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Supplementary Figure 1 from Inhibition of Transforming Growth Factor-β–Mediated Immunosuppression in Tumor-Draining Lymph Nodes Augments Antitumor Responses by Various Immunologic Cell Types

Supplementary Figure 2 from Inhibition of Transforming Growth Factor-β–Mediated Immunosuppression in Tumor-Draining Lymph Nodes Augments Antitumor Responses by Various Immunologic Cell Types

The twenty-first century has seen advances in endoscopic and robotic surgery, and minimally invasive surgery—which reduces harm to the body wall—is currently being developed. However, suturing following the resection of diseased tissue in the body cavity is not minimally invasive. There is an urgent requirement for surgery to be functional and minimally invasive, and this necessitates the restoration of organs by tissue engineering (TE). Moreover, if it is often necessary to transplant complexes comprising cells and a foundation for the organ requiring restoration, a cell processing center (CPC) also needs to be near the operating room so as to deal with emergencies. In the near future, there will be a need for surgery-related facilities that include such preparation rooms for organ restoration.

Backgrounds Anastomotic leakage following colorectal cancer is associated with significant morbidity and mortality. However, whether the choice of the treatment for anastomotic leakage may affect the oncological outcomes is under debate. We evaluated the oncological outcomes after colorectal cancer surgery for anastomotic leakage between conservative and surgical treatment. Methods We retrospectively analyzed data for patients with colorectal cancer who underwent curative colectomy from April 2010 to January 2020. Results A total 1039 patients underwent surgery colorectal cancer in our hospital. After exclusion, a total of 915 patients underwent a low anastomosis with diverting stoma for colorectal cancer of which 92 (10.0%) anastomotic leakage occurred. After stage Ⅳ and emergency surgery case were excluded, a total of 75 patients were included for the analysis. The surgical treatment group was 25 cases. The conservative treatment group was 50 cases. Early anastomotic leakage was more than in surgical treatment compared to conservative treatment (84% vs 54%, P =0.008). The 5-year overall survival rates and the 5-year disease free survival did not differ significantly between the two groups. The recurrence location of liver metastasis was more than in surgical treatment compared to conservative treatment (20% vs 2 %, P=0.02). On a multivariable analysis, anastomotic leak did not impact overall survival and disease free survival. Conclusion We found that the treatment for anastomotic leakage was not depended on increased local, distance recurrence, overall survival, and disease free survival. Our findings may help surgeons determine which AL treatment is most appropriate, when the decision is unclear.

OBJECTIVE The purpose of this study was to test the hypothesis that apical opacities on computed tomography (CT) are related to occurrence of primary spontaneous pneumothorax (PSP) in young male patients. METHODS We compared the frequency of apical opacities on thin-section CT between 70 male patients with PSP (PSP group) and 74 male patients without a history of PSP (non-PSP group). We also evaluated histopathologic findings of 39 specimens from 37 surgical cases in the PSP group. RESULTS Apical opacities were significantly more frequent in the PSP group than in the non-PSP group (right side, P = 0.01; left side, P = 0.005). Histopathologically, subpleural band-like alveolar collapse was seen in 35 specimens (89.7%), which was always accompanied by fibroelastosis and fibroblastic foci. CONCLUSIONS Apical opacities on CT were significantly associated with PSP in young male patients. These apical opacities histopathologically correspond to fibrotic pleural thickening with subpleural alveolar collapse.

A case is a 46-year-old woman visited us with a chief complaint of bloody stools. A diagnosis of rectal cancer(Rs)was made, and laparoscopic resectomy plus D3 was performed. After progressing to pT4a(SE)N2, M0, pStage III b, postoperative adjuvant chemotherapy(6 courses of XELOX)was administered. Two months after initiating chemotherapy, since the CEA value increased, chest abdominal CT was performed. Five nodules were found in the bilateral lungs and diagnosed as lung metastases(PUL2). Systemic chemotherapy(IRIS plus BV)is administered to PUL2(Grade C)of rectal cancer metachronous metastases. After 3 courses, the effect judgment was SD. Based on the recurrence period from postoperative adjuvant chemotherapy and the findings during this time, it was judged that weight loss surgery was appropriate for the rectal cancer lung metastatic lesions in which chemotherapy was ineffective, and partial resection of both lungs under thoracoscopic assistance was performed. Systemic chemotherapy(TAS-102 plus BV)was initiated to prevent postoperative recurrence. The patient is currently alive without relapse after 12 months. We reported a case of metachronous metastasis of colon cancer in which multidisciplinary treatment was successful.

