[Analysis of the mechanism of trophoblast infiltration].

A cytotrophoblast (CT) infiltrates into the stroma, forming an extravillous trophoblast (EVT) in the placenta early in gestation and the phenomenon is strictly controlled, differing from the infiltration of cancer cells. The expression of matrix metalloproteinase 2 (MMP2) and matrix metalloproteinase 9 (MMP9), which deeply involve infiltrative metastasis of cancer, and the reactivity to transforming growth factor beta 1 (TGF beta 1), which controls the expression of these MMPs and inhibits the growth of epithelial cells, were investigated in CT derived from villi at normal gestational week 6 (early CT) and CT derived from villi at normal gestational week 37 (full-term CT), and also the choriocarcinoma cell line BeWo (BeWo). The ability of normal epithelial cells and BeWo cells to proliferate and infiltrate were evaluated in vitro by northern blotting, gelatin zymography, and invasion assay. It was revealed that early CT had a higher capacity for infiltration than full-term CT as well as BeWo. MMP2 and MMP9 appeared in the early CT, whereas only MMP9 was observed in the full-term CT. MMP2 and MMP9 were more abundantly observed in the early CT and the full-term CT rather than in BeWo. In uterine stroma-derived cells, membrane type matrix metalloproteinase (MT-MMP), which activates MMP2, was observed. These results indicated that the motility of normal villous cells was higher in the early CT than in the full-term CT. The expression of MMP2 in the early CT, which was not observed in the full-term CT, was thought to be related to this difference in motility. As for the responsiveness to TGF beta 1, which is a growth inhibiting factor for epithelial cells, the villous carcinoma cell line was insensitive to the growth inhibiting effect of TGF beta 1, but the early CT was sensitive to this effect. When TGF beta 1 was added, MMP2 and MMP9 increased in the early CT. This response was also seen in BeWo. That is, it was assured that the growth capacity was not inhibited in BeWo, but was certainly inhibited in the early CT. The overall results of these evaluations indicated that the development to EVT by infiltration of the early CT was associated with the increase in the mobility of cells caused by MMP2 and the increase in amounts of MMP2 and MMP9 caused by TGF beta 1, and the predominant inhibitory effect of TGF beta 1 on the growth of normal epithelial cells could explain why normal epithelial cells do not grow as cancer cells do.

[Usefulness of newly developed subcutaneous one point lifting method in gynecological laparoscopic operation].

We first introduced the abdominal wall lifting method in gynecological laparoscopic operations in 1994. Now we have developed a new one-point lifting technique (Tokyo Medical College method) that enables gynecological laparoscopic operations to be performed more safely, easily and economically. 1. The TMC method provides a sufficiently spacious operative field in the same way as artificial pneumoperitoneum and can overcome the negative influence of obesity on the operative field. 2. Because the abdominal wall is lifted up by means of a single stainless steel wire passed under the skin in this method, the limitations of previous methods are completely overcome. Furthermore setting up for this method is very easy and can be completed in a short time. 3. Because the aperture for the Surgigrip made in the abdominal wall is short and has a large internal diameter, we can manipulate operative instruments freely. Especially suturing and ligation can be carried out simply and accurately. 4. We were able to continue irrigation and suction without deterioration of the operative field and to easily remove resected tissue from the abdominal cavity. 5. The frequency of intracorporeal suture and ligation in this method increased significantly compared with the pneumoperitoneum method in cases of ovarian diseases. As a result, most operative procedures in ovarian diseases became cystectomies, preserving the healthy part of the ovary. This also reduced operative cost by avoiding expensive autosuture equipment. 6. There were no complications such as subcutaneous bleeding with this method. There was no significant difference between this method and pneumoperitoneum in terms of postoperative pain. The TMC method is a new laparoscopic operative technique that allows procedures to be performed under conditions close to laparotomy procedures and solves most of the problems of the pneumoperitoneum method.

[A clinical study of advanced cases of small sized lung cancer].

Survival rates and several effective factors for the postoperative course of 10 advanced cases of small sized lung cancer (ASLC) were evaluated. Followings were considered as characteristics of these patients: 1) ASLC were observed at the rate of 4.0% of whole lung cancers, 2) ASLC were more often seen in relatively young patients, females and adeno carcinomas than ordinary lung cancer, 3) as factors concerned to postoperative prognosis, stage III A (especially T1N2M0), few numbers of metastatic lymph nodes in N2, and performance of relative curative operation may predict good prognosis, but adenosquamous type will be a sign of poor prognosis. Satisfactory result was obtained even in a case of stage IV when complete resection of metastasis was carried out. There was no significant difference of survivals between 2 cm and 3 cm of diameter of the tumor. In conclusion, above mentioned points should be considered when operative indication of ASLC is evaluated.

[Superselective bronchial arterial catheterization via a sheath catheter (SS-BAC)].

Bronchial artery infusion therapy including embolization of the artery has been widely used in the treatment of lung cancer and also for the treatment of hemoptysis due to various lung diseases. However, some serious complications such as spinal cord lesion, tracheobronchial fistula formation and so on have been documented in the literature and these complications are attributed to anatomical characteristics of the bronchial artery having a common trunk with feeding arteries to the spinal cord, esophagus and trachea. To prevent these hazardous events we attempted to infuse and embolize the proper bronchial artery with high selectivity by using catheter-in-catheter technique. A Cook green catheter, 7.2 Fr. size, was wedged in the intercostobronchial trunk artery by a Seldinger technique and then a small catheter, 3.0 Fr. size, was passes through the former catheter to the proper bronchial artery beyond the orifices of other feeding arteries. In 26 out of 30 patients who underwent this procedure we successfully performed this superselective bronchial artery catheterization and the 26 patients consisted of 15 patients with lung cancer and one with metastatic lung tumor who were treated with bronchial artery infusion therapy and ten with various lung diseases who were treated with bronchial artery embolization because of hemoptysis. Bronchial artery infusion therapy including embolization has gained higher safety and effectiveness by means of this superselective catheterization.

Diagnosis of a case of pulmonary carcinosarcoma by detection of rhabdomyosarcoma cells in sputum.

Cytologic examination of sputum samples from an elderly patient revealed the presence of two cell populations: squamous cell carcinoma cells and rhabdomyosarcoma cells. The abnormal squamous cells showed both keratinizing and nonkeratinizing forms while some of the rhabdomyosarcoma cells showed cross striations. Sputum cytology was thus able to suggest a diagnosis of pulmonary carcinosarcoma. Histologically, the tumor was composed mainly of sarcomatous tissue showing various kinds of cells: fusiform or fibrous cells, round anaplastic cells, spindled cells with typical cross striations and myoblastic cells. A partially myxomatous degeneration was present. In addition, squamous cell carcinoma proliferated along the bronchi and formed small invasive cell nests in the sarcomatous tissue. No transition between the two components was noted. Both cellular constituents had metastasized to an interlobar lymph node.