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Background Wilms’ tumor 1 (WT1) is highly expressed in various solid tumors and hematologic malignancies. DSP-7888 (adegramotide/nelatimotide) Emulsion is an investigational therapeutic cancer vaccine comprising three synthetic epitopes derived from WT1. We evaluated the mechanism of action of DSP-7888 Emulsion, which is hypothesized to induce WT1-specific cytotoxic T lymphocytes (CTLs) and helper T lymphocytes (HTLs). Methods The ability of nelatimotide and adegramotide to induce WT1-specific CD8+ T cells and CD4+ T cells was assessed in human peripheral blood mononuclear cells (PBMCs). The ability of DSP-7888 Emulsion to induce WT1-specific CTLs in vivo was assessed using human leukocyte antigen-I (HLA-I) transgenic mice. To assess how adegramotide, the helper peptide in DSP-7888 Emulsion, enhances WT1-specific CTLs, HLA-I transgenic mice were administered DSP-7888 or nelatimotide-only Emulsion. Interferon-gamma secretion under antigen stimulation by splenocytes co-cultured with or without tumor cells was then quantified. The effects of combination treatment with DSP-7888 Emulsion and an anti–programmed cell death protein 1 (PD-1) antibody on tumor volume and the frequency of tumor-infiltrating WT1-specific T cells were assessed in HLA-I transgenic mice implanted with WT1 antigen-positive tumors. Results The peptides in DSP-7888 Emulsion were shown to induce WT1-specific CTLs and HTLs in both human PBMCs and HLA-I transgenic mice. Unlike splenocytes from nelatimotide-only Emulsion-treated mice, splenocytes from DSP-7888 Emulsion-treated mice exhibited high levels of interferon-gamma secretion, including when co-cultured with tumor cells; interferon-gamma secretion was further enhanced by concomitant treatment with anti-PD-1. HLA-I transgenic mice administered DSP-7888 Emulsion plus anti-PD-1 experienced significantly greater reductions in tumor size than mice treated with either agent alone. This reduction in tumor volume was accompanied by increased numbers of tumor-infiltrating WT1-specific CTLs. Conclusions DSP-7888 Emulsion can promote both cytotoxic and helper T-cell-mediated immune responses against WT1-positive tumors. Adegramotide enhances CTL numbers, and the CTLs induced by treatment with both nelatimotide and adegramotide are capable of functioning within the immunosuppressive tumor microenvironment. The ability of anti-PD-1 to enhance the antitumor activity of DSP-7888 Emulsion in mice implanted with WT1-positive tumors suggests the potential for synergy.

Background Composite hemangioendothelioma is an extraordinarily rare form of vascular neoplasm which develops predominantly in the skins and soft tissues of the adults. Neuroendocrine marker expression in composite hemangioendothelioma is considered as specifically relevant to the more aggressive behavior. Case presentation The patient was a 71-year-old man complaining continuous back pain. Computed tomography (CT) showed that 10 cm of contrast-enhanced soft tissue mass was occurring on the right posterior chest wall and developing adjacent to the spinal canal. Via the laminectomy, the tumor end was identified and separated from the dura mater. Then, via the posterolateral thoracotomy, the en bloc resection was achieved by separating the tumor from the diaphragm and vertebras. Histologic examination showed a complex combination of epithelioid and retiform hemangioendothelioma areas which were positive for anti-synaptophysin staining. At 12-month follow-up, there were no signs of tumor recurrence on CT, and the patient had no symptom. Conclusions We achieved the complete resection of a huge thoracic neuroendocrine composite hemangioendothelioma developing adjacent to the spinal canal. The combination of the posterior lumbar laminectomy and the following posterior thoracotomy is a viable approach to radically resect a thoracic neuroendocrine composite hemangioendothelioma involving chest wall.

According to the current American College of Chest Physicians (ACCP) guideline, a cardiopulmonary exercise test (CPET) is indicated in patients with lung cancer being considered for lung surgery. The measurement of maximum oxygen consumption ([Formula: see text] max) is not sufficiently prevalent because it requires special technical equipment. Considering that stepping is a simple and common exercise, we aimed to establish a simple and reproducible test with standardization of exercise intensity using a triaxial accelerometer.Twenty healthy volunteers (10 male, 10 female) were included in the study. The subjects were obliged to step on the same spot at the rate of 80 and 110 counts for 1 min each and then step as quickly as possible for the last minute. Oxygen consumption ([Formula: see text]) (mL/kg/min) for every breath was continuously measured during the exercise. A triaxial accelerometer was attached to the hip of test subjects whereby metabolic equivalents (METs) at each test level were measured.The mean age of the study subjects was 42.9 ± 11.4 (mean ± SD). The mean value of [Formula: see text] at each level increased linearly along with the stepping level in each individual but varied among subjects. Using METs instead of step counts minimized the difference in regression lines among subjects. A receiver operating characteristic analysis revealed the possibility of [Formula: see text] prediction for the critical values of 10 and 20 mL/kg/min using METs.A simple and reproducible stepping test was suggested as applicable to standardizing the intensity of exercise using a triaxial accelerometer.

