Total esophagectomy versus proximal esophagectomy for esophageal cancer at the cervicothoracic junction.

To investigate the adequate extent of esophagectomy and lymphadenectomy for an esophageal cancer localized at the cervicothoracic junction, the mortality and morbidity rates, survival rates, and patterns of recurrence were retrospectively analyzed in two groups-14 patients who underwent total esophagectomy with or without laryngectomy and 15 patients who underwent proximal esophagectomy with or without laryngectomy-at Kurume University Hospital from 1981 to 1996. Proximal esophagectomy with or without laryngectomy resulted in a lower hospital mortality rate and better overall survival for patients who underwent curative esophagectomy compared with total esophagectomy with or without laryngectomy. Multivariate analysis indicated that the extent of esophagectomy (total esophagectomy versus proximal esophagectomy) was not a prognostic factor. The incidence of recurrence was not different between the two groups. Lymph node metastasis or recurrence from such esophageal cancers was localized to the neck and upper mediastinum. For an esophageal cancer localized at the cervicothoracic junction, therefore, proximal esophagectomy with or without laryngectomy and with cervical and upper mediastinal lymphadenectomy could be better indicated for preselected patients.

Pattern of recurrence after extended radical esophagectomy with three-field lymph node dissection for squamous cell carcinoma in the thoracic esophagus.

Factors responsible for recurrence of esophageal cancer were investigated in 90 patients who underwent extended radical esophagectomy with three-field dissection for a squamous cell carcinoma in the thoracic esophagus. The initial tumor recurrence was grouped as either locoregional (site of the primary tumor, anastomotic site, or lymph nodes) or as distant (distant organs, pleura, or peritoneum). Nineteen patients (21%) developed a locoregional recurrence, and 19 (21%) developed a distant recurrence. One (1%) developed both recurrences simultaneously and was classified as a distant recurrence. The locoregional recurrence was correlated with the stage factors, particularly the number of metastasis-positive nodes. For the distant recurrence, vascular invasion was found to have been the most important prognostic factor. Our findings suggested that locoregional recurrence was due to tumor progress related to the extent of lymph node metastasis, whereas distant recurrence was due to the oncologic behavior of the tumor. Locoregional recurrence in patients with limited disease may be reduced by extended radical esophagectomy with three-field dissection. Distant recurrence cannot be controlled by surgery. Adopted postoperative adjuvant therapies showed no effect on recurrence.

[Massive hemoptysis caused by disruption of a bronchial aneurysm diagnosed by microscopic examination of the resected lung].

A 29-year-old woman in the 6th month of pregnancy was admitted to our hospital because of repeated hemoptysis after an acute respiratory infection. Fiberoptic bronchoscopy revealed a polypoid lesion at the orifice of the right B3 bronchus and bleeding around the lesion. Bronchial arteriography showed no abnormalities. Transcatheter embolization was unsuccessful. Therefore, a right upper lobectomy was done. Microscopical examination showed a mass of coagulated blood on the mucosal surface of the wall of the B3 bronchus, and a bronchial artery running toward the mucosal surface was seen underneath. The mass was thought to be the polypoid lesion seen during bronchoscopy. Serial sections showed a bronchial aneurysm 1 mm in diameter that had ruptured into the bronchial lumen. Several bronchial arteries were located in the propria mucosa in other bronchial segments, as observed in the B3 bronchus, but no other focus of bleeding was identified. Some cases of hemoptysis of unknown cause may result from similar histological alterations.

[The strategy against post-operative infection in the patients with esophageal cancer].

Post-operative infection with esophageal cancer patients was investigated. The subjects were 325 esophageal cancer patients. The most frequent infectious complication after the surgery was pneumonia, followed by anastomosis between the cervical esophagus and plastic stomach tube. The bacteria frequently found in infectious lesions were pseudomonas or staphylococcus. The more severe infection the patients had, the more gram negative bacteria were found. Bacterial examination during operation showed that more than 80% bacteria was gram negative. Since esophageal cancer patients had a low nutritional state, their immune function was impaired and infection was apt to occur post-operatively. Therefore, special nutritional care was indispensible, such as essential fatty acid, BCAA, and glutamine supplementation.

