Expression of ABH/Lewis-related antigens as prognostic factors in patients with breast cancer.

PURPOSE: The prognostic value of altered blood group factor and Lewis-related carbohydrate antigen expression in breast cancers has not been fully determined. METHODS: To this end, breast carcinoma samples from 87 radical mastectomy patients with primary cancer were analyzed by immunohistochemistry for the ABH factors, Le(a), sialyl Le(a), Le(x), and sialyl Le(x). RESULTS: It was found that ABH, Le(a), sialyl Le(a), Le(x), and sialyl Le(x) antigens were expressed in 25 (21.8%), 26 (22.6%), 26 (22.6%), 36 (31.3%), and 37 specimens (32.2%), respectively. Tumors with lymph node metastasis expressed Le(x) or sialyl Le(x) antigens more frequently than those without lymph node metastasis ( P=0.0020 or P=0.039, respectively). The survival time of patient s after surgery was significantly shorter for those whose tumors expressed Le(x) or sialyl Le(x) than for those without Le(x)- or sialyl Le(x)-positive tumors ( P=0.0028 and P=0.0029, respectively). Cox's multiple regression analysis revealed that sialyl Le(x) expression was an independent prognostic factor for patient survival regardless of primary tumor (T factor) and lymph node (N factor) status (hazards ratio, 3.80). CONCLUSIONS: Thus, expression of sialyl Le(x) antigen in tumor cells is associated with poor prognosis in patients with breast cancer and must be considered in the design of future therapeutic trials.

[Results of carinal resection for primary lung cancer].

Carinal resection for primary lung cancer was clinical evaluated. Carinal resection was performed in 18 patients. Thirteen patients underwent carinal resection and the other 5 sleeve or wedge pneumonectomy. The carinal reconstruction was of montage type in 10 patients and the double-barrel type in 2. There were 2 operative deaths, postoperative mortality rate was 11.1%. The 5-year survival for 16 patients excluding the 2 operative deaths was 38.8%. The 5-year survivals were 41.7% and 21.4% for N0 and N2 disease, respectively. Selected patients with localized lesion without mediastinal lymph node metastasis are the candidate for carinal resection and reconstruction.

[A case of left main bronchus obstruction due to recurrent esophageal cancer successfully treated by Nd-YAG laser followed by radiotherapy, low-dose CDDP and continuous infusion of 5-FU].

A 63-year-old female patient with obstruction of left main bronchus due to recurrent esophageal cancer was treated by emergency Nd-YAG laser therapy under bronchoscopy. Severe dyspnea subsided dramatically and she was the given radiotherapy with a total dose of 50 Gy (2 Gy/f and 25 f/5 wks). Concurrent chemotherapy was performed at the 3rd week of radiation therapy. In this chemotherapy of CDDP plus 5-FU, CDDP (10 mg/day) was given for 5 days by intravenous and 5-FU (500 mg/day) for 5 days by continuous infusion the same week. By this treatment, a partial response (PR) was obtained, and the patient returned to normal life. But after 4 months, she had a recurrent lesion at the same place, and underwent only palliative laser therapy. Nd-YAG laser therapy for obstructive lesion of trachea due to recurrent cancer is the most useful one, but some subsequent treatment is required.

[Long-term survival in terms of DNA-RNA contents in breast cancer].

Fifty-nine primary breast cancers were analyzed by flow cytometric cellular DNa-RNA contents stained by acridine orange simultaneous DNA-RNA double staining. Forty-three cases (72.9%) out of 59 had abnormal stemlines (DNA aneuploidy), and 16 normal ones (DNA diploidy). RNA indices widely ranged from 1.41 to 9.02 (2.99). There was no correlation between DNA indices and RNA indices. The patients with DNA diploidy had a better prognosis than those with DNA aneuploidy, but the differences were not significant. The patients with a high RNA index of more than 4.0 had a significantly poorer prognosis than those with an index of less than 4.0. Those results suggest that RNA contents, and DNA contents are independent prognostic factors, and especially RNA contents may be a good prognostic factor in long-term survival in breast cancer.

[A case of hepatic arterial infusion chemotherapy for multiple liver metastasis from breast cancer].