Thoracoscopic partial pulmonary resection for small peripheral nodules without using a stapler has been introduced to our hospital. After partial resection was performed with electrocautery, two different methods of surface sealing were used: a coagulation method (C method) with Soft Coagulation alone, and a coagulation-suturing method (CS method) with Soft Coagulation combined with continuous suturing. The clinical outcomes of the two methods were retrospectively compared in this study. The C method was used in 19 lesions of 18 cases, and the CS method was used in 20 lesions of 19 cases. Primary lung cancer was the most frequent diagnosis (22 lesions of 21 cases). There were no differences between the two groups in the size and depth of the lesions. Operative time was longer with the CS method than with the C method. Postoperative air leakage was a complication in 4 cases with the C method, and one of them required re-do surgery, whereas only one case with the CS method had temporary air leakage. Postoperative computed tomography showed cavitation in 3 C method cases and 5 CS method cases, all without related symptoms. There were no local recurrences at resected sites. In conclusion, the C method was technically easy to perform, but air leakage may be prolonged after surgery. The CS method may have the advantage of causing less air leakage than the C method, but mastering the technique is important to shorten operative time.

Chest wall resection is traditionally performed via open thoracotomy, a procedure that increases surgical morbidity and reduces postoperative quality of life. Conversely, thoracoscopic chest wall resection may minimize invasiveness but the optimal procedure remains uncertain. We previously reported rib resection using a pneumatic high-speed power drill during video-assisted thoracoscopic surgery for selected lung cancer patients. In this report, we present two cases of chest wall tumor resected using the drill via the thoracoscopic approach. We also report thoracoscopic chest wall reconstruction in one patient using a patch sheet.

Rib resection for chest wall tumors, including lung cancer with chest wall invasion, is usually performed through open thoracotomy. Resection of part of the external rib cage requires an elongated or additional incision depending on the location and extension of the tumor, eventually becoming more invasive to patients. We recently introduced a technique of rib resection using a pneumatic high-speed power drill system known as "air tome". This novel technique is easy to perform through a small incision or even via video-assisted thoracoscopic surgery (VATS) in selected patients. We present our clinical experience and discuss the usefulness of this technique for rib resection in patients with lung cancer and chest wall invasion.

Thoracoscopic bronchoplasty requires high technique to control stitching during bronchial reconstruction. Improved quality of suturing instrument may contribute to overcome this difficulty of bronchial anastomosis. Recently, a unique and expected articulated instrument for suturing has been launched on endoscopic surgery. We have successfully performed two cases of thoracoscopic sleeve lobectomy using this instrument.

We compared the effectiveness of 3-dimensional computed tomography pulmonary angiography (3D-CTPA) and thin-section multiplanar reconstruction (MPR) images obtained using contrast-enhanced multidetector row CT (MDCT), in the evaluation of pulmonary artery (PA) branches of the right upper lobe. We studied 127 patients suspected of having lung cancer of the right upper lobe who underwent contrast-enhanced MDCT scans and a right upper lobectomy. We compared the intraoperative findings of the PA branches of the right upper lobe obtained with 3D-CTPA and thin-section MPR images. In 125 (97.7%) patients, one or more PA branches arose from arteries other than the superior trunk. Among 10 (7.9%) patients, a PA branch arose from the middle lobe in one patient and from the superior segment of the lower lobe in the other 9 patients. According to the intraoperative findings, 97.2% and 99.7% of the PA branches were identified by 3D-CTPA and thin-section MPR images, respectively (p ＜ 0.03). The single branch missed by both imaging modalities was 1.0mm in dia. The 8 branches missed only by 3D-CTPA were ＜ 1.4mm in dia. Both the 3D-CTPA and thin-section MPR images provided precise preoperative information regarding PA branches of the right upper lobe. However, the thin-section MPR images appeared to contribute more to the evaluation of smaller PA branches.

