[Show abstract][Hide abstract] ABSTRACT: Bronchial complications owing to airway anastomosis still remain a cause of morbidity and mortality following lung transplantation, and bronchial stenosis is the most common manifestation. Current treatment strategies include endoscopic balloon dilation, laser ablation, and stent insertion. Although a variety of stent types are currently available, it is unclear as to which type of prosthesis is most suitable for post-transplant bronchial complications with regard to the primary effects and long-term outcomes. We herein discuss a case of stenosis of the right bronchial anastomosis in a patient who underwent right single lung transplantation for idiopathic pulmonary fibrosis. This complication was successfully treated with the placement of a modified Dumon Y-stent. The stent was removed 2 months after insertion, and the patient has subsequently maintained an adequate airway caliber. Computed tomography, especially the sagittal section through the chest, is useful for detecting bronchial stenosis and monitoring the healing of this condition.
Surgery Today 09/2011; 41(9):1302-5. · 1.21 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Tracheal surgery is an established treatment for various diseases; however, it is still a potentially challenging procedure. We herein discuss the safety of this procedure with regard to the coordination with airway interventional and anesthetic support.
A tracheal resection was performed on 18 patients. The dyspnea due to pre-existing severe airway stenosis, which was considered to be a risk factor for the safe induction of general anesthesia, was present in 12 (66.7%) cases.
Seven of the 12 patients with pre-existing airway obstruction required interventional airway treatment before surgery. One case with a polyp-like tracheal tumor required venoarterial percutaneous cardiopulmonary support to establish adequate oxygenation before surgery. All 18 cases underwent a segmental resection of the trachea, with the average length of 3.6 rings. Postoperative recovery was uneventful for all but one patient with postintubation tracheal stenosis, who died 17 days after surgery due to a methicillin-resistant Staphylococcus aureus infection. Complications in the other patients included four cases of laryngeal nerve palsy, three of aspiration, and one patient with Horner syndrome, with a total morbidity of 27.7%.
A tracheal resection is currently a safe procedure; however, cooperation with sophisticated airway interventional treatment teams, cardiopulmonary bypass support, or a well-trained anesthesiologist is essential for obtaining a successful outcome, especially for the cases with pre-existing severe airway obstruction.
Surgery Today 04/2011; 41(4):490-5. · 1.21 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: We report a long-term outcome of extremely oversized lung allograft. A left lower lobe transplantation from an adult donor was performed on a four-year-old recipient after left pneumonectomy. Lobar lung allograft volume was calculated to be approximately 180% of the recipient's predicted left thoracic capacity. Accordingly, the lung allograft was compressed to 47% of its original size immediately after transplantation. Initial postoperative functional recovery of the allograft was excellent despite this severe compression. As the patient grew physically, both his forced expiratory volume in 1 s (FEV(1)) and his left lung volume increased slowly but steadily during an observation period of two years and four months after transplantation.
Interactive Cardiovascular and Thoracic Surgery 03/2011; 13(1):114-6. · 1.11 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: We evaluated the clinical outcomes of patients after lung resection with pulmonary artery (PA) plasty for non-small cell lung cancer (NSCLC).
From 1995 to 2006, 36 patients (26 males and 10 females) with NSCLC underwent lobectomy or segmentectomy with PA plasty at our institution. The mean age of the patients was 65.9 years old (range 45-87 years old). There were 17 left upper lobectomies, 10 right upper lobectomies, five left lower lobectomies, two right upper-and-middle bilobectomies, one right lower lobectomy, and one left upper division segmentectomy. Both bronchoplasty and PA plasty were performed in 15 patients. Six patients received preoperative chemotherapy, and one had preoperative radiotherapy.
The postoperative morbidity rate was 27.8 % (10/36), and the mortality rate (30 days) was 2.8 % (1/36). One patient underwent completion pneumonectomy on postoperative day 13. Macroscopic residual cancer was identified in two patients at the thoracic wall and aorta, respectively; microscopic residual cancers were identified in two patients at the stumps of the pulmonary artery and in one patient at the bronchial stump. Postoperative radiation therapy was additionally given to those four patients, except one. The 5-year survival rate for all patients was 51.8 %. There was no significant difference in the 5-year survival rate between clinical N (cN) 0-1 patients and cN2 patients. However, in pathological N (pN) 0-1 patients, the 5-year survival rate was significantly better than that of pN2 patients (71.9 % versus 0.0 %; P < 0.001).
PA plasty for NSCLC is acceptable and highly recommended for pN0-1 patients. Strict patient selection should be considered so as to avoid surgical operations in patients with pN2 staging.
The Thoracic and Cardiovascular Surgeon 12/2009; 57(8):484-8. · 0.93 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: The peroxisome proliferators-activated receptor-alpha (PPARalpha) is important in lipid metabolism and regulation of inflammation. Recent studies have demonstrated the immunoregulatory effects of PPARalpha. This investigated the immunosuppressive effects of PPARalpha using its ligand, WY14643, on acute lung allograft rejection in a rat model and its mechanism of action.
The left lungs were transplanted orthotopically from Brown-Norway donors to F344 recipients. The recipients were then divided into control and WY14643 treatment groups. The allograft rejection was evaluated by daily chest X-ray imaging and was evaluated histologically on Day 7 after transplantation. The cytokine messenger RNA (mRNA) expression at Days 3 and 5 were also evaluated in allografts and recipient spleens.
The radiologic and histologic findings indicated that treatment with the WY14643 reduced acute allograft rejection. WY14643 also significantly extended the allograft survival time. This amelioration of acute rejection by WY14643 was also associated with up-regulated interleukin (IL)-4, IL-10, and transforming growth factor-beta (TGFbeta) mRNA expression in the lung allografts and spleens.
