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We examined the levels of expression of the multidrug resistance-associated protein (MRP) gene quantified by Northern blot analysis in comparison with those of the MDR1 gene determined by reverse transcription-polymerase chain reaction (RT-PCR) in 104 non-small-cell lung cancer (NSCLC) specimens [59 adenocarcinoma (Ad), 40 squamous cell carcinoma (Sq), four large cell carcinoma (La) and one adeno-squamous carcinoma (AdSq)]. Thirty-three (31.7%) of the 104 NSCLC expressed the MRP gene at various levels. The NSCLC showing high (++) levels of MRP gene expression (19 out of 33, 57.6%) were predominantly squamous cell carcinomas (Ad, 5; Sq, 13; La, 1) (P < 0.05). Six of the eight NSCLCs expressing high levels of MRP mRNA and no MDR1 (MRP ++, MDR1-) were squamous cell carcinomas. Sixty-one of the 104 NSCLC patients received chemotherapy with MRP-related anti-cancer drugs [vindesine (VDS) and etoposide (VP-16)]. Twenty-three patients (37.7%) with tumour expressing high or moderate levels of MRP showed significantly worse prognoses than those with non- or low-MRP-expressing tumours (P < 0.05). These results suggest that the level of MRP gene expression is related to the histopathology and prognosis of NSCLC. Images Figure 1

We determined the clinicopathological features of primary lung carcinomas with rhabdoid cells by defining the immunophenotype of rhabdoid cells and analysing survival.Rhabdoid cells are distinctive in having an eccentric nucleus and a large intracytoplasmic inclusion on routinely stained sections. Based on the number of rhabdoid cells, 45 cases of large cell carcinoma were divided into the following three types: lung tumour with a rhabdoid phenotype (LTRP) (n=4), lung carcinoma with a small number of rhabdoid cells (LCSR) (n=10), large cell carcinoma containing no rhabdoid cells (LCNR) (n=31). LTRP is composed of at least 10% rhabdoid cells. In LCSR the percentage of rhabdoid cells is less than 10%. LTRP and LCSR are associated with locally advanced disease. Immunohistochemical stains were positive for epithelial markers in all LTRP and eight LCSR, for neuroendocrine markers in one LTRP and three LCSR. The outcome is worse for patients with LTRP than LCSR or LCNR. LCSR shows a trend close to LCNR. Stage-matched survival analysis, however, revealed no statistically significant difference among the histological subtypes.Rhabdoid cells are heterogeneous except for epithelial markers and vimentin positivity. Less than 5% of rhabdoid cells has a negligible effect on prognosis.

Trans-sternal bilateral thoracotomy has been performed in 4 patients with bilateral metastatic lung tumors. The primary lesion was rectum in one case and the colon in three cases. Two patients were male and 2 were female. Their ages ranged from 63 to 78 years old. An inframammary incision was made with the patient in the supine position, and the chest was entered via the 4th or 5th intercostal space. This procedure provided excellent exposure of the entire mediastinum. Postoperative pain was comparatively severe in the early postoperative period, but was controlled by administering an epidural block. This procedure allows good exposure of the entire thoracic space through a single operative field. We conclude that trans-sternal bilateral thoracotomy is an excellent approach in the patient with bilateral metastatic lung tumors.

Multidrug resistance-associated protein (MRP) is one of the major factors for non-P-glycoprotein (PGp)-mediated multidrug resistance. We reported previously that overexpression of the MRP gene was related to the prognosis of non-small cell lung cancer (NSCLC). It is unclear how MRP expression is regulated in NSCLC. In this study, we examined MRP and mutant p53 expression in 107 NSCLCs by immunohistochemical procedures. Forty-seven (43.9%) of these 107 NSCLCs were positive for MRP in the cytoplasm. Mutant p53-positive NSCLC showed a significant correlation with MRP overexpression (P=.011). Coexpression of MRP and p53 in the same cells of NSCLC was confirmed by double-staining procedures. Twenty-six patients with MRP-positive tumors who underwent postoperative chemotherapy with MRP-related anticancer drugs (vindesine and etoposide) had significantly poorer prognoses than did those with MRP-negative tumors (P=.017). This correlation between MRP expression and prognosis was also seen in Stage III patients (P=.022) and in patients with squamous cell carcinoma (P=.062). NSCLC patients with coexpression of MRP and p53 showed poorer prognoses than did those without MRP and p53 (P=.014). These results suggested that MRP overexpression affected by mutant p53 had a significant effect on prognosis through atypical non-PGp-mediated multidrug resistance in NSCLC.

A 65-year-old man was facing to tracheal stenosis due to proximally developed lung cancer with hypercalcemia mediated by production of PTHrP from the cancer cells. We treated the stenosis use of Dumon stent and hypercalcemia with drugs such as biphosphonate and so on. The treatment was effectively keep the patient under better performance status for about 3.5 months.