A 52-year-old woman underwent Auchinclass' operation for breast cancer. The histological type was papillotubular carcinoma. One year and 5 months after operation, multiple liver tumors were found on the CT scan and multiple bone metastasis on MRI. The former were treated by hepatic artery infusion chemotherapy with epirubicin and 5-FU using a subcutaneous implanted pump and the latter by 50 Gy irradiation. The patient began to complain of abdominal pain and discomfort after hepatic artery infusion, so all treatment was discontinued. Six months later the patient died of respiratory failure due to pleural dissemination. No liver mass was detected, and bone metastasis was not changed in section tissues. This suggested that the therapy for a breast cancer patient with distant metastasis must be considered according to the region of recurrence.

[A case of mediastinal mature teratoma presenting increased serum CA19-9 level].

A case of mediastinal mature teratoma with elevated serum CA19-9 level is reported. A 50-year-old woman admitted to our hospital complaining of cough and chest pain. Chest X-ray showed an abnormal mass shadow with retention of the right pleural effusion. Her serum CA19-9 level was high (204.4 U/ml), while serum AFP, CEA, HCG levels were normal. On lateral thoracotomy, an anterior mediastinal tumor perforating into the right lung was revealed and the total resection of the tumor with adherent part of the right lung was performed. Postoperatively, her serum CA19-9 level returned to normal. Histological examination disclosed a mature teratoma consisting of skin, pancreatic tissue, cartilage, bronchial epithelium, etc. Immunohistochemical staining were positive in the bronchial epithelium and bronchial gland but was negative in the pancreatic tissue of the tumor. This is a rare case of mediastinal mature teratoma with elevated serum CA19-9 level and negative immunohistochemical staining for it in the pancreatic tissue of the tumor.

[A study of infusional port re-insertion in patients with liver metastasis].

We evaluated the importance and usefulness of re-insertion of the intra-arterial infusion catheter in 10 patients with liver metastasis who showed problems in the catheter or system during intra-arterial infusion chemotherapy. The route of re-insertion was laparotomy-->left subclavian method in 3 patients, left subclavian-->left subclavian method in 5, and left subclavian-->femoral method in 2. The cause of re-insertion was dislocation in 5 patients, obstruction of the system in 4, and obstruction of CHA in 1. In the patients showing dislocation, re-insertion was performed after a mean of 4 months, and CEA improvement and direct effects evaluated by imaging techniques were marked, suggesting good indication. In the patients showing system obstruction or CHA obstruction, re-insertion was performed after a mean of 8.6 months, and CEA improvement and direct effects were less than those in the patients showing dislocation. Of the 10 patients who underwent re-insertion, 5 have survived to the present for 13-20 months (mean, 17 months). The prognosis of liver metastasis may be improved by active re-insertion of the intra-arterial infusion catheter.

[Effect of FK-506 on bronchial healing of canine lung allografts].

The effects of the immunosuppressive agents on the healing of the bronchial anastomosis following canine lung allo-transplantation were evaluated. Auto- or, allo-transplantation was performed in 44 dogs. The dogs were classified into following three groups: Group A (18 dogs) underwent autograft, Group B (13 dogs) underwent allograft following immunosuppressive therapy with cyclosporin A (20 mg/kg/day) orally and Group C (13 dogs) underwent allograft with FK-506 (0.1 mg/kg/day) injection intramuscularly and omentopexy on the bronchial anastomosis. The dogs were sacrificed at 1, 2, 3 or 4 weeks after surgery. The grafted lung and anastomosed bronchi were removed, and microscopic examination was performed. We estimated bronchial healing according to the inflammatory response score (IRS), which was defined as comprehensive assessment by histologic findings in each of the inflammatory response: inflammatory cell type, a degree of the proliferation of collagen fibers, edema, bleeding, degeneration and ulcer. There was no significant difference between the incidences of rejection and the inflammatory cell types. The degree of the proliferation of collagen fibers in Group C was moderate at 2 weeks and remarkable at 3 or 4 weeks. IRS at one week after operation was 9.1 +/- 1.5 in Group A, 8 in Group B and 8 in Group C. IRS at two weeks after surgery was 4.8 +/- 1.3 in Group A, 5.1 +/- 1.2 in Group B, 4.3 +/- 1.0 in Group C. IRS at three or four weeks after transplantation was 3.0 in Group A, 3.2 +/- 1.9 in Group B and 2.0 +/- 1.2 in Group C. There was no significant difference between each group and each week.(ABSTRACT TRUNCATED AT 250 WORDS)

[Comparison of typical and atypical bronchoplasty for bronchogenic carcinoma].