This study demonstrated that the administration of the PPARa ligand, WY14643, ameliorates acute lung allograft rejection in rats. Treatment with WY14643 reduced histopathologic scores, prolonged graft survival, and up-regulated the expression of anti-inflammatory cytokine IL-4, IL-10, and TGFbeta mRNA compared with the control.
The Journal of heart and lung transplantation. 11/2009; 28(11):1172-1179.
[Show abstract][Hide abstract] ABSTRACT: Pleomorphic carcinoma is an uncommon malignant tumor of the lung. As there are few large-scale studies of patients with pleomorphic carcinoma, the clinical characteristics and behavior of the disease have been unclear until now. In this study, we investigated the clinicopathological findings and prognosis of 21 patients with pleomorphic carcinoma.
We identified 930 cases of pulmonary carcinoma in which the patient underwent a lung resection in our institute between January 1999 and June 2007. Of those patients, 21 (2.6%) were diagnosed with pleomorphic carcinoma as determined by the three pathologists in our institute.
The 21 study subjects consisted of 18 male and 3 female patients. The locations of the lesions were as follows: 13 cases, right upper lobe; 5 cases, left upper lobe; 2 cases, right lower lobe; and 1 case, left lower lobe. The mean diameter of the tumor in this series was 55.2 mm (17-100 mm). As for the pathological stage, four cases were stage IA, seven cases were stage IB, five cases were stage IIB, two cases were stage IIIA, and three cases were stage IIIB. The overall 5-year survival rate was 80.0%. There were no significant differences between the symptomatic group and the asymptomatic group, or between the p-factor positive group and the p-factor negative group. On the other hand, there was a significant difference in the disease-free survival rate between the node negative group and the node positive group, and there was also a significant difference in the overall survival rate between the curative operation group and the non-curative operation group.
In this clinical study, the presence of lymph node metastasis and the treatment by a curative resection of the tumor were the most important prognostic factors for pulmonary pleomorphic carcinoma. However, further investigation of a large number of cases is needed in order to gain a clearer understanding of the clinical characteristics and behavior of pleomorphic carcinoma.
European Journal of Cardio-Thoracic Surgery 01/2008; 32(6):873-6. · 2.81 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Tyrphostin AG490 (AG490) potently and selectively inhibits gammac/Janus kinase 3-dependent signaling pathways, including downstream Stat5a/b activation and subsequent T cell proliferation by alloantigen stimulation. We evaluated the effects of AG490 on acute rat lung allograft rejection.
A 7-day course of an intraperitoneal (IP) injection with 10 mg/kg, 15 mg/kg, or 20 mg/kg AG490 was administered to inhibit the rejection of orthotopically transplanted Brown Norway (RT1n) rat lung allografts in Fischer 344 (RT1(1vl)) rat recipients. The progression of allograft rejection was evaluated by X-ray with a semi-quantitative scoring system and was evaluated histologically with a semi-quantitative rejection scoring system for acute lung allograft rejection. Moreover, to determine whether AG490 regulates CD4+ T cell differentiation during acute rejection, flow cytometry was used to investigate Th1 (interferon-gamma) and Th2 (interleukin [IL]-4, IL-10) intracellular cytokine profiles and the CD4+CD25+ T cell population in recipient splenocytes.
Results of radiology and histology confirmed that treatment with AG490 significantly suppressed acute lung allograft rejection. Furthermore, the splenocytes of the AG490-treated recipients had significantly lower production of interferon-gamma and relatively higher production of IL-10, implying that a Th2 shift was induced by AG490. In addition, AG490-treated recipients had a significantly increased population of CD4+CD25+ T cells in their splenocytes on Day 6 after transplantation.
These findings suggest that treatment with AG490 prevents acute lung allograft rejection in rats. The effects of AG490 may contribute to development of CD4+CD25+ T cells and a Th2 shift of CD4+ T cells.
The Journal of heart and lung transplantation: the official publication of the International Society for Heart Transplantation 11/2005; 24(10):1557-64. · 5.61 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: The purpose of this article is to review the current significance of anti-tumor-associated antigen (TAA) antibodies in the therapy of cancer. Current data suggest that antibodies or their genes against TAAs can be used in order to increase the tumor specificity of various therapeutic approaches against cancer, thereby enhancing the tumoricidal effect of each treatment while reducing the side-effects.
Anticancer research 06/2003; 23(6):4377-4382. · 1.87 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Chemokines activate and recruit specific leukocyte subpopulations. We sought to determine whether neutrophil migration, which can contribute to the development of ischemia-reperfusion injury, correlates with lung allograft rejection. Orthotopic left lung allotransplantation was performed from Brown Norway (donor) to Fisher 344 (recipient) rats. Because the role of activated neutrophils in the development of allograft rejection is believed to be biphasic, we used specific CXC receptor inhibition with antileukinate in 2 dosing regimens. Recipients were allocated into 4 groups; A (early administration) received 2 doses of antileukinate (10.0 mg/kg) intramuscularly 24 h before and immediately after transplantation; B (continuous administration) continuously received antileukinate intraperitoneally (10.0 mg/kg/day) for 7 days after surgery. Groups A or B were compared with individual controls that received PBS alone. The progression of rejection was assessed radiographically. Histologic evaluation of allograft rejection based on pathologic rejection grade, performed on day 7, demonstrated significantly lower histologic rejection in group B compared with the control group (2.1+/-1.0 vs. 3.3+/-0.5; P=0.018), whereas there was no significant difference in group A compared with the control group. There were no significant differences between the aeration scores of groups A or B compared with their control groups. Our data suggest that neutrophils may play a promoting role in the development of allograft rejection, and blockage of neutrophil migration may suppress acute lung allograft rejection.
Molecular Medicine 12(9-10):208-13. · 4.82 Impact Factor