The dual effects of hemodialysis on cardiac function assessed by pulsed Doppler echocardiography.

To assess the effect of hemodialysis on cardiac function, a change of preload due to water removal was considered. In order to keep the preload constant during hemodialysis, extracorporeal ultrafiltration was induced before hemodialysis (step 1), and then hemodialysis without water removal was achieved (step 2). Cardiac performance in 8 patients was evaluated before and at the end of each step using pulsed doppler echocardiography. Step 1: Ultrafiltration was 1350 +/- 410 ml and hematocrit increased significantly. Left ventricular end-diastolic dimension (LVDd) decreased from 40.3 +/- 4.2 (mean +/- standard deviation) mm to 36.1 +/- 4.6 mm (p less than 0.005) and aortic peak flow velocity (PFV) also decreased from 59.9 +/- 16.0 cm/s to 49.0 +/- 11.0 cm/s (p less than 0.005). Step 2: In contrast, after hemodialysis without water removal, the mean velocity of circumferential fiber shortening (mVcf) increased from 1.36 +/- 0.26 circ/s to 1.86 +/- 0.36 circ/s (p less than 0.005). PFV and average acceleration (Aa) increased from 49.0 +/- 11.0 cm/s to 63.8 +/- 11.4 cm/s (p +/- 0.001) and from 750 +/- 220 cm/s/s to 1270 +/- 280 cm/s/s (p less than 0.001), respectively. During this step, serum potassium and osmolality decreased significantly. In conclusion, hemodialysis improves cardiac function under constant preload condition and this is due to the direct effects of hemodialysis by the correction of electrolytes and osmolar components such as uremic toxin.

Photocross-linking from SH1 of the myosin heavy chain to light chains through the dinitrophenyl group attached to SH1.

Trinitrobenzene selectively dinitrophenylates SH1, a specific thiol in the myosin heavy chain which contains 1 mol of this cysteinyl residue. When the SH1-DNP-myosin thus obtained was irradiated with a mercury lamp, a cross-linked product was formed with a molecular weight of about 220K daltons. It was shown that this product was composed of both heavy and light chains by fluorescence labeling of the heavy chain at SH2, another specific thiol, and immune reaction using an anti-light chain antibody, respectively.

Selective modification of myosin SH1 with 1,2,4-trinitrobenzene. VIII. Thiols of myosin.

Myosin has 2 mol of the most reactive thiol, named SH1. 1,2,4-Trinitrobenzene (TNB), a novel dinitrophenyl(DNP)ating reagent [Takahashi et al. (1983) Chem. Lett. 1445-1448], was found to react only with SH1 without any other amino acid residues in myosin under the conditions used. Its reaction with myosin SH1 was about 30 times faster than that with N-acetylcysteine (NAC). The reaction rate of TNB with SH1 was about twice compared with that of NEM, the most reactive selective reagent for SH1 so far found, although its rate with NAC was only one sixtieth that of NEM. As to the lambda max of the absorption spectrum of SH1-DNP-myosin, a large red shift of as much as 20 nm was observed compared with low molecular S-DNP derivatives. This red shift disappeared in 8 M urea. This outstanding feature of SH1 modification with TNB was discussed in terms of affinity labeling by interaction with an aromatic amino acid near SH1.

New fluorogenic, photoactivable, heterobifunctional crosslinking thiol reagents.

Properties of newly synthesized crosslinking reagents (ACM) and their applications to proteins are studied (ACM is the abbreviation for a series of photoactivable and heterobifunctional crosslinking thiol reagents, each of which has two reactive groups, maleimide and azide). These reagents bind specifically to the sulfhydryl residues of proteins in the first reaction step. Upon photoactivation, the azide group of the coumarin ring reacts with side or main chains of the proteins, and thus intra- or intermolecular crosslinking can be elicited. In addition, the coumarin moiety of the reagents becomes highly fluorescent after photolysis. Therefore, the crosslinking products can be detected by fluorometry with high sensitivity in the pattern of sodium dodecyl sulfate-polyacrylamide gel electrophoresis. Reaction of ACM with rabbit muscle aldolase led to extensive crosslinking between subunits of the enzyme and maximally 25% of the total subunits were found to be crosslinked to the dimer.