One-hundred and twenty-eight patients who underwent bronchoplasty for bronchogenic carcinoma from 1969 to 1990 were retrospectively analyzed. Ninety-six patients had upper sleeve lobectomy or upper lobectomy with wedge bronchoplasty (typical procedure) and 32 underwent bronchoplasty with lobectomy other than upper lobes (atypical bronchoplasty). The two groups were statistically similar in preoperative characteristics including sex, age, cell types and stages. In typical group, right upper sleeve lobectomy was performed in 48 patients, left upper sleeve lobectomy in 27, right upper lobectomy with wedge bronchoplasty in 11, left upper lobectomy with wedge bronchoplasty in 7 and sleeve bronchoplasty alone in 2. In atypical group, right middle and lower lobectomy with sleeve bronchoplasty in 10 patients, left lower sleeve lobectomy in 5, right lower lobectomy with wedge bronchoplasty in 4 and others in 13. Postoperative mortality was 5.2% in the typical group and 9.4% in the atypical group. Postoperative respiratory complications occurred in 16 patients (50%) in the patients with the atypical group and in 33 (34.7%) in those with typical group. Three years and 5 years survival rates in the typical group were 46 and 40% and those in the atypical group, 27 and 18%. However, there was no statistical difference in survival between the two groups. In conclusion, atypical bronchoplasty is useful for preserving the lung parenchyma, but, careful perioperative management and surgical technique of bronchoplasty are mandatory.

[Study of combined hepatocellular and cholangiocarcinoma].

Four patients with combined hepatocellular and cholangiocarcinoma were studied. One case received hepatic arterial infusion therapy (HAIT), 2 hepatectomy and the case with extrahepatic cholangiocarcinoma underwent enucleation. According to Allen's classification, two were combined type and the others mixed type. Tumor ploidy patterns on flow cytometric DNA analysis were aneuploid in 2 cases with curative resection, of which one is still alive 6 years and 3 months after surgery. It suggested that the patient's survival was affected by the pathological factors more than the ploidy patterns of the tumor. A case treated by HAIT improved considerably in terms of symptoms and evidenced reduction in the size of the deposits. Selection of anticancer agents sensitive to both hepatocellular and cholangiocarcinoma is required.

Transplantation of canine lung allografts preserved in UW solution for 24 hours.

To evaluate the efficacy of University of Wisconsin (UW) solution for lung preservation, we performed canine lung allotransplantation with lungs preserved in UW solution. Donor lungs from eight dogs were flushed with UW solution and lungs from four dogs with Euro-Collins solution, and these were preserved for 24 hr in cold storage at 4-6 degrees C. All recipient dogs were given cyclosporine at a dose of 20 mg/kg/day until death. None of the four dogs that received a lung allograft flushed with Euro-Collins solution survived contralateral pulmonary artery and bronchial occlusion. All eight dogs that received a lung allograft flushed with UW solution were alive between 8 and 21 days postoperatively. Six of them survived until pulmonary function tests were performed. The engrafted lungs functioned well until death between days 10 and 21 posttransplantation. The PaO2 was 428 +/- 26 prior to transplantation, 317 +/- 140 at 60 min after transplantation, and 382 +/- 76 mmHg at 10 to 21 days after transplantation. In the other two dogs, the grafted lungs functioned poorly, and macroscopically revealed diffuse organizing pneumonia. We conclude that UW solution is useful for up to 24 hr of cold preservation prior to lung allografting. However, we recommend that lungs preserved with UW solution be transplanted within 24 hr, because, despite adequate function, microscopic damage occurs in the grafted lung.

[Management of airway obstruction using the neodymium-yttrium-aluminium-garnet laser].