Chemoradiotherapy for non-small cell lung cancer can impair pulmonary function, particularly when it is followed by surgery. This study aimed to document the changes in respiratory function as a result of a perioperative intensive pulmonary rehabilitation program in patients with non-small cell lung cancer who underwent induction chemoradiotherapy.A total of 82 consecutive patients underwent pulmonary resection after undergoing induction chemoradiotherapy. A pulmonary rehabilitation program was started at the same time as the induction chemoradiotherapy. Standard respiratory function tests were performed before and after induction chemoradiotherapy. Treatment-related mortality and the incidence of postoperative respiratory complications were investigated. The Wilcoxon signed-rank test was used to analyze the differences in spirometric changes.All patients underwent a pulmonary rehabilitation program for an average of 10 weeks. Significant increases were observed in forced vital capacity (+6.4%, P = .0096) and forced expiratory volume in 1 second (+10.4%, P.0001). Diffusing capacity of the lung for carbon monoxide decreased (-14.0%, P.0001). Patients with respiratory impairment (forced vital capacity80% predicted or forced expiratory volume in 1 second/forced vital capacity70%) showed significant improvements in forced vital capacity (+13.9%, P = .0025) and forced expiratory volume in 1 second (+22.5%, P.0001). Significant increases were observed in forced vital capacity (+7.0%, P = .0042) and forced expiratory volume in 1 second (+10.8%, P = .0001) in patients with a smoking history. There was no mortality, and postoperative respiratory morbidity was 6.1%.A pulmonary rehabilitation program for patients with non-small cell lung cancer undergoing induction chemoradiotherapy seems to improve respiratory function. It is particularly recommended for smokers and patients with respiratory impairment.

We retrospectively investigated the possibility that the 6-min walk test (6MWT) could predict surgical outcomes in lung cancer patients with decreased predicted postoperative (ppo) lung function. Patients were enrolled based on their preoperative spirometry: 10 days, home oxygen therapy (HOT) requirement, unexpected readmission within 90 days, and 90-day mortality were included as surgical outcomes. The correlations with walking distance and the minimum SpO2 (SpO2min) and maximum decrease in SpO2 (ΔSpO2) during the 6MWT were analyzed using logistic regression analysis, adjusting for age, sex, and surgical procedure. Altogether, 121 patients were analyzed. Logistic regression analysis revealed that higher ΔSpO2 and lower SpO2min were significantly correlated with a higher risk of prolonged need for oxygen inhalation and HOT, surgical morbidity, and 90-day mortality. Cut-off values of > 4% for ΔSpO2 were significant for prolonged oxygen inhalation and surgical morbidity. Cut-off values of

Several molecules have been proven to be associated with responsiveness to chemotherapy. A clinical study on the expression of excision repair cross-complementing (ERCC)-1 and class III β-tubulin was conducted in advanced stage non-small cell lung cancer (NSCLC) patients. We investigated 34 resected stage III NSCLC patients treated with induction chemoradiotherapy using carboplatin-taxane. Immunohistochemistry was performed to evaluate the intratumoral expression of ERCC1 and class III β-tubulin. Nineteen tumors (55.9%) were ERCC1-high and 11 (32.4%) were class III β-tubulin-high. There was no correlation between ERCC1 and class III β-tubulin expression (r=0.208). Regarding the pathological effect of induction therapy, the percentage of ERCC1-positive tumor cells was lower in tumors with a major response than in tumors with a minor response (P=0.0851). The percentage of class III β-tubulin-positive tumor cells was significantly lower in tumors with a major response than in tumors with a minor response (P=0.0105). Regarding patient survival, the overall survival was significantly higher in patients with ERCC1-low tumors than in those with ERCC1-high tumors (P=0.0034). The overall survival was also significantly higher in patients with class III β-tubulin-low tumors than in those with class III β-tubulin-high tumors (P=0.0185). Cox regression analysis also demonstrated that ERCC1 (P=0.0467) and class III β-tubulin statuses (P=0.0237) were significant prognostic factors. Co-evaluations of the intratumoral expression of ERCC1 and class III β-tubulin are clinically useful for identifying patient populations responsive to chemotherapy using carboplatin-taxane.

Objectives We investigated a new technique for identifying the lung intersegmental line using infrared thoracoscopy with intravenous injection of indocyanine green. Methods This was an experimental animal study, and target segments were established preoperatively. Six adult beagle dogs underwent thoracotomy. After the corresponding pulmonary artery of the target segment had been ligated, indocyanine green was administered intravenously during infrared thoracoscopy. The lung was separated into 2 areas, white and blue, according to the blood flow on the monitor. We marked the visceral pleura with electrocautery along the transition zone showing a change in color from blue to white. The experimental lung was removed and subjected to pathologic and radiologic analysis. Results After injection of indocyanine green, infrared thoracoscopy showed that the area of normal perfusion changed to blue, whereas the area at which perfusion was absent remained white. The transition zone between colors was distinct, and the blue stain remained visible during the marking procedure. Three-dimensional computed tomographic analysis indicated that the marking separated the target segmental bronchus from the adjacent one. Detailed macroscopic and microscopic study confirmed that the marking corresponded to the intersegmental line. Conclusion By using infrared thoracoscopy with indocyanine green, it is possible to detect the intersegmental line without inflating the lung.

