<strong>June</strong> 20<strong>09</strong>KUWAIT MEDICAL JOURNAL 111endoscopic stapling. Many surgical techniques havebeen described for resecting the bullae. One wayis wedge resection using an endoscopic stapler [3,14] .Other methods, such as endoscopic stapling devicethat does not excise the bulla [9] , electrocoagulation,laser coagulation of bulla, or a combination of differentmethods, are favored by different authors [8,14] . Ogawaet al and colleagues have devised a method of sprayingthe staple line with aerosolized fibrin glue to seal theair leak sites [15] .Our long term recurrence rate is three out of 46patients (6.5%). All these recurrences occurred withinsix months after the intervention and two required are-operation. One reason for recurrence is failure torecognize the site of the leak in the absence of bullousdisease. Unrecognized bullae or inadequate resectionof the diseased portion of the lung may also contribute.Another factor is inadequate pleurodesis, especially inbetween the trocar sites. These failures suggest thatgauze pleural abrasion is probably less effective thanapical pleurectomy. Like Tanaka et al, we found that therecurrences were more frequent in patients in whommultiple bullous disease was identified [5] . It is for suchpatients for that apical pleurectomy may be indicated,and this will probably provide more pleural adhesionwith a decreased subsequent recurrence rate. It is nottime-consuming, difficult to achieve or a source ofpostoperative bleeding as others have suggested, andis, therefore, preferred to pleural abrasion which hasbeen associated with a higher recurrence rate [16] . Ourrecurrence rate is comparable to that reported in theliterature after thoracoscopy, which varies from fourto 8.6% [11,12,17] .CONCLUSIONSVATS procedure can be done safely in the treatmentof selected group of patients with secondary SP whoare in good general condition. The procedure is welltolerated and allows early discharge usually within fivedays. It is now our procedure of choice and has becomethe routine approach for the treatment of bullousdisease of the lung. Because of its less invasiveness,reduced morbidity and shortened postoperative stay,we tended to intervene slightly earlier in patientswith persistent air leaks and even during the firstepisode of pneumothorax. VATS wedge excision andapical pleurectomy represent a satisfactory treatmentmodality in patients with bullous emphysema andsecondary SP.REFERENCES1. Parry GW, Juniper ME, Dussek JE. Surgicalintervention in spontaneous pneumothorax. RespMed 1992; 86:1-2.2. Mouroux J, Elkaim D, Padovani B, et al. Video-assistedthoracoscopic treatment of spontaneous pneumothorax:technique and results of one hundred cases. J ThoracCardiovasc Surg 1996; 112:385-391.3. Ayed AK, Al-Din HJ. The results of thoracoscopicsurgery for primary spontaneous pneumothorax.Chest 2000; 118:235-238.4. Yim AP, Ng CS. Thoracoscopy in the managementof pneumothorax. Curr Opin Pulm Med 2001; 7:210-214.5. Tanaka F, Itoh M, Esaki H, Isobe J, Ueno Y, Inoue R.Secondary spontaneous pneumothorax. Ann ThoracSurg 1993; 55:372-376.6. Waller DA, Forty J, Morritt GN. Video-assistedthoracoscopic surgery versus thoracotomy forspontaneous pneumothorax. Ann Thorac Surg 1994;58:372-376.7. Bertrand PC, Regnard JF, Spaggiari L, et al. Immediateand long-term results after surgical treatment ofprimary spontaneous pneumothorax by VATS. AnnThorac Surg 1996; 61:16<strong>41</strong>-1645.8. Liu HP, Lin PJ, Hsieh MJ, Chang JP, Chang CH.Thoracoscopic surgery as a routine procedure forspontaneous pneumothorax: Results from 82 patients.Chest 1995; 107:559-562.9. Waller DA, Forty J, Soni AK, Conacher ID, MorrittGN. Videothoracoscopic operation for secondaryspontaneous pneumothorax. Ann Thorac Surg 1994;57:1612-1615.10. Passlick B, Born C, Haussinger K, Thetter O. Efficiencyof video-assisted thoracic surgery for primary andsecondary spontaneous pneumothorax. Ann ThoracSurg 1998; 65:324-327.11. Waller DA. Video-assisted thoracoscopic surgeryfor spontaneous pneumothorax- a 7-year learningexperience. Ann R Coll Surg Engl 1999; 81:387-392.12. Andres B, Lujan J, Robles R, Aguilar J, Flores B, ParrillaP. Treatment of primary and secondary spontaneouspneumothorax using videothoracoscopy. SurgLaparosc Endosc 1998; 8:108-112.13. Menconi GF, Melfi FM, Mussi A, Palla A, AmbrogiMC, Angeletti CA. Treatment by VATS of giantbullous emphysema: results. Eur J Cardiothorac Surg1998;13:66-70.14. Inderbitzi RG, Leiser A, Furrer M, Althaus U. Threeyears’ experience in video-assisted thoracic surgery(VATS) for spontaneous pneumothorax. J ThoracCardiovasc Surg 1994; 107:1<strong>41</strong>0-1<strong>41</strong>5.15. Ogawa J, Inoue H, Koide S, Shohtsu A. Newlydevised instrument for spraying aerosolized fibringlue in thoracoscopic operations. Ann Thorac Surg1993; 55:1595-1596.16. Berrisford RG, Page RD. Video assisted thoracicsurgery for spontaneous pneumothorax. Thorax 1996;51:S 23-28.17. Hatz RA, Kaps MF, Meimarakis G, Loehe F, MullerC, Furst H. Long-term results after video-assistedthoracoscopic surgery for first-time and recurrentspontaneous pneumothorax. Ann Thorac Surg 2000;70:253-257.
