thoracic surgery were enrolled in this study. The 331 patients consisted of 227 men and 104 women, with a median age of 58 years. The surgical procedures were lobectomy in 145, wedge resection in 177, and segmentectomy in 9. At the end of the operation, a 19F silastic drain under a pressure of -7 cm H(2)O was inserted. When no air leak was observed, we removed the drain on postoperative day 1. When an air leak was observed, the suction mode was changed to a water seal. The mean duration of chest tube drainage was 1.9 days. The chest tube was removed on postoperative day 1 in 243 (73.4%) patients. Postoperative complications, other than prolonged air leak, occurred in 5 (1.5%) patients. The drain was not effective in 4 (1.2%) patients, and it was replaced with a conventional rigid drain. Management of air leaks using silastic flexible drains is safe and effective after wedge resection. Care should be taken in cases of lobectomy and segmentectomy when a large air leak is anticipated.     

Initial experience of carotid artery stenting using the Carotid WALLSTENT and FilterWire EZ in Japan

Purpose

The Carotid WALLSTENT (CWS) and Filter-Wire EZ (FWEZ) embolic protection devices for use in carotid arterial stenting (CAS) were newly approved for national health insurance coverage in Japan in April 2010. This article describes our initial experience of CAS using the CWS and FWEZ.

Material and methods

A group of 14 patients (12 men, 2 women; mean age 70.1 years, range 59?C83 years) with 15 carotid artery stenoses at high risk for carotid endarterectomy were treated by CAS using the CWS and FWEZ. Of these stenoses, 5 were symptomatic with ??50% stenosis of the common or internal carotid artery (ICA), and 10 were asymptomatic with ??80% stenosis. The rates of technical success, ICA flow impairment during filter protection, periprocedural ischemic stroke, 30-day major adverse events (MAEs) (stroke, death, myocardial infarction), and development of new ischemic lesions on diffusion-weighted imaging (DWI) were assessed.

Results

CAS was successful in all cases. There was no ICA flow impairment, periprocedural ischemic stroke, or MAEs. DWI showed new ipsilateral ischemic lesions in only one patient (6.7%).

Conclusion

Our initial clinical experience using the CWS and FEWZ for CAS was generally excellent, and the incidence of postprocedural ischemic lesions was low.     

Outcome of surgical resection for recurrent pulmonary metastasis from colorectal carcinoma

Background

The outcomes after repeat pulmonary resection for colorectal cancer (CRC) and the factors associated with the prognosis of these patients remain uncharacterized.

Methods

Data on 156 patients who underwent curative resection of pulmonary metastasis from CRC were reviewed. Repeat pulmonary resection was performed in 25 patients; the present study examined the outcomes and factors associated with prognosis after repeat pulmonary resection.

Results

The 5-year survival rate after the first pulmonary resection was 56.2%. A multivariate analysis identified a histological type other than well-differentiated adenocarcinoma, a high prethoracotomy serum carcinoembryonic antigen (CEA) level, and the presence of hilar or mediastinal lymph node metastasis as poor prognostic factors for the first pulmonary resection. The 5-year survival rate after repeat pulmonary resection was 42.1%. Hilar or mediastinal lymph node metastasis at the time of the repeat resection was significantly associated with poor survival.

Conclusions

Repeat pulmonary resection for metastatic CRC provides satisfactory outcomes. Hilar or mediastinal lymph node involvement is consistently associated with a poor prognosis after the first and repeat pulmonary resections.     

Serial chest films are needed after a diagnosis of pneumopericardium because of risk of cardiac herniation

A 76-year-old man was transferred to our institution with blunt chest trauma after falling off a roof. Chest computed tomography (CT) revealed left pneumothorax and pneumopericardium but no displacement of the heart into the hemithorax. These findings suggested traumatic pericardial rupture without cardiac herniation. After chest drainage, a follow-up CT scan demonstrated no pericardial or pleural air. At thoracotomy, we observed that the pericardium was torn and that the heart was exposed. The tear was repaired with direct sutures. This case report highlights the importance of reviewing the initial CT scan.     

Biological implications of thymectomy for myasthenia gravis

Myasthenia gravis (MG) is an autoimmune disease mediated by autoantibodies to the striated muscle tissue. It is often treated by thymectomy. We review recent studies to investigate the biological implications of thymectomy. In anti-acetylcholine receptor antibody (anti-AchR Ab)-positive patients without a thymoma, abnormal germinal center formation in the thymus seems to play an essential role in the pathogenesis of MG. Specific differentiation of B cells producing anti-AchR Ab takes place uniquely in the thymus, and thymectomy is thought to assist in terminating the provision of high-affinity anti-AchR antibody-producing cells to peripheral organs. Thymectomy is not indicated for anti-AchR Ab-negative MG patients who are antimuscle specific kinase antibody (anti-MuSK Ab)-positive, although some anti-MuSK Ab-negative patients may benefit from the procedure. A thymoma can be considered as an acquired thymus with insufficient function of negative selection. The resection of a thymoma is thought to terminate the production of selfreactive T cells. Thus, the biological implications of thymectomy for MG have been partially revealed. Nevertheless, additional studies are needed to elucidate the ontogeny of T cells that recognize AchR and the mechanism of the activation of anti-AchR antibodies producing B cells.     

A tip for keeping the surgical sutures in order during bronchoplasty

We describe a device that we use to keep many surgical sutures in order during bronchoplasty. This device is torus-shaped with slits at regular intervals radially, which encircles the surgical field. We tuck the suture material into the slits in the suture runner. Traditionally, they are controlled by the use of many mosquito forceps. We believe that this device is useful, and that our method is simpler than the traditional method.