症例は70歳女性．甲状腺癌の術後経過観察中に胸部CTで右S8に増大傾向を示す約1cmのすりガラス陰影（ground-glass opacity：GGO）を認め，原発性肺癌を疑った．インドシアニングリーン（ICG）静注を併用した赤外光胸腔鏡（IRTS）で観察したところ，病変部分は正常肺に比べ青く描出された．部分切除を行い，術中迅速病理組織診で腺癌（野口分類C型）と診断されたため，右下葉切除術を施行した．我々はこれまでにICG静注併用のIRTSが気腫肺の検出に有用であることを動物実験並びに臨床研究で明らかにしてきたが，今回の症例で，末梢小型肺癌もICG静注併用IRTSを用いて同定できる可能性が示唆された．

The remaining pleural dead space after pulmonary resection sometimes causes serious complications, such as empyema. The objective of this study was induction of granulation tissue in uninfected pleural space after pneumonectomy in a rabbit model using implantation of bioabsorbable and porous poly-l-lactic acid and epsilon-caprolactone copolymer (PLAC) cubes. Twelve Japanese white rabbits were randomly split into two groups: the control group (n = 6) underwent simple left pneumonectomy, whereas the experimental group (n = 6) underwent left pneumonectomy followed by filling of the left hemithorax with PLAC cubes. One rabbit in each group was killed at 1, 2, 3, and 6 months after surgery, and pleural tissue was evaluated. In the experimental group, granulation tissue inside the PLAC cubes had begun to form at 1 month after implantation. From 3 months to 6 months, proliferated granulation tissue occupied the left postpneumonectomy pleural space with no residual space. The implanted PLAC material was being gradually degraded. We were able to induce self-assembled granulation tissue in the pleural space after pneumonectomy in a rabbit model using bioabsorbable PLAC cubes. The use of this technique allowed the residual pleural space to be closed after pulmonary resection.

Objective We have previously reported that infrared thoracoscopy was useful in detecting emphysematous lesions in a canine model of lung emphysema. We applied infrared thoracoscopy to determine the feasibility and efficacy of planning bullectomy for patients with spontaneous pneumothorax. Methods A total of 8 patients with spontaneous pneumothorax were included in the study. No procedure-related complications were observed. Infrared thoracoscopy with a single injection of indocyanine green (3.0 mg/kg) was used to detect bullous lesions of the lung during surgical intervention. Partial lung resections of the bullous lesions were performed after image analysis based on color density data obtained by means of infrared thoracoscopy. Results Bullous or emphysematous lesions of the lung were demonstrated in white, whereas normal lung tissue was imaged in blue, under infrared thoracoscopy. We were able to detect small bullous lesions with infrared thoracoscopy because of its clearer visualization compared with thoracoscopy. Quantitative color-density analysis revealed a marked decrease of indocyanine green intensity, which reflected decreased blood flow of bullous lesions. All resected specimens were confirmed as bullous lesions based on microscopic examinations. Conclusion Infrared thoracoscopy–guided lung resection is a safe and useful procedure in detecting small bullous lesions.

当科において呼吸リハビリ後に肺切除を施行した低肺機能症例について検討した．2000年11月から2003年8月までに肺切除を施行した術前FEV1.0≦1.0lの症例12例を対象とした．患者背景は男性9例，女性3例で，年齢は65歳以上が11例であった．術前呼吸リハビリは平均14.8±8.7回施行されており，VC，FEV1.0いずれも有意に改善していた（p＝0.0145，p＝0.0112）．術後合併症，術関連死は認められず，在宅酸素療法を必要とした症例もなかった．低肺機能症例において，術前呼吸リハビリは有用である可能性が示唆された．

症例1は19歳女性．動悸を自覚し，甲状腺腫大および前縦隔腫瘤を指摘された．甲状腺腫大は機能検査からバセドウ病と診断され，抗甲状腺剤を開始した．前縦隔腫瘍はCT下吸引細胞診からは胸腺腫も否定できなかったが，画像診断も踏まえ胸腺過形成が強く考えられた．甲状腺機能亢進症に伴う胸腺過形成と判断し経過観察とした．抗甲状腺剤内服から3ヵ月後には胸腺の縮小を認めた．症例2は52歳女性．前縦隔腫瘤を指摘された．画像上，胸腺はびまん性肥大であり，甲状腺の軽度腫大も認めた．甲状腺機能検査を行い，バセドウ病の診断を得た．甲状腺機能亢進症に伴う胸腺肥大と判断し，バセドウ病の治療を開始した．3ヵ月後には胸腺の縮小を認めた．甲状腺機能亢進症に合併した胸腺肥大では，外科的処置の前に抗甲状腺剤の投与による画像上の経過観察も可能と考えられる．無用な手術を回避するためにも呼吸器外科医は，この病態を知っておく必要がある．