The neodymium-yttrium-aluminium-garnet laser (Nd-YAG laser) has proved to be useful therapeutic tool for the management of endobronchial lesions. Between February 1983 and January 1991, 16 patients received endobronchial laser therapy at the Nagasaki University Hospital, 7 patients for tracheal stenosis, and 9 for endobronchial obstruction. In 4 patients with tracheal stenosis, the therapy was performed in an emergency. The type of lesions were lung cancer in 7 patients, thyroid cancer in 3, tracheal tumor (squamous cell carcinoma, and chondrosarcoma) in 2, esophageal cancer in 1, bronchial submucosal tumor in 1, and tracheobronchial tuberculosis in 2. Good symptomatic relief was obtained in 13 patients. One patient died from massive bleeding in the left main stem bronchus. Reobstruction had occurred in 2 patients with cicatricial lesion in right main stem bronchus. In patients with an unresectable malignant lesion, concurrent radiotherapy was needed to prevent the reobstruction.

[A case of idiopathic fibrous mediastinitis with superior vena caval obstruction].

Uncommon case of superior vena caval obstruction secondary due to idiopathic fibrous mediastinitis was reported. A 38-year-old female was admitted in our hospital with the complaint of dyspnea and facial edema. Venography revealed occlusion of vena cava. Venous pressure showed 30 cmH2O in the external carotid vein. Mediastinal computed tomogram revealed no tumor but calcification in the anterior mediastinal fatty tissue. Therefore, with a 12 cm EPTFE, left brachiocephalic vein-right atrium bypass operation was performed. Facial edema was disappeared dramatically in early postoperative stage. She is uneventful 20 months after the operation.

[A case of accidental pneumatic rupture of the esophagus].

A case of pneumatic esophageal rupture secondary to distension from compressed air was reported. The patient, a 69-year-old man who was repairing an automobile tire suddenly exploded. The blast was directed into the open mouth. He was admitted to our hospital 12 hours after the onset with the complaint of chest pain and dyspnea. Subcutaneous emphysema was seen in the neck. The chest roentgenogram revealed a partial right hydropneumothorax. The diagnosis of esophageal rupture was established by Gastrographin swallowing study. Operation was performed 46 hours after the onset. Primary closure of the middle thoracic esophagus was judged to be impossible because of a 6 cm longitudinal laceration with contaminated pyothorax. Thereafter, total esophagectomy was indicated. Esophageal reconstruction using the pediculated gastric tube was performed throughout the retrosternal route. The leakage of esophagogastrostomy in the cervical area occurred in early postoperative stage. Re-esophagogastrostomy was successfully carried out 6 weeks after the first surgery. He is uneventful 6 months after the operation. We have not found any reports of surgical cases with pneumatic esophageal rupture treated by this approach in the literature.

[Results of abdominal surgery in patients over 90 years old].

During a year period (1978-1987), 105 cases of abdominal surgery were performed at Sasebo Chuo Hospital on patients over 80 years of age. This study discusses 4 patients who were over 90 years old at time of their surgery. Emergency surgery had been required for 2 patients (a 91-year-old male with a sigmoid colon ca., and a 91-year-old female with a descending colon ca.), and elective surgery had been performed on the other two patients (a 95-year-old male with a caecum ca., and a 97-year-old female with a leiomyosarcoma of stomach). The patients who underwent elective surgery had a uniformly smoother hospital course and an overall better prognosis then the patients who underwent emergency surgery, whose prognosis was poor. We have concluded that early diagnosis and elective surgery is the necessary procedure in the elderly patient.

[Causes of death after an early gastric cancer operation].

From April, 1972 to December, 1984, 329 early gastric cancer case were operated on by this department. Results of these operations have revealed the following statistics: The 5-year survival rate of those with an m-cancer was 97.6% and for those with an sm-cancer, 92.6% and, the 10-year survival rate of m-cancer was 91.6% and sm-cancer, 89.9%, respectively. Twenty-nine postoperative deaths were recognized in this series, and the causes of death in each case have been analysed. Prophylactic measures to prevent postoperative death also are discussed.

Cytologic diagnosis of male breast cancer with nipple discharge. A case report.

The cytologic findings in a nipple discharge from a male patient with breast cancer are described. Malignant epithelial cells and cell clusters believed to be derived from ductal carcinoma were observed. The subsequent mastectomy specimen contained a ductal carcinoma with minute foci of stromal invasion.