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Background A mediastinal mediobasal segmental pulmonary artery (A7) from the right main pulmonary artery is extremely rare. Case presentation: We have reported a case of a 71-year-old woman with aberrant A7 who underwent right lower lobectomy for lung cancer (cT1bN0M0, stage IA2). Preoperative three-dimensional computed tomography (CT) angiography revealed an aberrant mediastinal A7 from the right main pulmonary artery. Right lower lobectomy and mediastinal lymph node dissection were performed. Intraoperatively, A7 was observed between the superior and inferior pulmonary veins, and at the front of the lower bronchus near the anterior hilum. The artery was carefully dissected from the caudal side after dissection of the inferior pulmonary vein. Then, the lung parenchyma, which was within the fissure due to poor lobulation between the middle and lower lobes, was safely divided. Conclusions Thoracic surgeons need to evaluate CT angiography or enhanced multidetector CT carefully at preoperative conferences and always keep this anomaly in mind.

The risk of complication following pneumonectomy is high; therefore, the decision to perform pneumonectomy should be carefully evaluated. A retrospective multicenter study of patients with metastatic lung tumors who underwent pneumonectomy was conducted.The database from the Metastatic Lung Tumor Study Group of Japan was retrospectively reviewed. Between 1984 and 2013, 4,742 patients underwent pulmonary metastasectomy. Of the 4,742 patients, 55 patients (1.16%) who underwent pneumonectomy were analyzed, and their survival parameters and prognostic factors were evaluated.Of the 55 patients who underwent pneumonectomy, 34 patients were male and 21 patients were female. The primary tumor sites were colorectal in 28 patients, head and neck in 12 patients, bone in three patients, bladder in three patients, and other regions in nine patients (breast, uterus, liver, soft tissues in two patients, respectively, and pancreas in one patient). The overall 5-year survival rate of patients following pneumonectomy was 28.9%. The rate was significantly lower than that of patients who underwent other metastasectomy which had an overall 5-year survival rate of 53.4% (P0.001). There were 3 hospital mortalities (3/55, 5.45%). Univariate analysis revealed that patients 55 years old or older (P=0.016) and patients who had lymph node metastasis (P=0.032) were significant predictors of poor prognosis. Multivariate analysis indicated that the age group 55 years old or older was an independent prognostic factor (P=0.040).The indication of pneumonectomy should be carefully reviewed, especially for patients 55 years old or older, however characteristics of each primary organ should also be considered.

Objectives Thoracoscopic surgery for lung metastasectomy remains controversial. The study aimed at determining the efficacy of thoracoscopic surgery for lung metastasectomy. Methods This was a multi-institutional, retrospective study that included 1047 patients who underwent lung metastasectomy for colorectal cancer between 1999 and 2014. Prognostic factors of overall survival were compared between the thoracoscopic and open thoracotomy groups using the multivariate Cox proportional hazard model. The propensity score, calculated using the preoperative covariates, included the era of lung surgery as a covariate. A stepwise backward elimination method, with a probability level of 0.15, was used to select the most powerful sets of outcome predictors. The difference between the radiological tumour number and the resected tumour number (delta_num) was also evaluated. Results The c -statistics and the P -value of the Hosmer-Lemeshow Chi-square of the propensity score model were 0.7149 and 0.1579, respectively. After adjusting for the propensity score, the thoracoscopy group had a better survival rate than the open group (stratified log-rank test: P = 0.0353). After adjusting for the propensity score, the most powerful predictive model for overall survival was that which combined thoracoscopy [hazard ratio (HR): 0.468, 95% CI: 0.262-0.838, P = 0.011] and anatomical resection (HR: 1.49, 95% CI: 1.134-1.953, P = 0.004). Before adjusting for the propensity score, the delta_num was significantly greater in the open group than in the thoracoscopy group (thoracoscopy: 0.06, open: 0.33, P = 0.001); however, after adjustment, there was no difference in the delta_num (thoracoscopy: 0.04, open: 0.19, P = 0.114). Conclusions Thoracoscopic metastasectomy showed better overall survival than the open approach in this analysis. The thoracoscopic approach may be an acceptable option for resection of pulmonary metastases in terms of tumour identification and survival outcome in the current era.