当科において非小細胞肺癌に対し施行した肺全摘術について検討した．1993年3月から2003年7月までに肺全摘術を施行した45例を対象とした．患者背景は男性36例，女性9例で，病期はIII期以上が33例であった．また組織型では扁平上皮癌が28例と最も多かった．手術時間は平均281.6分で，術後平均在院期間は46.8日であった．一方術後合併症は12例に認めたが気管支断端瘻はなく，術関連死は1例であった．5年生存率は全体で32.1％で，I期とII期をあわせると22.2％，IIIA期は30.4％であった．肺全摘術において合併症の頻度は許容範囲であり，予後も肺葉切除に対し遜色はなかった．

悪性胸膜中皮腫に対し，GEM＋CDDPの術前化学療法後に胸膜肺全摘術を行った2症例を経験したので報告する．症例1は50歳男性．症例2は52歳男性．2症例ともに組織型は上皮型であり，IMIG病期分類にてc-II期であった．GEM＋CDDPの術前化学療法を行い，評価は症例1がPRで，症例2はSDであった．胸膜肺全摘術を行い2症例とも完全切除であった．術後合併症はなく，現在術後30ヵ月と13ヵ月で無再発生存中である．悪性胸膜中皮腫に対し，GEM＋CDDPによる術前化学療法後に外科療法を加えることで有望な成績が得られる可能性はあると考えられた．

症例は63歳，女性．検診の胸部レントゲンで異常陰影を指摘されたため，近医を受診．胸部CTで右肺S6に径2cm大の辺縁不整な空洞を伴った結節影が認められ，また，FDG-PETで同部位に一致して異常集積像を認めた．原発性肺癌もしくは同じくFDG-PETで異常集積を認め発見された乳癌の肺転移を疑い，診断・治療目的で開胸下肺部分切除術を施行し，術中迅速病理で肺犬糸状虫症と診断された．肺犬糸状虫症では胸部CT所見が肺癌と類似し，またFDG-PETで異常集積像を示すことがあるため，悪性疾患との鑑別が困難となる場合がある．胸部異常陰影の鑑別疾患の1つとして本症の存在を念頭に置くことが重要と考えられた．

OBJECTIVES Nutritional status is associated with an effect on oncological outcomes. However, the effect of nutritional status on postoperative survival in lung cancer has not been well studied. We retrospectively analysed and evaluated the effect of preoperative body mass index (BMI) and changes in body weight on postoperative outcomes of lung cancer surgery. METHODS A total of 1311 patients with non-small-cell lung cancer who underwent surgery between January 2001 and December 2011 were included in this study. Preoperative body weight at 4-12 weeks prior to surgery was obtained in 737 patients and the ratio of change in body weight was calculated. RESULTS The patients were classified into four groups as follows: underweight (BMI < 18.5), normal weight (BMI from ≥18.5 to

Bevacizumab exerts anti-angiogenic effects in cancer patients by inhibiting vascular endothelial growth factor (VEGF). However, its use is still limited due to the development of resistance to the treatment. Such resistance can be regulated by various factors, although the underlying mechanisms remain incompletely understood. Here we show that bone marrow-derived fibrocyte-like cells, defined as alpha-1 type I collagen-positive and CXCR4-positive cells, contribute to the acquired resistance to bevacizumab. In mouse models of malignant pleural mesothelioma and lung cancer, fibrocyte-like cells mediate the resistance to bevacizumab as the main producer of fibroblast growth factor 2. In clinical specimens of lung cancer, the number of fibrocyte-like cells is significantly increased in bevacizumab-treated tumours, and correlates with the number of treatment cycles, as well as CD31-positive vessels. Our results identify fibrocyte-like cells as a promising cell biomarker and a potential therapeutic target to overcome resistance to anti-VEGF therapy., Acquired resistance to anti-angiogenic drugs, including bevacizumab, may occur in cancer patients. In this study the authors identify in the tumour microenvironment, fibrocyte-like cells derived from the bone marrow that mediate the resistance to bevacizumab through the production of FGF2.