112KUWAIT MEDICAL JOURNAL <strong>June</strong> 20<strong>09</strong>Original ArticleExpression of NC-2 Receptor on MCL Cells and ItsNatural Cytotoxicity Against Cancer CellsHedayatollah Shirzad, Behnam Zamanzad, Ghorbanali ShahabiDepartment of Microbiology and Immunology, Cellular and Molecular Research Center, Shahrekord University ofMedical Sciences, Shahrekord, IranABSTRACTKuwait Medical Journal 20<strong>09</strong>; <strong>41</strong> (2): 112-116Objectives: To identify the expression of NC-2 onan interleukin-3 dependent mast cell line (MCL) andinvestigate the activity of this receptor against tumorcellsDesign: Laboratory studySetting: Cellular and Molecular Center, Shahrekord, IranSubjects and Methods: The MCL cells were stained withD9 monoclonal antibody (anti-NC-2) and analysed by flowcytometry. This was confirmed by immunoperoxidasestaining. The cytotoxicity assay was performed to showthe cytotoxic activity of MCL cells against 51Cr-labelledWEHI-164 tumor cells.Intervention: The expression of NC-2 on MCL cells, andthe anti-tumor activity of this receptor were investigated.Main Outcome Measure(s): Flow cytometric analysisand in vitro experiments were performed for showing theactivity of NC-2 against cancer.Results: NC-2 receptor was expressed on more than95% of MCL cells. Pretreatment with D9 monoclonalantibody resulted in about 63% reduction in naturalcytotoxicity of MCL cells against WEHI-164 tumortarget cells.Conclusions: NC-2 is also one of the receptors expressedon MCL and utilized for WEHI-164 tumor cell killing.KEY WORDS: monoclonal antibody, natural cytotoxicity, receptor, tumorINTRODUCTIONNatural cell-mediated cytotoxicity (NCMC) isa major component of innate cellular immunityagainst cancer and infection. NCMC is mediatedprimarily by leucocytes which perform naturalkilling (NK) and natural cytotoxicity (NC) withoutthe requirement for prior sensitization and there isno immunological memory associated with this typeof responses. This mechanism is characteristicallyand functionally different from the cell-mediatedcytotoxicity of cytotoxic T lymphocytes. Cellsmediating NK and NC are two distinct andprobably related NCMC effector mechanismswhich are distinguishable from each other by thetime differences required to mediate their killing, aswell as the kinetics of their appearance and declinein mice [1-3] .Natural killer (NK) cells belong to an importantlymphocyte population that eliminates transformedcells and invading viral pathogens without any priorsensitization. These cells possess not only naturalkilling activity against non-self and altered-self cellsbut also exhibit cytokine production and antibodydependentcell-mediated cytotoxicity (ADCC) [4] .It has been shown that NK cells might not servemerely as cytotoxic lymphocytes combating viralpathogens and malignant tumors, but must also beconsidered as important immunoregulatory cellswith a significant influence on adaptive immunity [5] .The effector’s functions of NK cells are regulated byintegrated signals across the array of stimulatoryand inhibitory receptors engaged upon interactionwith target cell surface ligands [6] . Intensive researchduring the 1990s has defined a large number ofactivating and inhibitory receptors [7-9] . NK cellsare heterogeneous in their receptor repertoire,in the sense that different cells express differentcombinations of activating and inhibitory receptors.In addition, a functional heterogeneity is emerging,at least in the human. The majority of blood NK cellsexpress moderate levels of CD56 in combination withvarious molecules of killer cell immunoglobulinreceptor (KIR) family [10] . In addition, there is a smallsubpopulation of blood NK cells that express highlevels of CD56 in combination with the inhibitoryreceptor NKG2A, and no receptors of the KIR family.This subset has low perforin levels and seems to bespecialized for high cytokine secretion rather thanAddress correspondence to:Dr Behnam Zamanzad, MD, PhD, Departement of Microbiology and Immunology, Shahrekord University of Medical Sciences, Shahrekord, Iran.Fax: +98-381-333491, E-mail: Bzamanzad@yahoo.com