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Biomedical subjects

E Tsuboi

Publications and source records attributed to E Tsuboi.

At least 19 recordsLinked to original sources
PubMed1995

Bronchoscopic findings of extramural lung cancer invading the subepithelium or submucosa.

Bronchoscopic findings from the main to segmental bronchi were compared with the histopathological findings in 185 resected cases of lung cancer, in order to determine which bronchoscopic features are associated with lung cancer invading the subepithelium or submucosa from beyond the bronchial wall. Carcinoma invaded the subepithelium or submucosa from beyond the bronchial wall in 43 cases (22.9%) out of the total of 185 cases. Bronchoscopic findings were evaluated in these 43 cases, and were summarized as follows: (1) The bronchoscopic findings in cases of subepithelial invasion consisted of vascular engorgement, bleeding, subepithelial tumor, and emphasized longitudinal relief; (2) irregularity of the mucosa was observed in cases of epithelial or muscular invasion; (3) indistinct bronchial cartilage was observed in cases of invasion proximal to the extramuscular layer; (4) accentuated irregular folds were observed in cases of invasion of the extramuscular or cartilage layers; and (5) edema and redness were not specific for malignancy. In addition, the occurrence of mediastinal lymph node metastasis was higher in cases of invasion to main or lobar bronchi. This result indicates that recognition of invasion of the subepithelium or submucosa of the central bronchus may be helpful in indicating the probability of mediastinal lymph node metastasis. Accordingly, there may be specific bronchoscopic findings which correlate with invasion of the bronchial subepithelium or submucosa. Accurate recognition of these findings may be useful in determining appropriate biopsy sites and may provide more information concerning selection of therapeutic strategy.

Bronchoscopy↗
PubMed1994

[The duty of hospice for holistic medicine].

The hospice program has a sense of absolute in the context of the provision of treatment by the medical establishment. The aim of the medical establishment is humanistic treatment. The aim of the hospice program is to allow doctors in charge, thru their medical skills, to make the most effort for the life of the patient. As such, the goal of the hospice program is not just to ease the physical pain of terminal patients, but rather to help the patient live the remainder of his or her life in a meaningful way, offering intensive support and energy to help the patient challenge and even defy his or her life. Today in Japan, the hospice care program has established a system of renumeration for use of special cancer wards and pain-easing treatments. Because of this, hospice care is becoming wide-spread among medical care organizations. Such wide-spread care is a very desirable thing. But if the economic value of hospice care is only to ease physical pain, then hospice care is essentially a formless act. If we do not effect the appropriate value both socially and economically, one wonders if the hospice care in Japan will be able to develop the correct approach.

Holistic Health↗
PubMed1992

[A case of Legionella pneumonia with myelodysplastic syndrome].

A 40-year-old man was admitted with high fever and cough. Pneumonic shadows of the left middle and lower lung fields increased rapidly, and his blood gases worsened. Initial treatment with cefmenoxime, piperacillin, and minocycline was ineffective. Administration of rifampicin was started for suspected legionella pneumonia, but it did not control the spread of the pneumonia shadows. After addition of an antifungal agent and trimethoprim-sulfamethoxazole, his symptoms gradually improved. Isolation of Legionella pneumophila from sputum specimens collected on the 4th day of admission confirmed the diagnosis on day 10. The patient was then given oral rifampicin plus cefmenoxime to prevent mixed infection, and showed a satisfactory improvement. Legionella pneumonia developed secondary to compromise of the patient's immunity due to steroid therapy for MDS. After recovering from Legionella pneumonia, the patient subsequently developed tuberculous pleurisy and Pneumocystis carinii pneumonia, which were cured by antituberculous therapy and trimethoprim-sulfamethoxazole. However, acute hepatitis followed by hepatic failure developed, and he died on day 121 after admission.

Adult↗
PubMed1992

[A case of hepatic hydrothorax treated by pleuro-venous shunt].

We reported a successful pleuro-venous shunt operation (Pl-V shunt) for a patient of liver cirrhosis with secondary hydrothorax. A 78-year-old female was admitted to our hospital because of severe dyspnea and palpitation. Chest x-ray film revealed right sided massive pleural effusion. Over several weeks the chest tube drainaged about 1,500 ml of transudative fluid per day. We performed Pl-V shunting and pleural effusion subsequently decreased in amount and dyspnea disappeared. This Pl-V shunting is thought to be useful for such a patient with massive pleural effusion which failed to respond to medical therapy.