We investigated the efficiency of basic fibroblast growth factor (b-FGF) released from a gelatin sponge in the regeneration of tracheal cartilage. A 1-cm gap was made in the midventral portion of each of 10 consecutive cervical tracheal cartilages (rings 4 to 13) in 15 experimental dogs. In the control group (n = 5), the resulting gap was left blank. In the gelatin group (n = 5), a gelatin sponge alone was implanted in the gap. In the b-FGF group (n = 5), a gelatin sponge containing 100 mug b-FGF solution was implanted in the gap. We euthanatized one of the five dogs in each group at 1 month after implantation and one at 3 months and examined the implant sites macroscopically and microscopically. In the control and gelatin groups, no regenerated cartilage was observed in the tracheal cartilage gap at 1 or 3 months. The distances between the cartilage stumps had shrunk. In the b-FGF group, fibrous cartilage had started to regenerate from both host cartilage stumps at 1 month. At 3 months, regenerated fibrous cartilage filled the gap and had connected each of the stumps. The regenerated cartilage was covered with regenerated perichondrium originating from the host perichondrium. Shrinkage of the distance between the host cartilage stumps was not observed in the b-FGF group. We succeeded in inducing cartilage regeneration in the gaps in canine tracheal cartilage rings by using the slow release of b-FGF from a gelatin sponge. The regenerated cartilage induced by b-FGF was fibrous cartilage.

The objective of this study was to evaluate the ability of FDG-PET to predict the response of primary tumour and nodal disease to preoperative induction chemoradiotherapy in patients with non-small cell lung cancer (NSCLC).FDG-PET studies were performed before and after completion of chemoradiotherapy prior to surgery in 26 patients with NSCLC. FDG-PET imaging was performed at 1 h (early) and 2 h (delayed) after injection. Semi-quantitative analysis was performed using the standardised uptake value (SUV) at the primary tumour. Percent change was calculated according to the following equation: [see text]. Based on histopathological analysis of the specimens obtained at surgery, patients were classified as pathological responders or pathological non-responders. The clinical nodal stage on the post-chemoradiotherapy PET scan was visually determined and compared with the final pathological stage.Eighteen patients were found to be pathological responders and eight to be pathological non-responders. SUV(after) values from both early and delayed images in pathological responders were significantly lower than those in pathological non-responders. The percent change values from early and delayed images in the pathological responders were significantly higher than those in the pathological non-responders. The post-chemoradiotherapy PET scan accurately predicted nodal stage in 22 of 26 patients.FDG-PET may have the potential to predict response to induction chemoradiotherapy in patients with NSCLC.

To accurately excise emphysematous lung tissue in volume reduction surgery, we projected a digitally analyzed excision line on the real time image obtained by infrared thoracoscopy (IRT) with indocyanine green (ICG) intravenous injection. Emphysema was created in the canine lung by intrabronchial injection of elastase. We examined the emphysematous lung by IRT after intravenous injection of ICG. A digitized static image was obtained and analyzed in real time during the surgery. The color densities on the image were measured and the color density ratios (CDRs) calculated. We resected lung areas where the CDR was 1.0 or less. Resected and residual lung areas were examined microscopically. Microscopically, areas displayed as white by IRT with intravenous injection of ICG were emphysematous, and areas displayed as blue were normal. Areas with a CDR of 1.0 or less were emphysematous, and we were able to determine an appropriate excision line by connecting sample points with a CDR of 1.0. Use of digital image analysis combined with IRT after ICG injection enabled us to remove emphysematous regions accurately.

症例は61歳, 女性. 胸部CTで, 左肺S6に空洞を伴う腫瘤陰影と左肺S10に腫瘤陰影を認め, 肺門リンパ節の腫大も指摘された. PET検査で左下葉及び肺門と縦隔にFDG (fluorodeoxyglucose) の集積を認めた. CEAも高値で, 左下葉の原発性肺癌を疑いTBLBを施行するも悪性所見は認められなかった. 左肺S10の腫瘤陰影に対しCT下肺生検を施行したが確定診断には至らなかった. 消化管内視鏡検査を含む全身精査では他臓器に異常は認めなかった. 診断確定のために開胸肺生検を行い, 左肺S10の腫瘤は術中迅速病理で梗塞巣と診断された. 大動脈下リンパ節と気管分岐部リンパ節をサンプリングしたが, それぞれ低分化癌, 及び中分化腺癌と診断された. 肺門・縦隔リンパ節癌と考え, 術後同時放射線化学療法を施行した. 本症例は肺化膿症と肺梗塞のため画像所見からは左下葉原発の肺癌との鑑別が困難であり, 開胸生検で肺門・縦隔リンパ節癌と診断された.