Background and objective: To ensure the safety of bronchoscopic practice, the Japan Society for Respiratory Endoscopy conducted a national survey to investigate the current state of procedure for this technique. Methods: A questionnaire survey about procedures carried out during the whole of the year 2010 was mailed to 538 facilities accredited by the society. Results: Responses were obtained from 511 facilities (95.0%). Rigid bronchoscopes were used in only 18.5% of the facilities, while mobile/thin bronchoscopes were used in ≥50%, and fluoroscopy systems were used in 99.8%. Biopsies were performed after discontinuation of therapy in patients receiving antiplatelet drugs and anticoagulants in 96.7% and 97.4% of the facilities, respectively. Atropine was administered for premedication in 67.5% of the facilities, a decrease from previous surveys. Intravenous sedation was given in 36.1% of the facilities. In 21.9% of these, the procedure was conducted in the outpatient clinic for ≥70% of patients. A bronchoscope was orally inserted in ≥70% of patients in 95.7% of the facilities. Intravenous access was maintained during the examination in 92.5% of the facilities, oxygen saturation was monitored during examinations in 99.0%, oxygen was administered in 97.6% and resuscitation equipment was available in 96%. In 98.6% of the facilities, bronchoscopes were disinfected using an automatic washing machine, with glutaraldehyde used in 42.2%. Conclusions: Japan-specific characteristics of bronchoscopic practice were identified. Whether procedures used in Japan meet international guidelines with respect to safety should be monitored continuously. In addition, a Japanese evidence-based consensus is needed.

Background and objective: In order to survey the current status of the use and complications associated with respiratory endoscopy, the Japan Society for Respiratory Endoscopy conducted a nationwide postal questionnaire survey. Methods: The survey was mailed to all 538 facilities certified by the society. The subjects were patients who underwent respiratory endoscopy in 2010. The numbers of procedures, and associated complications and deaths were investigated according to lesion and procedure using a specific inventory. Results: The inventory was completed by 483 facilities (89.8%). The total number of diagnostic flexible bronchoscopy procedures performed was 103 978, and four patients died (0.004%). The complication rate according to lesion ranged from 0.51% to 2.06%, with the highest rate being observed in patients with diffuse lesions. The complication rate according to procedure ranged from 0.17% to 1.93%, with the highest rate being observed in patients who underwent forceps biopsy. The complication rate after forceps biopsy of solitary peripheral pulmonary lesions was 1.79% (haemorrhage: 0.73%, pneumothorax: 0.63%), and that after endobronchial ultrasound-guided transbronchial needle aspiration of hilar and/or mediastinal lymph node lesions was 0.46%. Therapeutic bronchoscopy was performed in 3020 patients; one patient (0.03%) died due to haemorrhage induced by insertion of an expandable metallic stent. The complication rate according to procedure was highest for foreign body removal (2.2%). Medical pleuroscopy was performed in 1563 patients. The highest complication rate was for biopsy without electrocautery (1.86%). A total of 228 facilities (47.2%) experienced breakage of bronchoscopes and/or devices. Conclusions: Respiratory endoscopy was performed safely, but education regarding complications caused by new techniques is necessary.

Assessment of oxaliplatin-associated hepatotoxicity in patients receiving oxaliplatin, fluorouracil and leucovorin chemotherapy (FOLFOX) for colorectal cancer remains controversial. The aims of this study were to clarify which variables are indicators of such hepatotoxicity.Twenty-seven patients who were to receive FOLFOX for colorectal cancer were included in this study. A range of liver function tests, including serum hyaluronic acid (HA) and type IV collagen concentrations, indocyanine green (ICG) retention rate at 15 min (ICGR15) and splenic volume were assessed before commencement of chemotherapy and after four cycles of FOLFOX.No significant changes were found in conventional liver function tests or splenic volume. Significant changes pre- and post-FOLFOX were found in type IV collagen concentrations and ICGR15. Correlation analyses showed that the following two factors were associated with significant changes in ICGR15 after four cycles of FOLFOX: platelet count (p = 0.028, correlation coefficient 0.423), and type IV collagen concentration (p0.001, correlation coefficient 0.830). The regression line between type IV collagen concentration and ICGR15 was Y = 2.70 + 0.84 x X.Serum type IV collagen concentration is an indicator of oxaliplatin-associated hepatotoxicity and correlates with significant changes in ICGR15 in patients receiving FOLFOX.