Aged↗
PubMed1992

[A successfully treated case of empyema with a large tracheal fistula after a radical operation of esophageal cancer by fixation and plombage with major pectoral muscle flap].

We reported a successfully treated case of empyema with a large tracheal fistula which had developed after a radical operation of esophageal cancer (reconstructed with stomach). This 59-year-old male was treated by the method of fixation and plombage with major pectoral muscle flap and thoracoplasty, because we could not use the omentum that were frequently used nowadays for closure of the fistula. The size of the tracheal fistula was a large as the main bronchus bronchoscopically. Postoperative care were the following, the endotracheal tube was inserted from the tracheal stoma to the left main bronchus and 9 days left hemi-ventilation was performed. Continuous suction was performed at the same time from the right main bronchus in order to prevent secretion and blood pour into the left lung. Bronchoscopical examination done 28 postoperative day, the small fistula remained the tip of the muscle flap. But 72 postoperative day, the surface of the fixed muscle flap was replaced by normal bronchial mucomembrane and tracheal fistula was obliterated. Major pectoral muscle could be used as local flap to obliterate empyema cavity associated with tracheal fistula. We believe that utilizing an muscle flap for those who had undergone abdominal operation like our case is a valuable method.

Empyema↗
PubMed1992

[Sputum penetration of levofloxacin and its clinical efficacy in patients with chronic lower respiratory tract infections].

Sputum penetration of levofloxacin (LVFX) was evaluated after a single oral dose of 100 mg or 200 mg to 4 patients with copious purulent sputa. The sputum concentration of LVFX reached maximum levels of 1.27 and 4.36 micrograms/ml at 4 hours, and still remained at concentrations of 0.32 and 1.68 micrograms/ml at 8 hours after administration of 100 mg and 200 mg, respectively. The AUC ratio of sputum/serum was 0.9-1.0, indicating good sputum penetration of LVFX in these patients. The clinical efficacy and the safety of LVFX were also evaluated in a total of 13 patients with respiratory tract infections associated with bronchiectasis, diffuse panbronchiolitis, etc. LVFX was administered orally at a daily dose of 200 mg once a day, 100 mg t.i.d. or 200 mg t.i.d. for 7-28 days (mean 14.7 days). The clinical response to the drug was rated as excellent in 1 case, good in 5, fair in 3, and poor in 2 cases in 11 evaluable cases, thus the efficacy rate was 54.5%. All the 3 strains of Haemophilus influenzae were eradicated. Of the 3 strains of Pseudomonas aeruginosa, eradication, decrease, and unchange was observed for 1 strain each. One strain of Streptococcus pneumoniae remained unchanged. No adverse reaction was observed except for 1 case with slight and temporary increase of eosinophils. The above results suggested that LVFX would be clinically useful in the treatment of chronic lower respiratory tract infections.

Aged↗
PubMed1990

[Usefulness of the percutaneous marking method with a coil (PMMC) for the localization of small pulmonary nodules].

We surgeons have always encountered difficulty in localizing small pulmonary nodules, measuring less than 5 mm in diameter, through palpation during operation. In order to solve such a problem, we devised a new method of localizing small pulmonary nodules by applying a technique of CT-guided needle biopsy; namely, metallic spring coil is implanted through a 16 G eraster needle, the tip of which has been placed near the lesion. Our method not only secures the resection of entire lesions, but reduces an amount of lung resection through a small incision (mini-thoracotomy) as well. Furthermore, this method is also thought to be useful for open lung biopsy of pulmonary nodules, measuring less than 1 cm in diameter, in saving time and reducing an amount of lung tissue collection. In case of cystic lesion which is thought to be difficult to palpate on operation, this method can also be useful for its resection.

Adult↗
PubMed1990

[A case report of pleural involvement in primary macroglobulinemia].

A case of primary macroglobulinemia with pleural and gastric involvement was presented. A 48-year-old female was admitted with productive cough. On physical examination neither lymphoadenopathy nor hepatosplenomegaly were found. In addition, no bleeding tendency nor disturbance of the visual acuity were detected. Her chest roentgenogram showed a moderate amount of pleural effusion in the left pleural cavity without infiltration in the lung fields and no evidence of swollen hilar or mediastinal lymphnodes. A monoclonal M-band of to IgM-kappa type was observed in her serum and the pleural effusion. The diffuse ulcerative lesion in the gastric mucosa was detected by gastrofiberscopy. The lymphoid cells taken from the pleural effusion and the gastric mucosa stained positively with fluorescein-conjugated antiserum to u or the kappa chain. Pleural effusion and gastric infiltration of lymphoid cells improved remarkably following ACOP therapy.