OBJECTIVES New chemotherapeutic regimens (i.e. FOLFOX or FOLFIRI with molecular targeted drugs) have improved the prognosis of patients with unresectable or recurrent colorectal cancer. To estimate the prognostic impact of these chemotherapies, we examined the chronological change in survival rates of patients who underwent pulmonary metastasectomy for colorectal cancer metastasis. METHODS Using a large database, we conducted a retrospective, multi-institutional study to collect data of 1223 eligible patients from 26 institutions who had undergone pulmonary metastasectomy with curative intent. We divided those patients who underwent metastasectomy in different time periods according to the major trend of chemotherapy regimens for recurrent colorectal cancer: those who underwent metastasectomy between 1990 and 1999 ( N = 451, Group A), between 2000 and 2004 ( N = 433, Group B) or between 2005 and 2007 ( N = 339, Group C). RESULTS Five-year overall survival rates after metastasectomy were 45% in Group A, 56% in Group B and 66% in Group C ( P

Thymoma is the most common thymic epithelial tumor whose classification was first introduced in 1999. Type B2 thymoma is considered a moderate/high-risk tumor; however, extrathoracic metastases are extremely rare with limited reports to date. In this report, we present a rare thymoma metastasis to the semimembranosus muscle, which was resected with a wide margin after confirmation by open biopsy. At the final follow-up after 1 year, no local recurrence has been observed.

Background We conducted a multicenter randomized study of adjuvant S-1 administration schedules for surgically treated pathological stage IB-IIIA non-small cell lung cancer patients. Methods Patients receiving curative surgical resection were centrally randomized to arm A (4 weeks of oral S-1 and a 2-week rest over 12 months) or arm B (2 weeks of S-1 and a 1-week rest over 12 months). The primary endpoints were completion of the scheduled adjuvant chemotherapy over 12 months, and the secondary endpoints were relative total administration dose, toxicity, and 3-year disease-free survival. Results From April 2005 to January 2012, 80 patients were enrolled, of whom 78 patients were eligible and assessable. The planned S-1 administration over 12 months was accomplished to 28 patients in 38 arm A patients (73.7%) and to 18 patients in 40 arm B patients (45.0%, p = 0.01). The average relative dose intensity was 77.2% for arm A and 58.4% for arm B (p = 0.01). Drug-related grade 3 adverse events were recorded for 11% of arm A and 5% of arm B (p = 0.43). Grade 1–3 elevation of bilirubin, alkaline phosphatase, aspartate aminotransferase, and alanine transaminase were more frequently recorded in arm A than in arm B. The 3-year disease-free survival rate was 79.0% for arm A and 79.3% for arm B (p = 0.94). Conclusions The superiority of feasibility of the shorter schedule was not recognized in the present study. The conventional schedule showed higher completion rates over 12 months (p = 0.01) and relative dose intensity of S-1 (p = 0.01). Toxicity showed no significant difference among the shorter schedule and the conventional schedule, except for grade 1–3 elevation of bilirubin. Trial registration This randomized multicenter study was retrospectively registered with the UMIN-CTR (UMIN000016086, registration date December 30, 2014).

症例は52歳，女性．検診時の胸部Ｘ線写真で左下肺野に約1cm大の腫瘤影を指摘され近医を受診した．胸部CTで左肺舌区に境界明瞭な結節影を認め，肺動静脈瘻を疑われて当院を紹介された．3D-CTで左肺S4末梢に8mm大の結節影と結節に流入出する肺動静脈を認めたため肺動静脈瘻と診断し，胸腔鏡下に腫瘤を含めた左肺S4部分切除術を施行した．肺動静脈瘻は常染色体優性遺伝疾患であるRendu-Osler-Weber病の部分症状として認められることがあるが，本症例は遺伝性を認めず，単発性であり，口唇などの毛細血管拡張を認めなかった．孤立性肺動静脈瘻の術前評価に3D-CTが有用であった症例に対して胸腔鏡下肺部分切除術を施行し，良好な結果を得たので若干の文献的考察を加えて報告する．

症例は64歳，女性．2008年4月頃から咳嗽，喀痰が出現したため近医を受診し，胸部レントゲン写真で両肺野に多発結節影を指摘された．胸部CTでは径5～27mm大，両肺胸膜直下に多発する境界明瞭，辺縁不整な結節影を認めた．一部に石灰化を伴っていた．PET-CTで多発結節影に集積を認めたため転移性肺腫瘍を疑い，確定診断目的で胸腔鏡下に右肺部分切除術を施行した．胸膜直下に暗赤色調で中心部に白色の浅い陥凹を伴う腫瘤を認めた．右肺S3の腫瘤を切除し迅速病理診断に提出し，肺アミロイドーシスの診断を得た．最終組織診断はAL（λ）型の多発性結節性肺アミロイドーシスであった．術後に血液検査などを追加し，シェーグレン症候群の合併を認めた．結節性肺アミロイドーシスの本邦報告例55例では，全身性のものは認めず，シェーグレン症候群を合併する頻度が22％（12/55）と高頻度であった．

