Localization and changes of diamine oxidase during cardiopulmonary bypass in rabbits.

BACKGROUND: We previously observed increased serum diamine oxidase activity during clinical cardiopulmonary bypass, indicating small intestinal mucosal ischemia followed by bacterial translocation. MATERIALS AND METHODS: In seven female rabbits undergoing cardiopulmonary bypass for 1 h, we analyzed the localization of diamine oxidase immunohistochemically, and measured its activity in serum and abdominal organs before and after cardiopulmonary bypass (CPB). RESULTS: Preoperatively, diamine oxidase activity and immunoreactivity were high in the small intestine, localized to villus tips. Serum activity increased significantly after CPB, whereas small intestinal diamine oxidase decreased with mucosal injury. CONCLUSIONS: In this model serum diamine oxidase activity appeared to reflect CPB induced intestinal mucosal injury.

Arterial air embolism during percutaneous pulmonary marking under computed tomography guidance.

Percutaneous pulmonary marking under computed tomography (CT) guidance is often used to identify the location of small nodules prior to pulmonary wedge resection by video assisted thoracoscopic surgery. Although pneumothorax and pulmonary hemorrhage are known complications that accompany this method, arterial air embolism is an extremely rare and occasionally fatal complication. We report a case of arterial air embolism during percutaneous pulmonary marking under CT guidance. Percutaneous pulmonary marking was performed in the prone position in a 59-year-old male with a right lung nodule. The chest CT performed immediately after this procedure revealed an air-fluid level in the heart. The skin of the patient's back appeared cyanotic and neurological dysfunction was noted in his left thigh, although his vital signs were stable. Four hours later, the air in the heart and aorta disappeared, as observed by a chest CT. The patient underwent pulmonary resection 12 days later.

Pleomorphic carcinoma of the lung associated with loss of heterozygosity of p53 gene.

We report a case with pleomorphic carcinoma of the lung in a 70-year-old man. Pleomorphic carcinoma is characterized by a heterogenous composition that includes epithelial and mesechymal malignancies. In the present case, the tumor was composed of a mixture of unequivocal squamous cell carcinoma and spindle cell components resembling sarcomatous overgrowth. The spindle component did not include a heterologous mesenchymal element characterized by overt differentiation for bone, cartilage, neuron or muscle tissue. To evaluate a state of differentiation of the spindle cell component, we immunohistochemically examined expression of the antigens including vimentin, cytokeratin, sarcomeric actin, alpha-smooth muscle actin, S-100 protein, CD34, Factor VIII, and CD68. The results showed sole expression of vimentin in the spindle cell component, suggesting an immature state of the mesenchymal lineage. Furthermore, the spindle cell component of this case was genetically characterized by loss of heterozygosity (LOH) at a codon 234 of exon 7 of the p53 gene. This mutation causes an amino-acid replacement (Tyr to Cys), which was previously proven to attenuate p53 function. The present case may suggest a relation between somatic alteration of the p53 gene and histogenesis of pleomorphic carcinoma.

Combined mediastinal node assessment by lymphadenectomy and intraoperative mediastinoscopy.

The purpose of this study was to determine the importance of combined mediastinal node assessment by lymphadenectomy and intraoperative mediastinoscopy to patients with left lung cancer. Forty-one patients with left lung cancer were divided into a group of 13 and a group of 28: in the first group, the aortic arch was mobilized, while in the second group the aortic arch was not mobilized. The mediastinal nodes of both groups were then dissected and mediastinoscopes were inserted into the operation field with an approach through thoracotomy to biopsy each mediastinal node. We compared nodal pathological assessment in these two groups. In the group with mobilized aortic arches, pathological assessment of lymphadenectomy at Naruke's station 3 was 11/13 (85%) and combined with intraoperative mediastinoscopy was 12/13 (92%). In the group without mobilized aortic arches, pathological assessment of lymphadenectomy of station 3 was 14/28 (50%) and combined use of intraoperative mediastinoscopy significantly improved the diagnoses to 24/28 (86%) (P=0.004). Combined use of lymphadenectomy and intraoperative mediastinoscopy could improve the assessment of station 3 in left lung cancer without mobilizing aortic arch.

Immediate localization using ultrasound-guided hookwire marking of peripheral lung tumors in the operating room.

A new method of marking peripheral lung tumors using an ultrasound-guided hookwire has been developed. The procedure was done for nine tumors taking 15-20 min for each method in the operating room; all of them had no complications. In eight cases (89%), the wire tips were shown to be located within the tumor itself or within 5 mm from the targets, close enough to support appropriate surgery. Ultrasound-guided hookwire marking of peripheral tumors can provide appropriate guidance and prove effective in immediately facilitating subsequent thoracoscopic resection.

Ischemia of the intestinal mucosa during cardiopulmonary bypass.

Bacterial translocation is believed to occur during cardiopulmonary bypass (CPB) because serum endotoxin concentrations rise. Intestinal ischemia during CPB, however, has never been proven directly. The condition of the intestinal mucosa during CPB was studied by measuring serum diamine oxidase (DAO) activity, an index of intestinal ischemia. Serum DAO activity, blood lactate concentration, and the arterial ketone body ratio (AKBR) were measured intraoperatively in four successive patients who underwent aortic arch replacement by the open distal anastomosis method. DAO activity rose after restoration of blood flow to the lower half of the body, and continued to rise throughout CPB. The lactate concentration also rose, mirroring the change in DAO activity, and returned to nearly normal 12 h after the operation. The AKBR decreased during CPB, with a mean minimum vale of 0.16-0.07 immediately after the restoration of blood flow to the lower half of the body. The parallel rise in DAO activity and serum lactate concentration once blood flow to the lower half of the body was restored implies that ischemic injury to the mucosa of the small intestine occurs during CPB. The continued rise in these parameters throughout CPB is consistent with ongoing injury due to splanchnic hypoperfusion, as reflected in the decrease in the AKBR during the same period.