Female↗
PubMed1989

Effects of sodium thiosulfate in combination therapy of cis-dichlorodiammineplatinum and vindesine.

The effects of sodium thiosulfate (STS) were studied in patients who received a combination therapy of cis-dichlorodiammineplatinum (CDDP) and vindesine. In this study, 61 patients with non-small-cell lung carcinoma were randomized to receive either CDDP and vindesine (both given i.v.) with i.v. STS [30 patients, STS(+) group] or CDDP and vindesine without STS [31 patients, STS(-) group]. In the STS(+) group, 16 patients who showed an improvement (reduction in tumor size or relief of symptoms) after the first course received the second STS(+) treatment, and 15 patients in the STS(-) group who showed an improvement after the first course received the second STS(-) treatment. Urinary levels of beta 2-microglobulin (BMG) and N-acetyl-beta-D-glucosaminidase (NAG) were measured as an index of proximal tubular function. Analysis of both levels indicated that STS suppressed CDDP nephrotoxicity to a minimal level. Serum BMG, blood urea nitrogen (BUN), and total as well as 24-h creatinine clearance levels were measured as an index of glomerular function. There were no significant differences in these levels between the STS(+) and STS(-) groups. The urinary recoveries of total platinum 24 h after CDDP administration were 29% and 21% in the STS(+) and STS(-) groups, respectively. The mean plasma concentrations of total platinum at 24 h after CDDP administration were 2.24 and 2.70 micrograms/ml in the STS(+) and STS(-) groups, respectively. There were no significant differences in the response rates of the STS(+) and STS(-) groups at a fixed dose of 100 mg/m2 CDDP. Therefore, the present study clearly demonstrates that systemic administration of STS reduces the side effects of CDDP to a minimal level without impairing its antitumor activity and that STS treatment is applicable in a repeated chemotherapy using CDDP alone or in combination with other antitumor agents.

Adenocarcinoma↗
PubMed1989

[A randomized phase II study of (2''R)-4'-0-tetrahydropyranyladriamycin and adriamycin in combination with vincristine and ACNU in small cell lung cancer--THP-ADM, VCR, ACNU vs ADM, VCR, ACNU].

Between April 1984 and March 1988, a comparative randomized phase II study was performed to compare the effects of (2''R)-4'-0-Tetrahydropyranyl-adriamycin (THP) and adriamycin in combination with vincristine (VCR) and ACNU in 60 previously untreated and evaluable patients with small cell lung cancer (SCLC). Arm AVA was constituted by adriamycin, VCR and ACNU, and arm TAVA by THP, VCR, ACNU. Of the 30 patients treated with AVA, there were 20 partial responses, 7 with no change and 3 with progressive disease, for an overall response rate of 66.7%. On the other hand, of the 30 patients on TAVA, one complete response and 22 partial responses were observed, for an overall response rate of 76.7% Median survival time of AVA was 10.0 M, that, of TAVA was 9.3 M. But significant differences between the two arms was not found. During induction therapy, leukopenia was the main side effect. Over WHO Grade 3 leukopenia was seen in 53.3% of patients on AVA and 70.0% of those on TAVA. Moderate hair loss (Grade 2) was significantly less frequent with TAVA than AVA. In conclusion, the results indicated that THP is active in SCLC with the same level of adriamycin, and has less toxicity. THP is a suitable drug as a first line combination chemotherapy for SCLC.

Adult↗
PubMed1989

[Successful treatment with continuous intravenous theophylline therapy at home for a patient with problems of oral theophylline absorption].

A 56-year-old male with non-atopic bronchial asthma was admitted to our hospital due to status asthmaticus. His asthma attacks could not be controlled by oral and/or inhalation therapy, but only by intravenous theophylline therapy with corticosteroid. A theophylline absorption test was performed on him after over night fasting. 500 mg of theophylline was administered. The maximum serum theophylline concentration was only 4.0 micrograms/ml at 30 minutes and the urinary one was 13.0 micrograms/ml at 360 minutes after starting the test. The threshold level of absorption from the intestinal tract was higher than the usual level in this patient. We conclude that among patients with intractable bronchial asthma there may be some who have problems with orally administered theophylline. Continuous theophylline therapy at home is recommended for such intractable asthmatics.