症例は64歳，女性．18年前に左乳癌で非定型的乳房切断術を受けた．病理診断はInvasive ductal carcinoma, solid-tubular type, T1N0M0 stage Iであった．今回，検診で胸部異常影を指摘され当院を受診した．胸部X線写真で右上肺野に第2肋骨と重なる不整型結節影を認めた．CTでは右S1末梢に径1cm大の境界明瞭で辺縁不整な結節影を認めた．乳癌および肺癌関連の腫瘍マーカーはいずれも正常範囲内であった．乳癌の肺転移，あるいは原発性肺癌の診断で，胸腔鏡下肺部分切除術を施行し，迅速病理診断で乳癌の転移性肺腫瘍の診断であった．乳癌は遠隔期にも転移をきたすとされているが，原発巣切除後15年以上経過してからの肺のみの転移手術症例は本邦では本症例を含め10例の報告しかなく稀であるため文献的考察を加えて報告した．

Supplemental oxygenation is important in reversible pulmonary failure. To determine whether the peritoneal cavity can be used as a source of "extrapulmonary respiration," we perfused the peritoneal cavity with oxygenated red blood cells (RBCs) and saline, and measured the amount of oxygenation delivered through the peritoneum of dogs under controlled ventilation. Inflow and outflow catheters were placed in the peritoneal cavity and connected to a perfusion circuit. We investigated the safety of this procedure by examining the relationship between intraperitoneal infusion volume and hemodynamic changes in dogs that underwent peritoneal perfusion with oxygenated RBC (n = 6) and with oxygenated saline (n = 6). The controls comprised dogs that underwent a sham operation (n = 6). We found that an intraperitoneal infusion of less than 1,250 mL was hemodynamically safe. Oxygenation levels (PaO2) increased most obviously with an intraperitoneal infusion of oxygenated RBC. The peritoneum can potentially serve as an "artificial lung" in critically ill patients.

A 60-year-old man with a 7-year history of multiple pulmonary nodules presented to our hospital because the nodules were seen to have increased in size on review of films on a regular medical checkup 1 week earlier. Computed tomography (CT) revealed multiple pulmonary nodules with calcification in the lungs. The largest nodule measuring 2.5 cm in the maximum dimension was lobulated and ill-defined. The patient underwent 18F-fluorodeoxyglucose positron emission tomography/CT (18F-FDG-PET/CT) to evaluate the multiple nodules and to search for a primary lesion. 18F-FDG-PET/CT revealed increased uptake in only two nodules with a standardized uptake value of 4.61 and 2.10, respectively. The two foci with increased 18F-FDG uptake were resected and pathologically proven to be pulmonary epithelioid hemangioendothelioma (PEH). PEH can transform into malignancy with metastasis. An 18F-FDG-PET/CT finding may be an indicator to decide on PEH resection.

One-Step Dry-Coated tablets (OSDrC) of a colon-targeting drug were prepared using Eudragit L 100-55 (Eud-L) and chitosan (Chit) as the outer layer. Lag time in the 1st fluid, which simulated the stomach, was affected by differences in the pores occurring as a result of Chit dissolution. The dissolution rate of Chit was decreased by the addition of Eud-L. On the other hand, lag times in phosphate buffer (pH 7.4) simulating the small intestine, and in the 2nd fluid simulating the colon, were affected by differences in the pores occurring as a result of Eud-L dissolution and Chit swelling. The lag time of OSDrC with an outer layer of Eud-L:Chit at a ratio of 3:1 in each test medium was greater than the gastric emptying time in the 1st fluid and the small intestine transit time in phosphate buffer (pH 7.4). Furthermore, lag times were similar when test media were changed sequentially. Therefore, it is possible to deliver colon-targeting drugs as OSDrC with an outer layer of Eud-L:Chit at 3:1.

Background: Telomeres are important for chromosome structure and function, protecting them against degradation. However, few studies have examined telomeres in pulmonary neuroendocrine (NE) tumors. Methods: We investigated deparaffinized sections obtained from 70 primary NE lung tumors [34 typical carcinoids (TCs), 10 atypical carcinoids (ACs), 16 large cell neuroendocrine carcinoma (LCNECs) and 10 small cell lung carcinomas (SCLCs)]. Results: Positive expressions of human telomerase mRNA component (hTERC) and human telomerase reverse transcriptase (hTERT) mRNA were recognized, respectively, in 58% and 74% of TCs, and in 100% and 100% of ACs, LCNECs and SCLCs. Alteration of telomere length was greater in both LCNECs and SCLCs than in TCs. Telomerase activity was detected in LCNECs, but not in TCs. By the reverse-transcriptase polymerase chain reaction (RT-PCR), hTERC mRNA was detected in 100% of LCNECs and TCs examined, while hTERT mRNA was detected in 67% of LCNECs, but not at all in TCs. Conclusions: These results suggest that alterations in telomere length, telomerase activity, and the expression of hTERT mRNA may (i) play roles in pathogenesis in pulmonary neuroendocrine tumors, and (ii) be a useful tool for differential diagnosis between TCs and LCNECs.

