[A case of mediastinal esophago-bronchogenic cyst associated with high serum level of CA 19-9].

We report a case of mediastinal esophago-bronchogenic cyst in a patient with a high serum level of CA 19-9. A 49-year-old man presented with a complaint of dysphagia. Chest X-ray, CT, and MRI showed posterior mediastinal cystic shadow which was diagnosed preoperatively. The serum level of CA 19-9 was 158 U/ml. We underwent extirpation of the cyst through video-assisted thoracoscopic surgery (VATS) and confirmed to be a bronchogenic cyst histologically. The serum level of CA 19-9 returned to normal after the operation.

Critical contribution of OX40 ligand to T helper cell type 2 differentiation in experimental leishmaniasis.

Infection of inbred mouse strains with Leishmania major is a well characterized model for analysis of T helper (Th)1 and Th2 cell development in vivo. In this study, to address the role of costimulatory molecules CD27, CD30, 4-1BB, and OX40, which belong to the tumor necrosis factor receptor superfamily, in the development of Th1 and Th2 cells in vivo, we administered monoclonal antibody (mAb) against their ligands, CD70, CD30 ligand (L), 4-1BBL, and OX40L, to mice infected with L. major. Whereas anti-CD70, anti-CD30L, and anti-4-1BBL mAb exhibited no effect in either susceptible BALB/c or resistant C57BL/6 mice, the administration of anti-OX40L mAb abrogated progressive disease in BALB/c mice. Flow cytometric analysis indicated that OX40 was expressed on CD4(+) T cells and OX40L was expressed on CD11c(+) dendritic cells in the popliteal lymph nodes of L. major-infected BALB/c mice. In vitro stimulation of these CD4(+) T cells showed that anti-OX40L mAb treatment resulted in substantially reduced production of Th2 cytokines. Moreover, this change in cytokine levels was associated with reduced levels of anti-L. major immunoglobulin (Ig)G1 and serum IgE. These results indicate that anti-OX40L mAb abrogated progressive leishmaniasis in BALB/c mice by suppressing the development of Th2 responses, substantiating a critical role of OX40-OX40L interaction in Th2 development in vivo.

[Prospective study on evaluation of the ischemic heart disease for preoperative patients with lung cancer].

One hundred twenty-four patients with lung cancer undergoing operation in our hospital were prospectively studied on evaluation of the ischemic heart disease before operation. They performed master double electrocardiogram and exercised T1 scintigram before operation. The patient with positive master double electrocardiogram and/or exercised T1 scintigram was taken into high risk group. All patients in high risk group performed coronary angiography. This high risk group consisted of 37 patients (29.8%), including 6 single vessel disease (4.8%), 2 double vessel disease (1.6%), and 1 triple vessel disease (0.8%). Preoperative revascularization was done 8 patients (6.5%). These revascularization patients had uneventful course during and after lung operation. However 2 cases of vasospastic angina (VSA) occurred in non-risk group during operation. It was impossible to anticipate VSA before lung operation in our series. Therefore our preoperative evaluation and care of organic ischemic heart disease was effective in preventing cardiac complications.

[A case of synchronous resection of double cancers in the lung and stomach through median sternotomy and abdominal incision].

A 72-year-old male was admitted to our clinic for the treatment of early stomach cancer. A chest X-ray film on admission showed a mass in the right lung field. CT scan and transbronchoscopic lung biopsy revealed lung cancer (C-T2N2M0-stage IIIA). Histologically it was poorly differentiated adenocarcinoma, which was different from stomach cancer. We underwent synchronous resection of this double cancer through median sternotomy and abdominal incision. We conducted lobectomy, bilateral mediastinal lymph node dissection, and wedge resection of stomach. Postoperative diagnosis was early lung cancer (p-T2N0M0-stage I) and advanced stomach cancer (A-IIc+IIa advanced t2 (mp) n1H0P0M0-stage II). Postoperative course was stable and the patient was healthy at present. As such, this case report suggests that synchronous double cancers involving the lung and stomach, if both cancer are early stage, should be resected synchronously.

Co-deletions of the retinoblastoma gene and Wilms' tumor gene and rearrangement of the Krev-1 gene in a human insulinoma.

We found deletions of both alleles of the retinoblastoma gene (Rb) and the candidate Wilms' tumor gene (WT33) in a surgically resected human insulinoma by blot hybridization. Rearrangement of Krev-1, a transformation suppressor gene, was also detected in this case. The clinical and histological findings suggested that this tumor would be a benign insulinoma. The result suggests that the inactivation of multiple tumor suppressor genes could be involved even in the development of benign human tumors.

Deletions and rearrangements of the retinoblastoma gene in hepatocellular carcinoma, insulinoma and some neurogenic tumors as found in a study of 121 tumors.

The retinoblastoma gene (Rb) is one of the tumor suppressor genes to have already been cloned. Deletions and inactivations of the gene have been widely observed in various types of human tumor. To study the generality of Rb alteration in human tumors, 121 cases of tumor DNAs were examined for abnormalities in the gene structure by blot hybridization. Deletions of both alleles were detected in hepatocellular carcinoma, insulinoma and neuroblastoma. Rearrangements and allelic deletions of the Rb gene were, moreover, observed in some brain tumors and hepatocellular carcinomas, respectively. All were surgically resected tumors. The observations suggest the inactivation of Rb through structural alterations sometimes to correlated with the development or progression of these types of human tumor.