症例は57歳，女性．胸部X線で左肺異常陰影を指摘され入院となった．入院時CTで左S8に径1cmの腫瘤陰影と左S5に浸潤影を認めた．左S8およびS5の腫瘤に対して胸腔鏡下生検を行った．S8の腫瘤は肺内リンパ節，S5の腫瘤は肺mucosa-associated lymphoid tissue（MALT）リンパ腫と診断された．肺MALTリンパ腫は画像上，多彩な像を示し，確定診断の困難な疾患である．肺MALTリンパ腫および肺内リンパ節ともに，その発生および増大には慢性的な吸入性抗原刺激が関連していると考えられ，本症例でもその関与が考えられた．肺内リンパ節と考えられる病変に加えて浸潤影が存在する症例においては，肺MALTリンパ腫の存在も念頭におき厳重な経過観察を行い，陰影の変化があれば胸腔鏡下生検を施行するなどの対応が必要であると思われる．

当科で左肺上葉管状切除後に左残存肺全摘術を必要とした2例を経験した．症例1は68歳男性．肺小細胞癌に対して化学療法と放射線治療後，左肺上葉管状切除術を施行．初回手術後，21ヵ月目に第二癌（扁平上皮癌）を確認．遠隔転移を認めなかったので左肺残存全摘術を施行した．再手術後，6年8ヵ月無再発生存中である．症例2は70歳男性．初回手術後，24ヵ月で吻合部再発を確認．再手術では，正中アプローチにより残存肺全摘術可能と判断．肺動脈処理後，体位変換を行い後側方アプローチで手術を完遂させた．再手術後，20ヵ月目に原病死．再手術施行時，2症例とも通常の左肺上葉切除後と比較してより高度な頭側への肺動脈の屈曲・変位を認めた．血管損傷回避のため心嚢内で血管処理を行った．症例2のように肺門部に病変が及んでいる可能性のある症例に対しては，正中アプローチにより比較的容易に肺動脈を処理でき，有用な方法と思われた．

背景．前縦隔には胸腺原性，上皮性，胚細胞性腫瘍やリンパ増殖性疾患など様々な腫瘍が発生する．なかでもリンパ球優位型胸腺腫とリンパ腫との鑑別には難渋することがある．症例．65歳の男性．胸部単純X線検査で前縦隔の腫瘤を指摘され当科に入院となった．胸部CT写真上，前縦隔から左胸腔側に突出する腫瘤がみられ，胸腺腫の疑いで胸腺全摘術を受けた．術後の病理組織学的検査で正岡分類I期，リンパ球優位型胸腺腫（WHO type B1）と診断された．手術から約1ヶ月後に胸腹水，全身リンパ節の腫大および脾腫が出現し，再入院した．左鼠径部のリンパ節生検でT細胞性リンパ芽球性リンパ腫と診断され，全身化学療法を受けたが，多臓器不全のため死亡した．結論．前縦隔腫瘍において，リンパ球優位型胸腺腫が考えられる場合には，早急に強力な化学療法を要するリンパ腫も考慮し，腫瘍の組織学的診断に加えて，迅速かつ正確な確定診断に努めるべきである．

目的．当科では，ゲフィチニブ有効例の中等度副作用の軽減目的と維持療法目的として隔日投与法を試みており，その効果についてレトロスペクティブに検討し報告する．対象．2002年7月から2004年5月までにゲフィチニブを50例に投与した．全例連日投与にて開始し，長期投薬となる過程で中等度副作用が出現し12例が隔日投与法へ移行した．今回その12例についての検討を行った．結果．全例副作用が軽減し長期投与が可能となった．全例の治療成功期間の平均は18.4ヶ月で，隔日投与期間は平均10.9ヶ月であった．特に女性例4例において600日以上にわたる効果維持・投薬継続が可能となった．結論．隔日投与法は副作用の軽減と維持療法として有用な可能性があり，今後他の内服療法とのプロスペクティブな比較検討が必要と考えられた．

Since immunity is generally suppressed by immunoregulatory factors, such as transforming growth factor-beta (TGF-beta), interleukin (IL)-10, and vascular endothelial growth factor (VEGF), produced by tumor cells or stromal cells surrounding tumor cells, various kinds of cancer immunotherapy mostly fail to elicit potent antitumor immunity. Herein, we tested whether neutralization of TGF-beta can elicit strong antitumor immune responses and tumor regression in tumor-bearing mice. A plasmid DNA, pcDNA-sTGFbetaR/huIg, encoding a fusion protein consisting of the extracellular domain of TGF-beta type II receptor (TGFbetaRII) and the Fc portion of human IgG heavy chain, was injected through different routes into B6 mice carrying established tumors of E.G7 cells, which consist of the poorly immunogenic tumor cells EL4, transfected with the ovalbumin (OVA) gene. The frequency of OVA-specific cytotoxic T lymphocytes (CTL), in the treated mice. increased resulting in the tumor eradication and relapse-free survival in around 70% of the E.G7-bearing mice. In contrast, administration of mock DNA into E.G7-bearing mice did not elicit tumor-specific immune responses. Therefore, administration of DNA encoding TGFbetaRII allowed tumor-bearing hosts to elicit sufficiently potent antitumor immune responses without requirement of further active antigen-immunization. This strategy seems to be applicable to clinical therapy against cancer, because it is low-cost, safe, and easy to manipulate.