We report six cases of primary pulmonary lymphoma in which a gene-rearranged band was shown by Southern blot analysis of transbronchial or surgical biopsy specimens. The cases were 3 mens and 4 women with an average age of 59.6, who had abnormal pulmonary shadows on chest X-ray. Two cases had Sjögren's syndrome and one case had monoclonal gammopathy (IgM-lambda type). Histopathologic and immunologic examination revealed diffuse infiltration of small lymphocytes (B-cell type) in all cases, and histological features of lymphoepithelial lesion or lympho-cytic interstitial pneumonia (LIP) in three cases. CT revealed an ill-defined margin, air-space consolidation, and air-bronchogram in all cases. A CT-angiogram sign was apparent in 2 cases. In all cases, Southern blot analysis of the tissue obtained from transbronchial or surgical biopsy revealed a gene re-arranged band, supporting the diagnosis of primary pulmonary lymphoma. We infer that an ill-defined margin, air-bronchogram and air space consolidation on CT were associated with the histopathological features of primary pulmonary lymphoma.

Autonomous or continuous granulocyte colony-stimulating factor. (G-CSF)-production in malignant neoplasms is considered to induce leukocytosis without apparent infection. We examined G-CSF gene expression in human non-small cell lung cancer (NSCLC) and discussed its clinicopathological significance. Northern blot analysis revealed G-CSF gene expression in 14 of 84 surgical specimens (16.7%, 10/30 squamous cell carcinoma, 3/50 adenocarcinoma, 1/4 large cell carcinoma). Eight patients (57.1%, 8/14) with NSCLC showing G-CSF gene-expression had peripheral blood leukocytosis (8,000/microliter). The prognosis was significantly worse in 10 stage I or II NSCLC showing G-CSF gene expression (p0.01, Cox-Mantel test). These findings suggest that G-CSF gene expression is common event in the early stage of primary NSCLC, while it cannot completely explain the leukocytosis induced by lung cancer.

The expression levels of nm23-H1 have been reported to correlate with the metastatic potential of some tumours. We have treated a child with a rare case of astrocytoma with diffuse osteoblastic metastases. We therefore decided to examine the expression of the nm23 gene product in 24 gliomas in order to clarify the association of its expression with the clinical features of the disease. A polyclonal antibody against a GST/nm23-H1 fusion protein was raised in rabbits. Twenty-four specimens, including 5 recurrent gliomas and one extraneural metastasis, were obtained from 19 patients treated surgically between 1990 and 1993 in our hospital. Immunohistochemical staining was performed on paraffin sections using an avidin-biotinyl peroxidase complex method. Of the 24 astrocytic neoplasms, 3 (12.5%) specimens from one patient with diffuse bony metastases stained intensely with nm23-H1. Two specimens obtained from glioblastoma multiforme patients stained weakly. The other 19 specimens were negative for nm23-H1 expression. Little or no nm23 expression was observed in adjacent nontumourous cerebral tissues. The results suggest that high levels of nm23 expression might correlate with extraneural metastatic potential in astrocytic neoplasms.

Diffuse intestinal arteriovenous malformation (AVM) is very rare. We describe a case of diffuse AVM involving the jejunum and the total colon in an adult. In addition, mesenteric varices without portal hypertension is demonstrated on angiography of the superior mesenteric artery. The high flow through the AVMs may be a major component in the etiology of the mesenteric varices in our case.

A 73-year-old man was admitted to our hospital because of jaundice. Ultrasonography and computed tomography showed a tumor of the hepatic hilus causing obstructive jaundice. Angiography revealed a stenosis of the right hepatic artery. Under the diagnosis of carcinoma of the hepatic hilus, extended right hepatectomy with resection of the caudate lobe was performed. A tumor showing expophytic growth, 2.1 x 1.9 x 1.5cm in size, was seen in the hepatic hilus. Histologically, the tumor was proved to be a non-neoplastic fibrous tissue simulating the inflammatory pseudotumor.

We report the result of treatment for thirty-two patients whose chief complaint was hemoptysis and represent the therapeutic guide line for hemoptysis. In thirty-two cases, there were twenty men and twelve women and average of age was fifty-two years old. Twenty-nine of them were chronic lung diseases such as tuberculosis and bronchiectasis and only three cases have malignant tumors. Two of them recovered with conservative therapy and bronchial arteriography (BAG) have been performed in thirty patients in order to determine the bleeding foci, BAG was failed in two cases, but these two cases have been recovered with following up, BAG was succeeded in twenty-eight cases and twelve cases of them could not been determined the bleeding foci by angiography and could be controlled using hemostatic and antibiotic agents. Embolization of bronchial arteries with gelatin sponge have been performed in sixteen cases and made success in eleven cases. In ten of these cases, BAE was effective less than two times. Only one of silicosis with restrictive lung function was considered contraindication of surgery and recovered by three times of BAE. Four cases of five uneffective BAE (rebleeding after two times of BAE) have been treated by operation in good course. But one case complicated with WPW syndrome has died because of aspiration pneumonia without operation. In our institute, the rate of operation for hemoptysis was low as 13% of thirty-two cases. In order to consider the indication of surgery, bronchial arteriography was essential to determine bleeding foci and BAE was effective in over 80% of hemoptysis.(ABSTRACT TRUNCATED AT 250 WORDS)

