Easier node dissection after chemoradiotherapy for lung cancer with collagen insertion at mediastinoscopy

Objective: Induction chemoradiotherapy followed by anatomical resection is a current therapeutic strategy for non-small-cell lung cancer with mediastinal node involvement. Dense peritracheal fibrosis and sclerosis after chemoradiotherapy cause difficult mediastinal node dissection. We evaluated a novel technique to make the mediastinal node dissection easier after induction therapy. Methods: At the end of mediastinoscopic node biopsy for staging of lung cancer, cotton-type collagen was inserted anterior and lateral to the trachea in patients with pathologically confirmed mediastinal node involve-ment (n=45). The induction therapy consisted of concurrent use of platinum-based chemotherapy and hyperfractionated radiotherapy. After the chemoradiotherapy all patients underwent a pulmonary resection with complete mediastinal node dissection 7–12 weeks after the collagen insertion. Surgical findings of the mediastinum and the time for node dissection were compared with those without collagen insertion at mediastinoscopy after chemoradiotherapy (n=5). Results: All five patients without collagen insertion showed sclerotic and fibrotic change of mediastinal nodes with severe adhesion to the trachea. In 42 of 45 patients with collagen insertion (93.3%) the collagen remained unabsorbed and separated the mediastinal nodes from the trachea. Mediastinal node dissection was easily accomplished by removing mediastinal tissues lateral and anterior to the collagen. The rate of mediastinal node separation was significantly higher with collagen insertion than without (p< 0.0001). The times for node dissection in patients with and without collagen insertion showed no significant difference. Conclusion: Cotton-type collagen insertion at staging mediastinoscopy for lung cancer separates the mediastinal nodes from the trachea and makes the node dissection easier after induction chemoradiotherapy.     

Prevention of Restenosis after Coronary Angioplasty with Low-Density Lipoprotein Apheresis

Abstract: A prospective study was performed to determine whether low-density lipoprotein (LDL) apheresis, when performed only immediately before and after percutaneous transluminal coronary angioplasty (PTCA), is effective in preventing restenosis of coronary artery lesions following PTCA. Thirty-six patients with coronary heart disease (CHD) and hypercholesterolemia were divided into 2 groups. The 9 patients in the LDL group underwent LDL-apheresis 1 day before and 5 days after PTCA while the 27 patients of the control group underwent PTCA but did not undergo LDL-apheresis. Follow-up coronary angiography (CAG) was performed 4 months after PTCA. The rate of restenosis of coronary artery lesions was significantly lower in the LDL group (0%) than in the control group (30%). These findings suggest that LDL-apheresis, when performed before and after PTCA, is effective in preventing restenosis of coronary artery lesions in patients with CHD and hypercholesterolemia.     

Contrast-enhanced intraoperative ultrasonography of small hepatocellular carcinomas

Nine patients with small hepatocellular carcinomas, ranging up to 2 cm in size (phi: 1.7 +/- 0.2 cm, mean +/- SD), have been encountered, and in two of these patients the cancer was not identifiable by intraoperative ultrasonography. Thus to achieve a better detection of such small hepatic cancers, enhanced intraoperative ultrasonography was tested. Detection by enhanced intraoperative ultrasonography proved successful in all cases. These preliminary results indicate the potential of carbon dioxide as a contrast agent to enhance intraoperative visualization of small liver cancers.     

Immediate changes in subcellular structures of transplanted tumors following photodynamic and laser hyperthermic therapy

Background and Objective: To further understand the precise process of the tumor cell degeneration after photodynamic therapy (PDT), laser hyperthermic therapy (LH), and combined treatments using an Nd:YAG laser. It is important to examine initial morphological alteration of tumor cells after these treatments. Study Design/Materials and Methods: In this study, nude mice bearing HeLa cell tumors were treated with PDT, LH, and combined treatments of the two. Tumor tissues obtained immediately after these treatments were analyzed using electron microscopy and morphometry. Results: In the combined treatments, which produced more severe effects on tumor cells, morphological features of apoptosis such as cytoplasmic condensation, blebs, and apoptotic bodies appeared in the cells, although the typical alteration in the nuclear chromatin was not seen. Conclusion: Cytoplasmic alterations may proceed more rapidly than nuclear alterations in the cellular degeneration induced by the single or combined treatments of PDT and LH.     

Tumor markers in human breast cancer

We described tumor markers which are considered to be useful for the detection of recurrence, index of the efficacy of treatment and assessment for the prognosis of the patients with breast cancer. CEA and CA 15-3 are relatively useful markers among various serological ones. However, although accuracy of the diagnosis with CA 15-3 and CEA is generally thought to be not superior to those of imaging method, CA 15-3 and CEA seems to be clinically useful tools for making diagnosis because of its simplicity and less cost. Estrogen and progesterone receptors shows good responses to endocrine therapy. Response rate was 70 to 80% in both receptor-positive patients. Presence of ER shows higher rate of recurrence and shorter survival of the patients than those with absence of ER. Recent attention has been focused on EGF and proto-oncogene, suggesting relationship of those to prognosis.     

Effects of tension on local blood flow in experimental intestinal anastomoses

In intestinal anastomoses, local blood flow is one of the most important factors contributing to the success of the healing process. While submucosal local blood flow is maintained better in the colon than in the small intestine, the incidence of anastomotic leakage is higher in the former than in the latter. To resolve this conflict, we have examined differences in the reactivity of the intestinal segments toward the application of tension. Anastomosis was performed with a stapler on the jejunum, ileum, and colon of experimental dogs. The anastomotic sites were subjected to tensile loads applied in incremental steps to measure and compare local blood flow, measured by the hydrogen clearance method, in the submucosal layers of the anastomoses in these intestinal segments. The results of these comparative evaluations indicate that, at a tensile stress level of more than 4 g/mm2, local blood flow in the colon is significantly smaller than that in the jejunum and ileum. These findings were corroborated by microangiographical observations carried out during stress application. The microangiographical data suggest that the rate of filling of the contrast medium is lower with colonic anastomosis than with jejunal and ileal anastomoses. In addition, the intraluminal pressure of the colon was higher than that of the small intestine during the induced peristalsis. The different sensitivity of the local microcirculation systems of the intestinal segments to tension may thus be considered one of the factors accounting for the higher incidence of clinical suture failure in colonic than in small intestinal anastomoses.