Chronic expanding hematoma of thorax extended to the neck.

We report a rare case of chronic expanding hematoma of thorax extended to the neck. An 83-year-old man with a history of Lucite ball plombage and thoracoplasty of bilateral thorax was admitted with numbness of left upper extremity. In 6 months, left supraclavicular fossa was gradually bulged like tumor. The lesion was diagnosed as chronic expanding hematoma. Surgically, Lucite balls were removed with surrounding hematoma debris and fluid, and neck hematoma, which was slightly communicated to the thorax, was extirpated. We discussed the genesis of this hematoma and its extension to the neck.

Treatment of chronic expanding hematoma of the thorax with median sternotomy.

Chronic expanding hematoma of the thorax is a rare disease. We report a 60-year-old man with chronic expanding hematoma, which occupied the left entire hemithorax. Its hematoma was extirpated with pleuropneumonectomy. It was performed through posterolateral thoracotomy following median sternotomy, through which left hilar structure including inferior pulmonary vein could be accessed and closed. After the operation, he was discharged without any significant complications.

Surgical resection of a primary pulmonary epithelioid hemangioendothelioma in bilateral lungs.

Pulmonary epithelioid hemangioendothelioma (PEH) is a rare pulmonary neoplasm that was initially described in 1975 as an intravascular bronchioloalveolar tumor. This report presents the case of a patient with multifocal primary pulmonary PEH (11 tumors) in the bilateral lungs. All of the tumors detected in the preoperative computed tomography scan were surgically resected. The patient has been doing well for 9 years after surgery. No tumor recurred for 8 years after surgery until a single recurrent nodule appeared and was thoracoscopically resected.

Significance of the urinary 8-OHdG level as an oxidative stress marker in lung cancer patients.

OBJECTIVE: In the present study, we investigated the relationship between the urinary excretion rate of the oxidized nucleoside 8-hydroxydeoxyguanosine (8-OHdG) and clinical factors in lung cancer patients. METHODS: The present study included 100 patients, who underwent a lung surgery. The patients included 62 men and 38 women with a mean age of 65.5 years ranging from 35 to 82. The diagnosis included 81 primary lung cancers, 9 metastatic lung cancers and 10 benign lung diseases. Urine samples collected for 24h were analyzed for the content of 8-OHdG using an ELISA assay. RESULTS: The urinary excretion rate of 8-OHdG in smokers was significantly higher than that in never-smokers. Specifically, the 8-OHdG excretion rate of current smokers was higher than that of patients who had quit smoking for longer than 1 month. Excluding current smokers, the urinary excretion rate of 8-OHdG did not relate to age or gender, but to the malignant potential of the disease. The urinary 8-OHdG level increased in the order of metastatic lung cancer, primary lung cancer and benign disease. In lung cancer patients, furthermore, the mean urinary 8-OHdG level of patients with stages II-IV disease was significantly lower than that of patients with stage I disease. CONCLUSIONS: Smoking significantly increased the urinary excretion rate of 8-OHdG, suggesting that smoking causes an increased rate of oxidative DNA modifications. On the other hand, the capacity to repair oxidative DNA modifications might be impaired to some extent in cancer patients.

Ex vivo electroporation as a potent new strategy for nonviral gene transfer into autologous vein grafts.

Gene transfer to vein grafts has therapeutic potential to prevent late graft failure; however, certain issues, including efficacy and safety, have hindered the clinical application of this treatment modality. Here, we report the successful and efficient gene transfer of plasmid DNA via ex vivo electroporation into veins as well as into vein grafts. Two approaches were used: one involved transluminal in situ gene transfer using a T-shaped electrode (the "Lu" method), and the other was an adventitial ex vivo approach using an electroporation cuvette followed by vein grafting (the "Ad" method). The Lu method was carried out at 10 V, with optimal gene transfer efficiency in the in situ jugular veins of rabbits, and transgene expression was observed primarily in endothelial cells. However, when these veins were grafted into the arterial circulation, no luciferase activity was detected; this effect was probably due to the elimination of the gene-transferred cells as a result of endothelial denudation. In contrast, optimal and satisfactory gene transfer was obtained with the vein grafts subjected to the Ad method at 30 V, and transgene expression was seen primarily in adventitial fibroblasts. Gene transfer of endothelial nitric oxide synthase cDNA to the vein graft via the Ad method successfully limited the extent of intimal hyperplasia, even under hyperlipidemic conditions, at 4 wk after grafting. We thus propose that the Ad method via ex vivo electroporation may provide a novel, safe, and clinically available technique for nonviral gene transfer to sufficiently prevent late graft failure.

Cytoplasmic expression and extracellular deposition of an antiangiogenic factor, pigment epithelium-derived factor, in human atherosclerotic plaques.

OBJECTIVE: To assess the expression and distribution of a neurotrophic/antiangiogenic factor, pigment epithelium-derived factor (PEDF), related to angiogenesis that is a possibly key event during atherogenesis in human atherosclerotic plaques. METHODS AND RESULTS: Twenty fresh aortic samples were used for reverse-transcription polymerase chain reaction (RT-PCR), Western blot, and immunohistochemistry (IHC). In addition, 80 stocked paraffin blocks of coronary arteries from 40 autopsy cases were also used. IHC revealed divergent staining patterns for PEDF in both the aortas and the coronary arteries tested, ie, "cytoplasmic staining" or "extracellular deposition," were observed, respectively. In the areas showing cytoplasmic staining, double PEDF was expressed in a majority of the foamy macrophages and in some smooth muscle cells, and the PEDF-positive cell frequency was positively correlated with that of microvessels in a cell-rich area in the coronary arteries (P<0.0001). Inversely, extracellular deposition of PEDF was seen in acellular areas and was negatively correlated with the number of microvessels (P=0.0003). CONCLUSIONS: These results suggest that PEDF may function as an antiangiogenic factor when it is deposited onto the extracellular matrix. Thus, PEDF may play a significant role in determining the balance of angiogenesis/ antiangiogenesis during atherogenesis.

A time trend of profile and surgical results in 1123 patients with non-small cell lung cancer.

BACKGROUND: A time trend for characteristics and prognoses of patients with non-small cell lung cancer (NSCLC) who underwent surgical resection was investigated. METHODS: A series of 1123 consecutive patients with NSCLC who underwent surgical resection from 1975 to 1998 was reviewed with respect to changes in patient profile and surgical outcome among subgroups classified by clinicopathologic factors. RESULTS: With time, the proportion of female, elderly (> or =70 years), pathologic stage IA, nonsmoking, and adenocarcinoma patients increased significantly whereas pneumonectomy, incomplete resection, and pathologic stage IIIA patients decreased significantly. Overall survival showed an upward trend with 5-year survival rates of 30.0% in the 1970s, 41.6% in the 1980s, and 50.1% in the 1990s (P <.0001). This tendency was similar in every pathologic stage that was observed. The proportion of female patients with adenocarcinoma that exhibited the most favorable prognosis among subpopulations classified by gender and cell types was significantly higher in the 1990s (28.0%) than in the 1970s (14.0%). Multivariate analysis revealed that female gender, adenocarcinoma, complete resection, and early pathologic stage were independently favorable factors whereas advanced age was an unfavorable factor. CONCLUSIONS: The improved survival following surgical resection for NSCLC during the study period was associated with an increasing population of female patients with adenocarcinoma, more detection of early disease, and effective elimination of unresectable cases.