Dissection with double arch.
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Biomedical subjects
Publications and source records attributed to A Katsura.
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A 72-year-old woman was admitted for cough and dyspnea. Bronchofiberscopy examination revealed lung cancer at the right main bronchus. Plain chest X-ray and chest CT revealed that the tumor had invaded to the mediastinum and esophagography demonstrated stenosis of the thoracic esophagus without fistula. Because pulmonary resection was contraindicated, chemotherapy for lung cancer was initiated. Complete response was noted, but an esophago-pleural fistula developed as a consequence of chemotherapy. After intrathoracic tube drainage, a permanent endoesophageal tube was inserted through a small incision in the stomach under general anesthesia. However, it migrated into the thoracic empyema after 4-postoperative days. Because the lung cancer was well-controlled, a second operation to reconstruct the esophagus was performed without resection of the thoracic esophagus or fistula. After the operation, thoracic empyema was washed out with povidone iodine and pure alcohol. The chest tube was removed 3 months after the second operation. We conclude that in cases of esophago-pleural fistula caused by chemotherapy for lung cancer, if complete response to chemotherapy is noted, reconstruction of the esophagus should be considered.
Stage-specific embryonic antigen-1 (SLX) is a glycolipid recognized by a monoclonal antibody (FH 6) which is produced by cells immunized with mice teratocarcinoma cell line. Using an SLX (Otsuka) kit from Ostuka Assay Laboratory, we measured the serum level of SLX in 96 patients with lung cancer, 305 patients with non-cancerous lung disease and 86 healthy adults, prospectively. When we adopted a cutoff level of 42U/ml (mean + 2S.D. in the healthy adults), the overall positive rates were 29.2% in the lung cancer patients, 15.1% in the non-cancerous patients and 0% in the healthy adults. The positive rate of the lung cancer patients was significantly higher than in the patients with non-cancerous lung disease (p less than 0.05). According to the histological type of lung cancer, the positive rates were 40.9% in 44 patients with adenocarcinoma, 18.4% in 37 patients with squamous cell carcinoma, 0% in 7 patients with small cell carcinoma, and 0% in 3 patients with large cell carcinoma. Staging of the lung cancer patients revealed positive rates for serum SLX of 5.6% in 18 stage I patients, 22.2% in 9 stage II patients, 33.3% in 21 stage IIIA patients, 33.3% in 27 stage IIIB patients, 42.9% in 21 stage IV patients. After we performed the immunostaining method for SLX using FH6, positive immunoactivity was demonstrated mainly in the cell membrane of adenocarcinoma cells. SLX seems to be a tumor-associated marker in patients with lung adenocarcinoma.
Fluconazole, a novel triazole antifungal agent, was given orally or intravenously to 10 patients with pulmonary mycosis (7 patients with primary pulmonary cryptococcosis and 3 with pulmonary aspergillosis). Routes of administration were changed in some patients depending on their condition. Two patients from whom foci was removed by surgical operations were excluded from the efficacy assessment. Clinical efficacies in the remaining 8 patients were good in 2 cases and fair in 3 cases of pulmonary cryptococcosis; excellent in 1 case of pneumonia due to Aspergillus; and fair in 1 case and poor in the other case of pulmonary aspergilloma. Side reactions developed in 9 patients who received intravenous drip infusion were nausea or loss of appetite in 3 patients, fever and/or feverish sensation in 3, vascular pain in 1 and diarrhea and eruption in 1. In the patient who reported fever the drug was discontinued and in the patient who complained of pain at the site of injection, dosing was changed to the oral route but was discontinued due to elevated GOT, GPT, Al-P and gamma-GTP. Seven patients who received the drug orally did not report side effects except 2 patients. None of these side effects reported was serious and from the above results, fluconazole was considered to be a useful agent for the treatment of pulmonary mycosis.
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A 34-year-old man was admitted to our hospital because of a tumor shadow in the posterior mediastinum. Leiomyoma of the esophagus was suggested by the findings of CT, esophagography, and esophagoscopy. He underwent thoracotomy. The operative procedure was enucleation of the tumor. The histological examination confirmed it to be a leiomyoma. The postoperative course was uneventful, and the passage of the esophagus was good. He was discharged 36 days after the operation.
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