Hypoxia-inducible factor-1 (HIF-1) is a transcription factor that plays an important role in tumor growth and metastasis by regulating energy metabolism and inducing angiogenesis. Elevated levels of HIF-1alpha, a subunit of HIF-1, are noted in various malignant tumors, but it is unclear whether this is so in esophageal carcinoma. The purpose of this study was to evaluate the implications of HIF-1alpha expression in esophageal squamous cell carcinoma. In 215 patients with esophageal carcinoma, we examined immunoreactivity for HIF-1alpha protein, vascular endothelial growth factor (VEGF) protein and p53 protein. In 38 patients, we examined the expression of HIF-1alpha messenger ribonucleic acid (mRNA) (using the semiquantitative reverse transcriptase-polymerase chain reaction [RT-PCR]). A positive HIF-1alpha protein expression was recognized in 95% of the patients, and was strongly apparent within both the nuclei and/or cytoplasm of tumor cells. The proportion of patients in the 'high score' group for HIF-1alpha protein expression increased significantly with increasing VEGF protein expression. Immunoreactivity for HIF-1alpha protein was found to have a significant effect on disease-free survival rate in our univariate analysis, but no effect on overall survival rate. In RT-PCR, HIF-1alpha mRNA scores correlated significantly with scores for HIF-1alpha protein expression, but not with any clinicopathologic factor or either of the survival rates. The detection of HIF-1alpha protein and mRNA would appear to offer limited information as to progression and prognosis in esophageal carcinoma.

症例は15歳, 男性. 2000年5月学校検診で胸部異常影を指摘された. 胸部X線写真で心陰影に重なり下行大動脈左側縁から左肺野へ突出する半円状の腫瘤影を認めた. CT, MRIでは左後縦隔に胸椎左縁に接する瓢箪形の充実性腫瘤影を認め, 左後腹膜腔の副腎部にも孤立性腫瘤影を認めた. 縦隔内神経原性腫瘍を考え胸腔鏡補助下小開胸開腹により腫瘍摘出術を施行した. 後縦隔の交感神経幹に沿って連続する3個の腫瘍と後腹膜腔左腎上部に1個の計4個の腫瘤を認め, これを一期的に摘出した. いずれの腫瘍も病理学的に神経節細胞腫であった. 後縦隔及び後腹膜腔に多発した神経節細胞腫は稀であるため文献的考察を加えて報告した.

65歳の女性.高血圧で通院中に胸部異常影を指摘され当院を紹介された.胸部X線写真上, 左中肺野に約10cm大の辺縁明瞭な円形腫瘤影を認めた.胸部CT・MRIでは左前縦隔から左胸腔内のほぼ半分を占める内部不均一な嚢胞状腫瘤であった.前胸壁から穿刺吸引細胞診を施行し, 胸腺癌あるいは肺癌の診断であったため左開胸により摘出術を施行した.開胸すると腫瘍は左前縦隔に存在する縦隔腫瘍で胸膜播種と左上葉への浸潤を認め, 左肺上葉を合併切除し, 播種巣を可及的に切除した.腫瘍は13×9×5.5cm大で線維性被膜を有し, 内腔に著明な出血壊死を伴うTypeB3 (WHO分類), IVa期胸腺腫であった.術後化学療法及び残存胸腺に対する放射線照射を追加したが, 2年後に左胸腔内再発を来たし, 術後4年6ヵ月で亡くなった.ほぼ全体が嚢胞状変性を来した胸腺腫は検索し得た限り自験例を含め47例のみであり比較的稀と考え報告した.