In 25 cases of primary hepatocellular carcinomas, the relationships between clinical, pathological features and DNA histogram patterns were investigated. Nuclear DNA histogram that represents cell cycle and indicates biological malignancy of carcinoma was analyzed by rapid image sensor analytical system scanning enable to measure the density, area and perimeter of nuclei even on thin tissue sections. Histograms of over 65 years old patients showed low ploidy pattern rather than that of less than 65 patients whose AFP values are over 1000 ng/ml showed statistically higher ploidy pattern compared to those of under 10 ng/ml. No significant relations were verified between pathological findings and DNA histogram patterns. But patients who died within 18 months after hepatectomy showed broad and high ploidy histogram patterns compared to patients who lived over 18 months. These results suggested that DNA histogram analysis is useful for evaluate the biological malignancy of primary hepatocellular carcinoma.

A case of left-sided gallbladder with an anomaly of the intrahepatic portal vein and cholesterol polyps of the gallbladder is presented. A 23-year-old man with sudden onset of epigastric pain, fever and abdominal irritation was admitted to our hospital and an emergency celiotomy was carried out. The gallbladder lay on the left side of the round ligament, that is, it was a left-sided gallbladder. Since operative findings such as cholecystitis, gastrointestinal perforation and pancreatitis were not observed, no more procedures were done. Postoperative ultrasonography showed some interesting findings as follows: multiple echogenic nonshadowing small polypoid lesions which did not change in size and shape during a 2.5 year interval were detected and were thought to be cholesterol polyps. The tail of the gallbladder was situated on the left side of the round ligament and the motion of the gallbladder as determined by postural exchange was not floating. These findings are compatible with a left-sided gallbladder. The left branch of the portal vein did not form an umbilical portion as is usually expected and the right branch formed a cystic structure similar to a normal umbilical portion with the anterior, posterior and medial branches ramified. The round ligament arose from the cul-de-sac of the umbilical portion. Twenty-six cases of left-sided gallbladder from the Japanese literature were reviewed and discussed.

A case of mediastinal immature teratoma was treated with a multimodality approach that included surgery, chemotherapy, and radiotherapy. Serum alpha-fetoprotein at admission was elevated and changed in parallel with the therapy and tumor growth. The patient died of sudden respiratory failure 18 months after admission. Mediastinal immature teratoma with elevated serum levels of alpha-fetoprotein carries a poor prognosis, as does endodermal sinus tumor. We concluded that this condition should most probably be treated with a combination of intensive chemotherapy, surgical resection, and radiotherapy.

Since there is little or no pseudocholinesterase at the motor end plate, the neuromuscular blockade by succinylcholine is terminated by its diffusion away from the end-plate into extracellular fluid. Pseudocholinesterase (ChE), therefore, influences the duration of action of succinylcholine (SCC) by controlling the rate of hydrolysis before it reaches the end-plate. SCC neuromuscular blockade can be prolonged in the presence of an atypical form of ChE. A 37 year old male with the deficiency of ChE activity underwent pancreatico-duodenectomy under neuroleptanesthesia. The mode, duration and treatments of neuromuscular blockade following succinylcholine (SCC) were studied using train-of-four (TOF). SCC was administered 6 times (total 170 mg) during the operation. Prolonged apnea was noted after the first intravenous injection of SCC (60 mg, 1 mg.kg-1). It was found that spontaneous resolution of the neuromuscular block had four phases and there was a pronounced fade of the TOF response. After the second injection of SCC (30 mg), a remarkable fade of the TOF was detected and the character of the block was considered to be a desensitizing block (phase II block). The block was treated by intravenous infusion of fresh frozen plasma (FFP) (400 ml) which contained ChE, at the rate of 231 +/- 56 IU/l/37 degrees C begun shortly after the fifth injection of SCC (20mg). The duration of the block was remarkably shortened but the recovery curves were almost unchanged, indicating the diffusion of SCC away from the end-plate and/or that receptor-channel is presumably slow. The neuromuscular blockade was fully reversed by additional injection of FFP (400 ml) before extubation.(ABSTRACT TRUNCATED AT 250 WORDS)