背景. 肺癌患者の治療経過中に低Na血症が出現することがあり, 稀ではあるが抗腫瘍薬投与により抗利尿ホルモン不適切分泌症候群 (SIADH) が原因となることがある. 症例. 71歳男性. 胸部異常陰影と顔面・上肢の浮腫で入院となった. 胸部CTで右上葉の腫瘤影と縦隔リンパ節腫大を認め, 経気管支肺生検で低分化型肺腺癌の診断を得た. 入院時より末梢血白血球数増多を認め, 血漿顆粒球コロニー刺激因子 (G-CSF) 高値よりG-CSF産生腫瘍と診断した. 放射線療法開始2週後にnedaplatinとdocetaxelによる全身化学療法を開始したところ, 9日後に傾眠傾向が出現した. 血漿浸透圧低下を伴った低Na血症と血漿ADH上昇を認め, 原因となる他疾患もないことから抗腫瘍薬によるSIADHと診断した. Na補充と利尿剤投与後, 水制限を行うことで症状は改善, その後は低Na血症の再発を認めなかった. 結論. 中枢神経症状を有する低Na血症例では緊急処置が必要であるが, 薬剤性SIADHも考慮しながら原因を鑑別することが重要である.

We have previously reported that 90K/Mac-2 binding protein (M2BP) was highly expressed in lung cancer and that M2BPspecific immunity was observed in many of cancer patients. In this study, we analyzed the ability of 11 M2BP-derived oligopeptides with an HLA-A*0201-binding motif to induce M2BP-specific cytotoxic T lymphocytes (CTL) from peripheral blood lymphocytes of normal donors by in vitro stimulation. One of the CTLs that were induced using M2BP216–224 (RIDITLSSV) produced interferon-c in response to HLA-A2-positive T2 cells pulsed with the same peptide and lysed MDA-MB-231 cells expressing both M2BP and HLA-A2. The cytolytic activities were blocked by antibodies against HLA class I or CD8. These findings suggest that M2BP216–224 is naturally processed from the native M2BP in cancer cells and recognized by M2BP-specific CTLs in an HLA-A2 restriction. We first identified M2BP-derived CTL epitopes that may be useful as a target antigenic epitope in clinical immunotherapy of cancer. 2004 Elsevier Inc. All rights reserved.

背景:肺芽腫は胎児肺の腺様期に類似した上皮性部分と問葉性部分から構成されるまれな腫瘍で上皮成分は異型性が弱いのが通例である. 今回, われわれは上皮成分に多形性の強調されたbiphasic pulmonary blastomaの症例を経験したので報告する。症例:80歳, 男, 肺炎にて入院中, 右上肺部にmass lesionの増大を認めたため, 胸腔鏡下右肺上葉の部分切除術を施行した. 術中迅速時の捺印細胞診では腺癌様細胞と肉腫様細胞が混在して認められたことから, 癌肉腫の可能性が考えられた. しかし, 組織所見で紡錘形細胞が束状に配列する像や多形性に富む横紋筋肉腫の像が複雑に混じり合うなかに胎児肺類似の腺管上皮が増生する像が認められたことから肺芽腫と診断された.結論:肺芽腫は肺腫瘍としてはきわめてまれな腫瘍であるが, 増殖能力が高く, 腺管上皮や間葉系成分の性格によっては予後が異なってくる. 細胞や組織形態のみならず, 免疫学的所見も参考にしながら, より詳細に腫瘍細胞の性格を捉えて診断していくことが重要である.

We present herein a rare case of mediastinal cavernous hemangioma in a 5-year-old boy. The patient was referred to our hospital for an evaluation of cough and high fever. On admission, a chest computed tomogram and magnetic resonance imaging revealed a large tumor arising from the left-sided mediastinum which compressed the left main pulmonary artery and left lung. The tumor, measuring 105 × 60 × 60 mm in size and weighing 170 g, was completely resected without any major bleeding, and a pathological examination confirmed the diagnosis of cavernous hemangioma.