Application of ultraviolet light (UV-) irradiation to a photocrosslinkable chitosan (Az-CH-LA) aqueous solution including fibroblast growth factor-2 (FGF-2) resulted within 30s in an insoluble, flexible hydrogel. About 20% of the FGF-2molecules were released from the FGF-2-incorporated chitosan hydrogel into phosphate buffered saline (PBS) within 1 day, after which no further significant release occurred under in vitro non-degradation conditions of the hydrogel. The FGF-2molecules retained in the chitosan hydrogel remained biologically active, and were released from the chitosan hydrogel upon the in vivo biodegradation of the hydrogel. In order to evaluate its accelerating effect on wound healing, full thickness skin incisions were made on the back of healing-impaired diabetic (db/db) mice and their normal (db/+) littermates. Application of the chitosan hydrogel significantly induced wound contraction and accelerated wound closure in both db/db and db/+ mice. However, the addition of FGF-2 in the chitosan hydrogel further accelerated wound closure in db/db mice, although not in db/+ mice. Histological examination also has demonstrated an advanced granulation tissue formation, capillary formation and epithelialization in wounds treated with FGF-2-incorporated chitosan hydrogels in db/db mice.

Periodate-treated, non-anticoagulant heparin-carrying polystyrene consists of about ten periodate-oxidized, alkaline-degraded low molecular weight-heparin chains linked to a polystyrene core and has a markedly lower anti-coagulant activity than heparin. In this study, we evaluated the effect of non-anticoagulant heparin-carrying polystyrene on tumour growth and metastasis. Non-anticoagulant heparin-carrying polystyrene has a higher activity to inhibit vascular endothelial growth factor-165-, fibroblast growth factor-2- or hepatocyte growth factor-induced human microvascular endothelial cell growth than heparin, ten periodate-oxidized-heparin and ten periodate-oxidized-low molecular weight-heparin, which is probably due to the heparin-clustering effect of non-anticoagulant heparin-carrying polystyrene. Non-anticoagulant heparin-carrying polystyrene inhibited human microvascular endothelial cell, B16 melanoma and Lewis lung cancer cell adhesion to Matrigel-coated plates. Non-anticoagulant heparin-carrying polystyrene also showed strong inhibitory activities in the tubular formation of endothelial cells on Matrigel and B16-melanoma and Lewis lung cancer cell invasion in a Matrigel-coated chamber assay. In vivo studies showed that growth of subcutaneous induced tumours and lung metastasis of B16-melanoma and Lewis lung cancer cells were more effectively inhibited by non-anticoagulant heparin-carrying polystyrene than ten periodate-oxidized-heparin and ten periodate-oxidized-low molecular weight-heparin. Furthermore, non-anticoagulant heparin-carrying polystyrene markedly reduced the number of CD34-positive vessels in subcutaneous Lewis lung cancer tumours, indicating a strong inhibition of angiogenesis. These results suggest that non-anticoagulant heparin-carrying polystyrene has an inhibitory activity on angiogenesis and tumour invasion and may be very useful in cancer therapy. British Journal of Cancer (2002) 86, 1803–1812. doi:10.1038/sj.bjc.6600307 www.bjcancer.com © 2002 Cancer Research UK

大腸癌肺転移36例の肺切除後予後について原発巣因子による検討を行った. 36例の5生率は35.9%で,肺切除後の予後因子としてリンパ節転移n2以上,癌先進部の簇出中等度以上,リンパ節以外の非連続性癌進展病巣(ex)陽性が有意であった.この3因子中,全因子陰性か1因子のみ陽性のp-Low群(n=17)は2因子以上陽性のp-High群に比べ肺切除後予後が有意に良好で(5生率75.1%: 0%, p=0.0002),術後無再発生存も長かった(50%無再発生存期間1, 848日: 202日, p

There has been an increase in the detection rate of small early lung cancer due to recent improvements in imaging technology. However, conventional imaging modalities such as computed tomography (CT) alone are not capable of differentiating small pulmonary nodules. New modalities such as F-18 2'-deoxy-2fluoro-D-glucose (FDG) positron emission tomography combined with CT (PET/CT) have contributed to the evaluation of lung cancer staging, although the differential diagnosis of pulmonary nodules showing ground-glass opacity (GGO) with PET/CT is controversial. In Japan, cancer screening with whole body FDG-PET has been available for asymptomatic individuals, and it has been reported that a wide variety of cancer types are detectable by FDG-PET at potentially curable stages. We present the case of a 62-year-old male with early lung cancer, which was revealed by repeated health screening. A PET/CT scan revealed definite intense FDG uptake (SUVmax 1.2) in the pulmonary nodules of the right upper lobe, while no definite FDG uptake was observed in the lesion in the previous annual screening. Right upper lobectomy was performed, and the pathological diagnosis was well-differentiated adenocarcinoma. Five-year survival has been noted since the thoracotomy, and the patient is doing well without recurrence. This is a significant case of early lung cancer with GGO lesions, which revealed intense FDG uptake during an annual repeated health screening with FDG-PET/CT.