We have presented the explicit formulas for first and second derivatives of A and B matrices, appearing in the random phase approximation (RPA), with the aid of Lagrangian technique. Owing to the 2n + 1 rule, the Lagrangian approach is more efficient than the conventional approach to evaluate the higher-order matrix elements. We have confirmed the validity of our formulation by demonstrating the geometry optimization of the first-excited singlet states of formaldehyde, ethylene, and 1-amino-3-propenal molecules. © 2005 Wiley Periodicals, Inc. Int J Quantum Chem, 2005

活性化自己リンパ球移入療法は自己のリンパ球をex vivoで増殖活性化し再びこれを癌患者の体内に戻すことによって癌の消退をはかる免疫治療である. 我々は再発転移肺癌患者に対して, 癌抗原MUC1を標的とした活性化自己リンパ球移入療法を施行した. 3例の治療患者のうち1例は治療後に抗原特異的細胞性免疫を獲得していた. 同患者は治療後, 全身倦怠感と食欲不振の症状軽減が認められた. いずれの患者においても, 腫瘍縮小や腫瘍マーカー値低下などの治療効果は認められなかった. 副作用として, 治療患者2例に発熱が, 1例に呼吸苦が出現したがいずれも軽度でかつ一過性であった.本治療は低侵襲であること, 癌患者に抗腫瘍免疫誘導が可能であることなどを考慮すると, 治療適応の見直しや培養技術のさらなる改良は必要と思われるが, 新しい分子標的治療として将来広く臨床応用されるものと期待できる.

症例は54歳, 男性. 左上葉原発c-T2N2M0 stage IIIAの扁平上皮癌に対し同時化学・放射線療法後に左上葉切除術 (ND2a) を施行した. 照射範囲であった残存左下葉S6を中心に放射線肺炎が出現し, ステロイドパルス療法を行った. その後病巣は空洞化し, 感染を伴い肺化膿症となった. 感染コントロールのため, 低圧持続胸腔ドレナージを行ったが肺瘻が続くため, 手術を行った. 開胸所見では膿気胸の状態であり, 肺剥皮術と術後胸膜癒着術も施行した. しかし肺瘻及び感染巣の沈静化には至らず, 全膿胸として胸郭形成術, 大網及び腹直筋遊離筋弁充填術を行った. 本症例は, 同時化学・放射線療法に手術を行い, そこに放射線肺炎から肺化膿症を合併し膿胸にまで進展した. ステロイド療法も加わり, 患者本来の治癒力が低下している状態であり, 治療することに難渋した症例であった.

Objective: The postoperative development or exacerbation of interstitial pneumonia (IP) in lung cancer patients often affects prognoses. We analyzed the patients who suffered from IP after surgery, to determine treatment and prevention of IP. Methods: One hundred and one consecutive patients who underwent resection were enrolled in the study. Clinical background and post-, perioperative course were compared between patients who developed IP and those who did not. Results: If IP developed or was exacerbated, steroid pulse (SP) therapy, immunosuppressant (IS) therapy or nitric oxide (NO) inhalation therapy was employed. Of 101 patients, 20 had suffered from IP before surgery. In four of these 20 (20%), postoperative exacerbation was observed. SP therapy was given to all patients. To one patient, IS and NO therapy were added. Three of the four patients died. 81 patients did not have IP; three of them (3.7%) developed IP after the operation and were treated with SP therapy. To one patient, IS and NO therapy were added. Two of the three patients died. IP development or exacerbation after surgery was observed in seven of 101 patients, and five of them died. It was significantly more frequent in patients with poorly differentiated squamous cell carcinoma, restrictive change in pulmonary function tests, and a low percentage diffusion capacity for carbon monoxide. Postoperative development or exacerbation was observed in patients who had undergone lobectomy or pneumonectomy. Conclusions: Postoperative IP is a serious complication. Further studies are needed to determine definitive therapeutic options. For the patients with the aforementioned risk factors, limited surgery must be considered.

We report a case of synovial sarcoma of the mediastinum, a very rare tumor, in a 50-year-old man hos-pitalized with anterior chest pain. Chest X-ray and computed tomography (CT) on admission showed a 10 × 8-cm mass in the right anterior mediastinal space, compressing the superior vena cava. A diagnosis of sarcoma was established by a CT-guided percutaneous needle biopsy. Systemic examination revealed no metastasis to the contralateral pleural cavity or other distant organs, and we resected the mediastinal sarcoma. Pathological and immunohistochemical analyses confirmed a diagnosis of monophasic synovial sarcoma. The patient is alive with recurrence 9 months after his operation, and is receiving chemotherapy with ifosfamide.

症例は28歳, 男性.職場健診で胸部異常陰影を指摘された.近医で気管支鏡下肺生検を行うも診断確定には至らず, 精査加療目的で当科紹介入院となった.胸部CT検査では1t.B8aと1t.B8bの間の領域に長径12mm大の腫瘤陰影を認めた.画像上肺過誤腫を疑ったが肺癌も否定できず手術を施行した.腫瘤の位置から部分切除が困難で, 核出術を行った.迅速病理で粘表皮癌と診断され, 引き続き左肺下葉切除術 (ND1) を施行した.本症例は画像所見から肺過誤腫と鑑別を要した点と, 粘表皮癌でも稀な末梢発生であった点で興味ある症例と考え報告した.