BACKGROUND The authors attempted to obtain shared proteins among lung carcinoma cells by column chromatographies. A glycoprotein with approximately 500 kDa isolated from QG56 cells showed an identical amino acid sequence to 90K/Mac-2 binding protein (M2BP). This protein has been reported to be highly expressed and to modulate the expression of surface molecules involved in immune responses on cultured cancer cells. Therefore, it would be beneficial for M2BP to be targeted in cancer immunotherapy. METHODS The authors analyzed the expression of M2BP in lung carcinoma cells and M2BP's immunogenicity as a tumor antigen. Eight cultured lung carcinoma cell lines and 28 tumor tissues from patients with lung carcinoma were examined for the expression of M2BP mRNA and protein. Sera from cancer patients (n = 23) and healthy donors (n = 19) were studied for their reactivity to M2BP peptides by enzyme–linked immunosorbent assay. RESULTS Seven of the 8 (87.5%) lung carcinoma cell lines and 17 of the 28 (60.7%) tumor tissues expressed high levels of M2BP mRNA. Most of the M2BP mRNA-positive cancer cell lines and tumors also showed M2BP protein expression. The serum levels of antibodies to M2BP were elevated in 30.4% of the patients. In addition, M2BP-specific immunoglobulin G was observed in all patients with anti-M2BP antibodies. CONCLUSIONS M2BP is highly expressed in lung carcinoma cells and is sufficiently immunogenic to elicit specific immunity to this molecule in patients with lung carcinoma. M2BP is expected to be useful as a tumor marker and a target antigen in cancer immunotherapy. Cancer 2002;95:1954–62. © 2002 American Cancer Society. DOI 10.1002/cncr.10899

In order to induce specific antitumor immunity in mice, we attempted to immunize C57BL/6 mice with DNA vaccine encoding MUC1 polypeptide. When the mice immunized with MUC1 DNA were challenged with EL4-muc, MUC1-transfected syngeneic lymphoma cells, they completely rejected tumors. When DNA vaccine was given to the EL4-muc tumor-bearing mice, this vaccination was insufficient to suppress tumor growth in the mice. However, activated, but nonprimed dendritic cells (DCs) obtained from syngeneic mice and MUC1 DNA vaccine were given simultaneously to the same site of EL4-muc tumor-bearing mice, tumor growth was markedly suppressed accompanying prolongation of survival time. MUC1 antigen was detected on the DCs at the vaccination site and in regional nodes in the mice which received MUC1 DNA vaccine and DCs. These mice showed markedly enhanced cellular immune responses specific for MUC1 compared to those in mice vaccinated with MUC1 DNA alone. No significant difference in titers of antibodies to MUC1 between the two groups was observed. These results suggest that nonprimed DCs inoculated at the DNA vaccine site are essential for eliciting strong antitumor cellular immunity to suppress tumor growth efficiently in DNA-vaccinated mice. This animal model is useful for developing DNA vaccine for anti-cancer immunotherapy.

We report two cases of periosteal chondroma of the rib, an extremely rare entity. The first case involved a 5-year-old boy who was admitted with pain and swelling around his left fifth rib. Surgery was performed in May 1999, and an 8 × 6 × 5 mm tumor was resected with the fifth rib. The second case involved a 39-year-old man with a 2-month history of cough who was referred to our department after a coin lesion had been detected on a chest roentgenogram. Physical examination on admission did not reveal any pain or tenderness. The rib tumor was resected along with the fourth rib by video-assisted thoracoscopic surgery and mini-thoracotomy in February 2000. The tumor was well encapsulated and consisted of an elastic hard mass measuring 22 × 15 × 13 mm. Both patients had an uneventful postoperative course and have remained well with no evidence of recurrence. Our review of the literature revealed only six previously documented cases of periosteal chondroma of the rib.

Aims Granzyme B and perforin, which are contained in cytotoxic granules produced by tumour-infiltrating immune cells, have been reported to be involved in suppression of cancer progression. In this study, the relationship between expression of these molecules and clinical factors in cancer patients was studied Methods Tumour tissue obtained from 23 breast cancer patients and 13 lung cancer patients were examined for expression of granzyme B, perforin and B7-1, using an immunohistochemical technique. The percentage of cells positive for expression of these molecules and the clinical status of each case were compared. Results Both granzyme B and perforin were distributed in the cytoplasm of cancer cells in many cases rather than in tumour-infiltrating lymphocytes. This was observed even in cases of early-stage tumours. In both breast and lung cancer patients, the percentage of cells positive for granzyme B and perforin expression was inversely correlated with the status of regional node metastasis. A competitive RT-PCR analysis confirmed that the expression of mRNA from these molecules extracted from the tumours was consistent with the immunohistochemical results. Conclusions Granzyme B and perforin may play a role in the suppression of nodal metastasis of cancer cells in breast and lung cancers.

症例は16歳, 男性.左側胸部痛を主訴に近医を受診し, 胸壁腫瘍と診断され紹介入院となった.左第4肋骨のほぼ全長にわたる硬化性変化が認められ, 腫瘍内部は嚢胞性あるいは壊死性変化を示した.経皮針生検を行うも, 確定診断は得られなかった.2000年4月に胸腔鏡下腫瘍生検による迅速病理で小円形細胞からなる悪性腫瘍と診断され, 第3～5肋骨合併切除術, 胸壁再建術を行った.腫瘍は8×3.8×2.2cmの大きさで第4肋骨への浸潤・破壊が著明であった.病理所見では胞体の乏しい類円形～短紡錘形の腫瘍細胞がalveolar patternを呈して増殖し, ロゼット構造も認められた.特殊染色ではMIC2遺伝子関連抗原 (CD99) が陽性であり, 胸壁に発生したPNET (いわゆるAskin腫瘍) と診断した.術後は順調に経過し, 放射線・化学療法を追加し, 現在, 術後11ヵ月が経過しているが, 再発, 転移等認めていない.