Cancer of unknown primary origin (CUP) is an aggressive disease with a poor prognosis. Metastatic brain tumors occur in approximately 15% of all cancer patients. F-18 2'-deoxy-2fluoro-D-glucose (FDG) positron emission tomography (PET) combined with computed tomography (PET/CT) contributes to the evaluation of cancer staging, although the benefits of PET/CT for detection of CUP origins has yet to be determined. In this study, we present a 37-year-old man with a brain tumor detected by magnetic resonance imaging. Surgical biopsy indicated a metastatic undifferentiated carcinoma, while clinical examination and a CT scan did not detect any abnormalities, with the exception of brain metastases. PET/CT did not reveal abnormal FDG uptake. PET/CT revealed abnormal intense FDG uptake in a small nodular lesion in the right lung 1 year following the detection of brain metastasis, and no other abnormal FDG uptake was observed elsewhere in the body. Right upper lobectomy and dissection of mediastinal lymph nodes were performed. The pathological diagnosis was poorly differentiated adenocarcinoma, which was similar to the brain metastatic lesion, and there was no lymph node metastasis. This case revealed an extremely rare lung cancer with primary lesions demonstrated by PET/CT 1 year after the detection of brain metastasis. This case reveals that F-18 FDG PET/CT imaging of CUP origin is capable of positively impacting on the identification of small primary tumor foci.

BACKGROUND Adenocarcinoma of the lung occasionally has acidophilic nuclear inclusions (ANIs). Some studies have reported that the incidence of ANIs was higher in well differentiated tumor types and have suggested that adenocarcinoma patients with ANIs might have a more favorable prognosis; however, to the authors' knowledge, statistically significant prognostic findings were not reported. The objective of the current study was to assess the prognostic significance of ANI in patients with pulmonary adenocarcinoma and, moreover, to characterize ANI immunohistochemically and ultrastructurally. METHODS Surgically resected tumor specimens from 147 patients with primary pure adenocarcinoma of the lung were examined. Only obvious ANIs surrounded by a clear halo on hematoxylin and eosin-stained slides were counted; the authors classified cases with ≥ 10 ANIs per 10 high-power fields (/10HPF) as frequent-ANI cases, cases with < 10 ANIs/10HPF as infrequent-ANI cases, and cases without ANIs as non-ANI cases in the current study. RESULTS Nineteen frequent-ANI cases (12.9%) and 16 infrequent-ANI cases (10.9%) were found; the remaining 112 cases (76.2%) were considered to be non-ANI cases. The majority of ANIs immunohistochemically contained surfactant apoprotein and ultrastructurally corresponded to invagination of the inner nuclear membrane, showing a tubular or amorphous configuration. Frequent-ANI patients showed significantly better prognosis than the other two groups on both overall univariate analysis and univariate analysis limited to patients with International Union Against Cancer Stage I disease (P = 0.0096 and P = 0.0095, respectively). However, on the multivariate analysis only disease stage was shown to be a significant prognostic factor and frequent-ANI showed borderline significance (P = 0.0956). CONCLUSIONS Frequent ANIs appear to be of limited value in clarifying the prognosis of patients with lung adenocarcinoma. Cancer 2001;91:1896–904. © 2001 American Cancer Society.

【目的】肺癌検診におけるCTの有用性の検討【対象・方法】最近4年間に当院に人間ドック目的で入院した男性1335人, 女性19人の合計1354人. 年齢は22歳から66歳で平均48.3歳である. 検査項目は問診, 喀痰細胞診, 直接胸部単純写真 (以下胸単), 胸部X線CT (以下CT) である. CT導入前の胸単のみの検診1281人と比較する.【結果】 CTを用いた検診では1354人中5人 (0.37%) の肺癌が発見された (10万人対369). 内訳は高分化型腺癌3例, 低分化型腺癌1例, AAH 1例であった. 低分化型腺癌の1例はMissed caseである. いずれも胸単では指摘できなかった. 一方, CT導入前の胸単のみの検診では肺癌は発見できなかった.【考察】胸部CT検診の早期肺癌発見における有用性の報告は多くの施設によりなされている. 今回我々の検討では, 対象は比較的若年層であり, 通年検診症例である. CT導入前の肺癌発見が1281例中0例に対し, 導入後は1354例中5例であり1例を除き早期肺癌であった. 費用効果などあらゆる側面からCTの有用性を検討すべきであり, また対象とする集団の年齢構成や職種などにより適切な検診方法を検討すべきである.