症例は66歳女性.気管支喘息の経過中に胸部X線像上, 右下肺野に結節影を指摘され当院を紹介された.胸部CTで右中葉S4からS5にかけて周囲に淡い浸潤影および胸膜嵌入像を伴う境界明瞭な10×8mm大の結節影を認めた.1ヵ月の経過で陰影の縮小傾向はなく悪性腫瘍も否定できなかったため, 胸腔鏡下に肺生検を施行した.胸腔鏡では, 胸膜嵌入を伴う暗赤色の小結節として認めた.術中迅速病理検査では, 中等度のリンパ球浸潤と血管壁の肥厚を指摘され炎症後の瘢痕様の病変が疑われた.切除肺の病理組織検査では, 肺胞壁と血管壁の著明な肥厚, 血管の拡張, 肺胞内出血を認め陳旧性出血性肺梗塞と診断された.気管支喘息を除き基礎疾患の関与が否定的な女性に発症し, 小結節影を呈した陳旧性出血性肺梗塞の一切除例を報告した.

症例は66歳, 女性.64歳時に右乳癌にて右胸筋温存乳房切除術を受けた.病理病期はstage IIで, 術後DMpC療法 (5'-DFUR: 800mg, MPA: 800mg, CPA: 100mg) を施行中であった.2003年1月16日, 胸部CTで左S8にspicula, notchを伴う小結節陰影の出現を認めた.結節陰影の増大を認め, またFDG-PETで, 左S8の結節陰影に一致して集積を認め, 精査目的で, 2003年3月24日当科へ入院した.CT下肺生検では確定診断に至らず, 2003年4月23日, 胸腔鏡補助下肺生検を施行し肺クリプトコッカス症と診断された.腫瘤陰影を呈する肺クリプトコッカス症のCT所見は肺癌と類似し, PETでも陽性を示すことがあるため画像上の鑑別は困難である.

BackgroundThe surgeon must use the results of preoperative computed tomography findings and scintigraphic studies to make a subjective decision during lung volume reduction surgery with regard to the best incision line.ObjectivesOur purpose was to develop an objective and real-time method of detecting areas of pulmonary emphysema by using infrared thoracoscopy.MethodsPulmonary emphysema was developed in various lobes of the lung in the dog by injecting porcine pancreatic elastase through the bronchi. One month after the injection, chest computed tomography and lung biopsy were performed. Infrared thoracoscopic study was then performed to reveal the presence of the emphysematous lung tissue. Simultaneously, indocyanine green was injected intravenously, and the time taken for each type of lung tissue to stain blue was measured.ResultsChest computed tomography and histologic examinations revealed pulmonary emphysema-like areas in the porcine pancreatic elastase-injected lung. The computed tomography numbers of the porcine pancreatic elastase-injected lung tissue, normal lung tissue, and the tracheal lumen were −868.8 ± 18.6, −752.2 ± 32.5, and −1013 ± 27.1, respectively. There were significant differences between the porcine pancreatic elastase-injected lung and the normal lung (P < .0001). The time for staining to begin was 10.7 ± 4.8 seconds for normal lung tissue and 25.8 ± 9.4 seconds for the emphysematous tissue; the onset of staining emphysematous lung tissue was significantly delayed (P = .003).ConclusionsWe developed a successful canine model of pulmonary emphysema by injecting porcine pancreatic elastase. Infrared thoracoscopic examination revealed that the staining of emphysematous lung using indocyanine green injection was significantly greater than of normal lung.

We investigated whether saber sheath-type tracheomalacia could be treated by the slow release of bone morphogenetic protein (BMP)-2 from a gelatin sponge. A 1 cm gap was made in the middle portion of each of 10 consecutive tracheal cartilage rings in the canine cervix (control group, n = 3), then a gelatin sponge containing 12 microg of BMP-2 solution was implanted in the gap (12 microg group, n = 3). In another group (120 microg + P group, n = 3), the implanted gelatin sponge contained 120 microg of BMP-2 solution, and the gap was covered with periosteum. All of the control dogs developed saber sheath-type tracheomalacia, whereas tracheomalacia was not observed in the 12 microg and 120 microg + P groups. In the 12 microg group, fibrous cartilage was observed at the ends of the cartilage stumps. In the 120 microg + P group, newly formed bone and cartilage were observed to form a bridge between the cartilage stumps. The regeneration of cartilage or bone induced by the slow release of BMP-2 from a gelatin sponge might be useful for treatment of tracheomalacia.