症例は46歳女性. 胸部異常陰影にて受診した. 胸部CT上, 右肺S6に一部に気管支透亮像を伴った多発性結節影と浸潤影を認め, 左肺S8に胸膜嵌入像を伴った径2cmの腫瘤陰影が認められた. 右B6・左B8それぞれより経気管支肺生検を施行し, 右肺S6は肺クリプトコッカス症, 左肺S8は腺癌と診断された. 左肺腺癌に対し胸腔鏡ガイド下左肺下葉切除術を施行した. 右肺クリプトコッカス症に対しては, 術前より抗真菌薬の投与を行い術後も継続した. 肺クリプトコッカス症は希な疾患であるが, 画像上は多彩な陰影を呈し肺癌との鑑別が困難である. 本症例では経気管支肺生検にて肺クリプトコッカス症・肺癌と診断することができ, 両者に低浸襲でかつ有効な治療法が選択可能であったが, 肺癌との合併例では肺内転移との鑑別が重要である.

BACKGROUND Indications for surgical treatment in advanced lung cancer still remain to be established. METHODS The outcomes of combined resection of adjacent organs in lung cancer were assessed in terms of complications and the invasiveness of surgery, using intraoperative blood loss and operation time as indices. RESULTS In 68 patients undergoing combined resection between 1980 and 1997, the 5-year-survival rates and the incidence of complications and hospital deaths were 24.5%, 52.9%,and 10.3%, respectively. The mean blood loss and operation time were 1,200 ml and 396 minutes. The rares of complications and hospital deaths were significantly higher in the group with 1,000 ml or more blood loss, and in the group with 360 minutes or longer operation time. CONCLUSIONS In terms of the survival rate, invasiveness of surgery, and complications, the pleura and pericardium were the best indications for combined surgery. For the thoracic wall, blood loss was greater and the rates of complications and hospital deaths tended to be higher among T3 cases. Both blood loss and operation time tended to be greater in T4 cases. Indications for surgery need to be carefully determined with respect to curability.

入院中に喀毛症 (trichoptysis) を認め, 左上葉気管支と交通のあった縦隔奇形腫の1手術例を経験した.症例は36歳, 女性.1995年6月の検診で左上肺野に異常陰影を指摘され, 血疾が出現したため当科に入院した.入院中に喀毛をきたし, 縦隔成熟型奇形腫の気道内穿破と診断された.同年7月に縦隔腫瘍摘出および左上区切除術を行った.切除標本で腫瘍は左B3気管支に穿破していた.縦隔成熟型奇形腫は比較的高頻度に隣接臓器, 特に肺・気管支への穿孔をきたすが, 画像診断が進歩した現在では, 喀毛症により診断される例は極めてまれである.穿孔する原因としては腫瘍内の膵, 腸管組織による自家消化作用が注目されているが, 本症例では, 膵, 腸管組織は認められず, 腫瘍内容物の増大に伴う嚢胞内圧の上昇と周囲組織との炎症性癒着が穿孔の主たる原因と考えられた.

Study objectives: There have been many studies on the physical characteristics at the time of contraction of a primary spontaneous pneumothorax (PSP), but it has not been shown when and how such physical characteristics develop. These issues were investigated. Patients and design: Physical development of 27 male patients with PSP were examined. Their physical records were collected with the patients’ permission, and standard curves, estimated from the Japanese nationwide records in the year corresponding to the ages of the patients, were plotted as control values. Results: The height of patients was already greater at 6 years of age. It showed a marked increase from 11 to 14 years. The body weight was more than the standard until 9 years, but it became less after age 11, and this difference increased after age 15. Rohrer’s index was significantly lower than the standard at all ages, and the difference was particularly large from 11 to 15 years. In the standard group, there was a balance between the annual height and weight gain. In the patient group, annual weight gain was similar to that in the standard group whereas height began to increase 2 years earlier, and as a result, ectomorphy, which was also observed before this age, became marked at this age. Conclusions: The rapid increase in the vertical dimension of the thorax compared with the horizontal dimension during the period of rapid physical development is considered to affect intrathoracic pressure at the apex of lung, which would have some influence on enhancing cyst formation. (CHEST 1999; 116:899 ‐902)