1999年1月から同年12月までに乳腺外来を受診し視触診, マンモグラフィ, 超音波検査等で強く悪性疾患を疑った61例に対して乳腺MRIを施行した。そのうち腫瘤性病変に対して組織学的診断の得られた58例 (良性疾患8例, 乳癌50例) を対象に, dynamicstudyによる腫瘤影の特徴, 時間信号強度曲線について良悪性疾患別に比較し, 造影MRI検査における造影パターンの解析の有用性を検討した。対象症例すべてが造影MRIで濃染した腫瘤を認め, 信号強度のピーク時間の平均値は良性疾患では約7分, 乳癌例では約2分であった。PRE (preripheral ring enhancement) は乳癌50例中40例 (80.0%) に認められたのに対して, 良性疾患では全例で認められなかった。乳腺疾患の画像診断は主にマンモグラフィ, 超音波検査が用いられてきたが, 乳腺腫瘤の治療方針を決定していく上で, dynamic MRIにおける造影パターンの解析が一助となると考えられる。

von Recklinghausen病に合併した悪性神経鞘腫の肺転移に対し, 胸腔鏡下切除を施行し得た1例を経験したので報告する.症例は32歳の女性で, 小児期よりvon Recklinghausen病と診断され, 1994年12月に右下腿の悪性神経鞘腫に対して, 術前化学療法, 放射線治療の後, 広範囲腫瘍摘出術を施行した.1997年9月の胸部X線写真で右中肺野にcoin lesionを認め, 転移性肺腫瘍の診断で1997年11月に胸腔鏡下肺部分切除術を施行した.術後の病理組織診断は, 悪性神経鞘腫の肺転移であり, 断端に肉腫細胞を認めず, 術後1年9ヵ月の現在までに新たな肺転移の出現を認めていない.悪性神経鞘腫の転移臓器としては肺が最も多く, その予後は著しく不良であるが, 本症例は比較的予後が期待できると考えられた.

Background The cut-and-sew Maze procedure has historically been the most efficacious therapy for patients with atrial fibrillation (AF) that is refractory to medical management, but is not widely used as a stand-alone treatment for AF. New ablation technologies can create pulmonary vein (PV) isolation without cardiopulmonary bypass. Methods and Results The `thoracoscopic mini-Maze' procedure includes bilateral PV isolation, ablation of the epicardial ganglionated plexi and excision of the left atrial appendage using small bilateral thoracotomies with thoracoscopic assistance. Between January 2006 and April 2007, 20 thoracoscopic mini-Maze procedures were performed at 2 institutions and over a mean follow-up of 16.6 months, 18 (90%) patients are in sinus rhythm. Perioperative bleeding complications occurred in 3 patients (15%) and there was 1e (5%) late instance of atrial flutter that required a right-sided ablation. None of the patients died or needed a pacemaker. Conclusions Early experience with the thoracoscopic mini-Maze procedure suggests that sinus rhythm can be re-established in most patients in the short-term and with more experience the rate of complications should reduce, which is required prior to defining the role of this therapy in the future treatment of AF. (Circ J 2008; 72: 434 - 436)

Two subtypes of thrombospondin (TSP-1 and TSP-2) have inhibitory roles in angiogenesis in vitro, although the biological significance of these TSP isoforms has not been determined in vivo. We examined TSP-1 and TSP-2 gene expression by reverse transcription polymerase chain reaction (RT-PCR) analysis in 61 colon cancers. Thirty-eight of these 61 colon cancers were positive for TSP-2 expression and showed hepatic metastasis at a significantly lower incidence than those without TSP-2 expression (P = 0.02). TSP-2 expression was significantly associated with M0 stage in these colon cancers (P = 0.03), whereas TSP-1 expression showed no apparent correlation with these factors. The colon cancer patients with TSP-2 expression showed a significantly low frequency of liver metastasis correlated with the cell-associated isoform of vascular endothelial growth factor (VEGF-189) (P = 0.0006). Vascularity was estimated by CD34 staining, and TSP-2(–)/VEGF-189(+) colon cancers showed significantly increased vessel counts and density in the stroma (P < 0.0001). TSP-2(–)/VEGF-189(+) colon cancer patients also showed significantly poorer prognosis compared with those with TSP-2(+) / VEGF-189(–) (P = 0.0014). These results suggest that colon cancer metastasis is critically determined by angiogenesis resulting from the balance between the angioinhibitory factor TSP-2 and angiogenic factor VEGF-189. © 1999 Cancer Research Campaign

Recent reports of cancers that produce colony-stimulating factors (CSF) and which are associated with leukocytosis indicate that most are granulocyte CSF-producing tumors. A 71-year-old man with metastatic chest wall tumors from large cell lung cancer with marked leukocytosis and eosinophilia was reported. His maximal leukocyte count was 48300/microliter with 37.5% eosinophils. Granulocyte-macrophage CSF (GM-CSF) activity detected by enzyme-linked immunosorbent assay (ELISA) in serum was 112 pg/ml (normal range < 2.0 pg/ml), but G-CSF was normal. Immunohistochemical detection of GM-CSF protein on a chest wall tumor sample was positive. Irradiation of the chest wall tumor was performed and the leukocyte count decreased temporally. However, he died of respiratory failure due to progressive tumor growth 56 days after admission. Based on these results it appears that autocrine production of GM-CSF is a possible cause of this leukemoid reaction.

