須田 康一

Background. Unilateral lung surgical insult can lead to bilateral pulmonary inflammation after transthoracic esophagectomy for esophageal cancer. An inflammatory response of the cytokine network induced by surgical stress followed by neutrophil sequestration is the major mechanism involved in these complications. We examined modulation of the inflammatory cytokine and neutrophil sequestration by preoperative steroid administration in a rat thoracotomy model. Methods. Adult male rats were subjected to right thoracotomy with pulmonary compression in the surgical stress model. In the another surgical stress model, 10 mg/kg of methylprednisolone (MP) was administered 1 h before the operation intraperitoneally, and peri-operative biological effects of steroid administration to neutrophil sequestration and cytokine-induced neutrophil chemoattractant (CINC) as an inflammatory cytokine were examined. Sham-operated animals were subjected to intubation only. Results. Surgical insult to the unilateral lung increased local CINC concentration followed by an increase in neutrophil sequestration, wet-to-dry weight ratio in bilateral lungs and systemic CINC concentration. Pre-treatment with methylprednisolone reduced CINC concentration as well as neutrophil sequestration and wet-to-dry weight ratio of both lungs. Conclusions. These data suggest that inflammatory changes induced by the unilateral operative procedure occur in both lungs through local inflammatory response. Pre-operative methylprednisolone administration down-regulates cytokine release and neutrophil sequestration, preventing lung edema, and possibly may act as a prophylactic treatment against acute lung injury caused by a so-called "second attack" theory. (c) 2006 Elsevier Inc. All rights reserved.

Background. High-mobility group box chromosomal protein 1 (HMGB1) has recently been shown to be an important late mediator of endotoxin shock, intraabdominal sepsis, and acute lung injury, and a promising therapeutic target of severe sepsis. We sought to investigate the effect of antibodies to HMGB1 on severe sepsis in a rat cecal ligation and puncture (CLP) model. Methods: Adult male Sprague-Dawley rats underwent CLP and then were randomly divided into two groups: treatment with anti-HMGB1 polyclonal antibodies, and non-immune IgG-treated controls. The serum HMGB1 concentrations were measured at ten time points (preoperatively, and postoperatively at 4, 8, 20, 32, and 48 h and at 3, 4, 5, and 6 days). Hematoxylin-eosin staining, elastica-Masson staining, and immunohistochemical staining for HMGB1 were performed on the cecum and the lung to assess pathological changes 24 h after the CLP procedure. Results: Treatment with anti-HMGB1 antibodies significantly increased survival [55% (anti-HMGB1) vs. 9% (controls); P < 0.01]. The serum HMGB1 concentrations at postoperative hours 20 and 32 of the anti-HMGB1 anti body-treated animals were significantly lower than those of the controls (P < 0.05). Treatment with anti-HMGB1 antibodies markedly diminished the pathological changes and the number of HMGB1-positive cells-in the cecum and the lung. Conclusions: The present study demonstrates that anti-HMGB1 antibodies are effective in the treatment of severe sepsis in a rat model, thereby supporting the relevance of HMGB1 eradication therapy for severe sepsis.

55歳女.1年前から続く嚥下障害を主訴に受診した.血液検査で鉄欠乏性貧血,食道造影検査で食道webを認めた.鉄剤とプロトンポンプ阻害剤の投与を行い,貧血は軽快したがwebと嚥下障害は改善しなかった.webに対して内視鏡下にバルーン拡張術を行ったところweb,嚥下障害とも軽快した

77歳男.心窩部不快感を契機に上部消化管内視鏡検査にて食道癌と中咽頭癌の同時性重複癌を認めた.静脈麻酔と咽頭麻酔を併用し,両者に対して一期的にEMRを施行した.病理組織学的には扁平上皮癌であり,脈管侵襲はなく,切除断端は陰性であった

Primary breast cancers with cartilaginous and osseous components are quite rare. We recently treated a 51-year-old woman suffering from primary breast cancer with predominant cartilaginous and osseous components, adjacent to a component of intraductal carcinoma. We discuss the management of this tumor with a review of the literature.

65歳女性.肝腫瘍の腹膜播種と考えられる未分化癌に対し手術的切除が有効であった1例を経験した.患者は2年前に肝S5に腫瘍が出現し,肝細胞癌(HCC)の診断でエタノール注入療法を行い,以後再発所見はなかった.しかし,その後,右鼠径部の有痛性腫瘤を自覚し手術を行い,その際の病理検査で転移性anaplastic carcinomaが認められた.画像では肝S5の腫瘍の増大と腹腔内の多発性実質性腫瘍がやはり認められ手術となった.術中所見では,大網に腫瘍3個と小結節10個前後を,小腸間膜にも小結節2個が認められた.そのため,S5腫瘍にmicrowaveによる凝固壊死療法を施行し,あわせて大網切除および小腸間膜の結節摘除を施行した.組織学的には大網の腫瘍は転移性のanaplastic carcinomaで,出血性中心壊死を伴い腹膜表面と連続し播種性腹膜転移と考えられた.なお,大網と小腸間膜の小結節には悪性細胞を認めなかった.術後は良好で15ヵ月経過にても再発を認めず生存中である