慢性出血性膿胸 (縦隔圧迫型膿胸, 進行性出血性膿胸) は, 通常の膿胸とは異なり易出血性で, 治癒困難な膿胸である.安易な胸腔ドレナージや, 開胸血腫除去は大量出血をきたす.肺結核のために施行した胸膜外充填術後33年目に発症した慢性出血性膿胸に対し, 開放術, 血管結紮術, 大網充填術で治癒せしめた1例を経験したので報告する.症例は58歳女性, 発熱に伴い右胸部の腫脹が増大したため当科紹介受診となった.25歳時に肺結核に対して胸膜外充填術を施行されている.胸部単純X線および胸部CT写真では右上中肺野から胸腔外に突出する腫瘤陰影を認め, 第1～5肋骨の破壊像が認められた.感染を伴った皮下の腫瘤を開放し, 胸肩峰動脈, 内胸動脈の結紮, 気管支動脈の塞栓術を施行した後に胸腔内血腫除去術を行った.気管支瘻に対しては開放療法後, 有茎大網弁被覆充填術を施行した.胸腔内血腫除去に先立つ血管結紮, 塞栓術は有効であった.

19歳男性の左第7, 10肋骨に発症したpolyostotic fibrous dysplasia の1切除例を経験した.中学生からアメリカンフットボールを行い, 接触時に左胸痛が出現していたが, 胸部X線写真上は異常を指摘されなかった.1996年, 大学入学時の胸部X線写真で異常陰影を指摘され, 疼痛が増強したため4月に近医を受診した.生検でfibrous dysplasia と診断され当科に紹介入院となった.胸部及び肋骨X線単純写真では左第7, 10肋骨に腫瘤陰影が認められ, 骨シンチグラムでも異常集積像が認められた.1996年8月6日に罹患肋骨である第7, 10肋骨腫瘤から2cm以上離れた正常肋骨部で切断し摘出した.第7肋骨は15cm, 第10肋骨は2cmにわたる病巣であった.術後経過は順調で, アメリカンフットボールを続けているが, 2年経過した現在, 再発等認めていない.

症例は60歳女性で, 膠原病, 膜性腎症等のため長期間ステロイドを投与されていた.1997年12月中旬から咳嗽, 喀痰が出現し, 翌年1月2日に39.3℃の発熱がみられた.1月4日に突然の右胸痛, 呼吸困難が出現し, 翌5日に緊急入院となった.入院時には発熱, 心肺不全を伴い起座呼吸, チアノーゼが認められた.胸部X線, CT写真では右胸腔の2/3を占める下葉中心の巨大肺嚢胞が認められ, 上中葉の無気肺, 胸水も存在した.血液検査ではCRPの高値及び低酸素血症が認められた.感染のコントロールのために抗生剤の投与をすると共に, 胸腔ドレナージ及び肺嚢胞内吸引療法を施行した.肺嚢胞吸引療法で嚢胞の増大進行を防止し, 胸腔ドレナージで呼吸不全から離脱できたため, 1月13日に安全に肺嚢胞切除術を施行できた.術後経過は順調であり術後3週間目に退院となった.

A 14-year-old girl was referred to the hospital because of a painless tumor of the left breast. About 4 months before the referral, she began to feel a swelling of the left breast but left it alone; she visited another hospital because the tumor gradually enlarged. On admission, a 12.5×10.5cm elastic soft and well defined tumor was palpated in the left breast and an elastic hard lymph node in her left axillary region. The tumor was diagnosed as phyllodes tumor because of multinodular figure by ultrasonography and enhancement in an early phase by dynamic magnetic resonance imaging and was resected by an enucleation with a little normal gland. Histological examination revealed that the tumor was benign phyllodes tumor 12.5×11.0×6.5cm in size and 400g in weight and no maligant finding were found in the lymph node. No signs of recurrence have been recognized 4 years after the surgery. Although the standard surgical treatment for phyllodes tumors has not been established as yet, wide excision with marginal normal gland is enough for benign phyllodes tumors. Normal gland should be conserved as much as possible and lymph node dissection should be avoided especially in early teens as shown in this present case.

Two cases of intraabdominal organ injuries due to blunt chest trauma are reported. A 58-year-old man was admitted to our hospital with multiple rib fractures, hemopneumothorax and left flail chest. An emergency operation was performed and intraoperative findings revealed that the fractured rib was penetrating through the diaphragm to the stomach. A 52-year-old woman was admitted to our hospital with left multiple rib fractures and hemopneumothorax. Her treatment included chest tube drainage, but a week after admission, intraabdominal bleeding occurred due to a ruptured spleen, necessitating an emergency operation (splenectomy). Blunt chest trauma injury is usually accompanied by multisystem injury. Therefore, it is important to detect intraabdominal injury during an emergency operation and the follow-up period.