Vascular endothelial growth factor (VEGF) is a well known factor that induces angiogenesis. Four isoforms, i.e. VEGF206, 189, 165, and 121, have been identified. We examined the isoform patterns of VEGF mRNA using reverse transcription polymerase chain reaction (RT-PCR) analysis in 61 colon cancers. All the colon cancers examined expressed VEGF121. The isoform patterns were classified into three groups: type 1, VEGF121; type 2, VEGF121 + VEGF165; type 3, VEGF121 + VEGF165 + VEGF189. Three of the 61 colon cancers examined showed type 1 expression, 26 showed type 2 expression and 32 showed the type 3 pattern. The patients with liver metastases showed the type 3 isoform expression pattern at a significantly higher incidence (12 of 16, 75%) than those without liver metastasis (20 of 45, 44%) (P=0.036). The type 3 isoform pattern was significantly associated with M1 stage (P=0.019). The patients with colon cancer and the type 3 isoform pattern showed significantly poor prognosis (P < 0.01, Cox-Mantel). The colon cancers with the type 3 pattern showed a significantly higher involvement of veins (P=0.006). These observations suggest that the aberrant type 3 expression pattern of VEGF189 mRNA isoforms is correlated with liver metastasis, M stage, and poor prognosis in colon cancer. Images Figure 2 Figure 3

症例は32歳, 女性.感冒様症状の為, 近医受診.近医での胸部単純X線写真で, 左上肺野に伏針を指摘され, 当科入院となった.腰痛で針治療の既往歴はあったが, 上半身には治療歴や外傷の痕はなく, 針が刺入したことを示唆する所見もなかった.透視下に全身を検索したが他部位には伏針は認めなかった.将来症状が出現する可能性が強い為, 手術を施行した.手術は針のみの摘出は考えず, 側方開胸で術中透視を使用し針を確認しながら肺部分切除術を施行した.術後経過は順調であった.針は長径約3.5cmで縫い針と考えられたが, 針刺入の原因は不明であった.若干の文献的考察を加え報告する.

肺転移を切除した稀な胃癌5例について, 原発巣と転移巣を臨床病理学的に比較するとともに免疫組織化学的に糖鎖抗原 (SLX, CA19-9) の発現を検討した.再発転移形式で分類すると, 肺の転移巣再切除が可能と思われたのは3例であった.これらは肺を主たる標的臓器として転移巣を形成する傾向があったと考えられ, 共通点は転移巣の病理組織が分化型 (腸型) であり, CA19-9が陽性を示したことであった.このうち1例に5年生存が得られた.この1例は原発巣よりも転移巣でSLXの減弱がみられた.胃癌の結節状肺転移の形成や予後に糖鎖抗原が関与している可能性が示唆された.

ERK2 (extracellular-signal regulated kinase 2, also known as p42 mitogen-activated protein kinase) is an integral member of the mitogen-activated protein kinase cascade that is crucial for many cellular events such as proliferation and differentiation. Here, we determined the genomic organization of the Erk2 gene and characterized its promoter. The Erk2 gene spans over 60 kilobases, and the coding region is split into eight exons. In the coding region, exon-intron organization was exactly conserved between the two mouse genes for ERK2 and ERK1 except one junction shifted by one nucleotide. Primer extension and S1 nuclease analyses identified two major transcription start sites located at −219 and −223 relative to the translation start site. The 5′-flanking sequence lacked TATA box but contained a CCAAT box located approximately 60 base pairs upstream of transcription start sites. Sequencing of the 5′-flanking region also revealed potential cis-acting elements for multiple transcriptional regulatory factors including Sp1, zif268, Ets, CREB, and PuF sites. The promoter activity of the 5′-flanking region was examined using chloramphenicol acetyltransferase as a reporter gene. Transient transfection experiments using Chinese hamster ovary cells defined a maximal promoter activity in a 371-base pair region immediately upstream of the translation start site. Furthermore, we demonstrated, using mouse P19 embryonal carcinoma cells, that this 371-base pair sequence is likely to be sufficient to confer the transcriptional activation of the ERK2 promoter during the retinoic acid-induced differentiation of P19 cells.