A case of esophageal leiomyoma with remarkable calcification is presented. A 67-year-old man was admited to the hospital because of a remarkably calcified mass in the mediastinum on a chest X-ray film which was found during clinical observation for hypertension, Chest CT revealed a 3×3cm calcification covering from the anterior to left side wall of the esophagus and under the bifurcation of the trachea, and a portion of it looked like to protrude into the esophagial lumen. Esophagography visualized a clearly demarcated and elevated lesion with calcification. Endoscopy showed a protruding lesion about 4cm in diameter over the anterior wall of the esophagus. The tumor was found to originate from the esophageal submucosa without involvement of the mediastinal organ by endoscopic ultrasonography. Enuculeation of the tumor was performed. The resected material revealed a hard and clamp-like tumor, 4×2×1.5cm in size. The tumor was diagnosed as leiomyoma histologically.

Inhalation of nitric oxide (NO) has been shown to have beneficial effects on a variety of acute lung injuries, including lung allograft reperfusion injury. The purpose of the present study was to investigate the effects of inhaled NO at the time of harvest on function of canine left lung allografts after transplantation.Ten dogs underwent left lung allotransplantation. Donor lungs were flushed with modified Euro-Collins solution and stored for 21 hours at 1 degree C. Immediately after transplantation, the contralateral main pulmonary artery and bronchus were ligated to assess isolated allograft function. Hemodynamics and arterial blood gases (inspired oxygen fraction, 1.0) were assessed intermittently for 6 hours prior to sacrifice. Allograft myeloperoxidase activity and wet to dry weight ratio were assessed. Donor animals were divided into two groups. Group I animals (n = 5) received no NO. In group II (n = 5), donors received inhaled NO (60 ppm) at the time of harvest.Pulmonary vascular resistance decreased to 79.6% of baseline because of inhalation of 60 ppm NO in group II donor animals. Thiobarbituric acid-reactive materials were reduced during the storage period in group II, a finding suggesting less oxidant injury during storage in donor lungs treated with NO. Throughout the 6-hour assessment, oxygenation in group II was superior to that in group I (p0.05). At 360 minutes of assessment, mean arterial oxygen tension in groups I and II was 88.9 +/- 11.4 mm Hg and 169.1 +/- 33.0 mm Hg, respectively. Myeloperoxidase activity was significantly decreased in group II (p0.05), data indicating reduced neutrophil sequestration. Wet to dry weight ratio was significantly lower in group II.These data suggest that inhaled NO at the time of harvest improves early function of preserved lung allografts by attenuating oxidant injury during storage and subsequent neutrophil sequestration.

Since the nuclear accumulation of p53 protein is known to correspond well with mutation of the p53 tumor-suppressor gene, we analyzed the p53 protein immunohistochemically with the anti-p53 mouse monoclonal antibody, DO-7, in 105 stage I lung adenocarcinomas. The p53 immunoreactivity was detected in the nuclei of cancer cells in 51 cases (49%). The p53-positive cases had a significantly poorer prognosis compared with the p53-negative cases (log-rank test; P < .001) When p53 expression was compared among the cytological subtypes of adenocarcinoma, the incidence of p53 expression in the bronchial surface epithelial cell type (11 of 15) was significantly higher than in the goblet cell type (1 of 6) and tended to be higher than the Clara cell/alveolar type II pneumocyte type (27 of 59). These findings indicate that immunohistochemical examination of the p53 protein is a potential prognostic factor in stage 1 lung adenocarcinomas, and that p53 expression has been associated with the cytological subtype.

1995年7月から1年間に気腫性肺嚢胞に隣接した原発性肺癌の4切除例を経験した.症例は38歳から68歳の男性で, 全例重喫煙者 (BrinkmanIndex=450-2000) であった.全例に肺葉切除術を施行した.組織型は1例が扁平上皮癌 (病理病期III A期) で, 3例が腺癌 (病理病期1期) で, 低分化腺癌は1例であった.転帰は, 全例が再発なく術後5-15ヵ月生存中である.気腫性肺嚢胞患者, 中でも男性の重喫煙者は肺癌のハイリスクグループとして胸部CT検査を中心とした経過観察が必要であり, 経過中に新たな陰影が出現した場合には, 肺癌を念頭に入れての精査が必要である.また, 気腫性肺嚢胞隣接肺癌は低分化型が多く, 発見時に進行している場合も多いため, 一般に予後が不良といわれているが, 早期発見, 早期診断して治癒切除ができれば良好な予後が期待できると考えられた.

A case of glycogen-rich clear cell carcinoma (GRCC) which arose in the right breast of a 35-year-old Japanese woman is reported. Light microscopic examination of the tumor revealed solid alveolar proliferation of clear cells containing abundant glycogen. Electron microscopy identified aggregates of glycogen particles and numerous empty glycogen lakes. This case is reported with a discussion on the other 42 GRCC cases reported in the international literature.