Administration, Oral↗
PubMed1989

[The use of an omental pedicle flap in the closure of a wide bronchial fistula after pneumonectomy: a case report].

A 52-years-old man with pulmonary hypofunction had a squamous cell lung carcinoma and underwent the right upper lobectomy. Bronchial fistula with lung abscess developed on the 6th post-operative day. So, the right middle and lower lobectomy (completion pneumonectomy) were done. But, bronchial fistula again appeared at the time of weaning from respirator. It increased in size to about 4.0 x 2.0 cm. Then, transposition of an omental pedicle flap for closure on a wide bronchial fistula, and muscular plombage and thoracoplasty for semifilling up a secondary empyema cavity were performed. On bronchoscopy performed 14 days after operation, the fistula was completely closed, and the transposed omentum did not project into the trachea. We accomplished our first aim to close the wide bronchial fistula with omentum. However, he died 59 days after the 3rd operation because we failed to control infection of the remaining empyema cavity of about 100 ml. The management of an empyema cavity remains to be a difficult therapeutic problem.

Bronchial Fistula↗
PubMed1987

[Randomized comparison of continuous and intermittent oral administration of 5'-deoxy-5-fluorouridine in the treatment of advanced gastric cancer; a phase II trial by the Multi-institutional Cooperative Study Group].

To investigate the optimal dosage schedule for 5'-deoxy-5-fluorouridine (5'-DFUR), a randomized comparative study was performed in patients with inoperable or advanced gastric cancer. Eight hundred mg/m2/day of 5'-DFUR was administered in the continuous administration group, while in the intermittent administration group 1,400 mg/m2/day was given for 4 days followed by 3 days with no medication in a one-week cycle, making the total dose 5,600 mg/m2/week in both regimens. In both groups, 5'-DFUR was administered for more than 4 weeks. Overall response rate was 14.3% (3/21) for both administration methods. The response rate for the primary site was 9.5% (2/21) in the continuous administration group, and 14.3% (3/21) in the intermittent group. As to toxicity, the incidence of diarrhea was 26.7% in the continuous group and 4.2% in the intermittent group. Although there was no significant difference between these two dosage schedules in efficacy and toxicity, the lower incidence of diarrhea suggested the clinical usefulness of the intermittent administration method. This result emphasized the need to further studies to investigate the most appropriate dosage schedule for fluorinated pyrimidine derivatives.

Administration, Oral↗
PubMed1987

[Serum NSE (neuron-specific enolase) levels in small cell lung cancer, with special reference to the measurement of serial serum NSE levels].

Serum neuron-specific enolase (NSE) was measured in 105 patients with lung cancer without prior therapy. Increasing serum levels of NSE were observed in 84% of cases of small cell lung cancer (SCLC). 11% of adenocarcinomas, 18.5% of squamous cell carcinomas and 37.5% of large cell carcinomas. Serum NSE levels changed in parallel with the effect of initial treatment. Although two of 5 patients with SCLC, in whom serial NSE levels were measured after treatment, showed elevation of serum NSE levels before clinical relapse, elevated serum NSE levels were not observed in 3 patients at clinical relapse. These data seem to suggest that measurement of serial NSE is useful for predicting relapse prior to clinical recognition. However, it still remains an important point to carry out clinical general surveillance for relapse.

Adult↗
PubMed1987

[Combination effects of cis-dichlorodiammineplatinum (II) and sodium thiosulfate on renal dysfunction].

Forty-five patients with lung carcinoma were randomized to receive CDDP alone (STS (-) group) or combination of sodium thiosulfate (STS (+) group). Among the 45 patients, 42 had primary lung carcinoma and four had metastatic lung carcinoma. The combination of CDDP and STS infusion was performed in twenty-three patients and CDDP alone in 22 patients. The patients given STS were evaluated for renal function and pharmacokinetics. Urinary excretion of beta 2 microglobulin (BMG) and urinary concentration of N-acetyl-beta-D-glucosaminide (NAG), which reflect the function of the proximal tubules, were almost normal in the STS (+) group, but abnormally high in the STS (-) group. For serum BMG, BUN, creatinine, and 24-h creatinine clearance, which reflect glomerular function, no significant differences were found between the two groups. Urinary platinum excretion over 24 h was 29% in the STS (+) group and 21% in the STS (-) group. Total concentration of serum platinum after 24-h administration of CDDP was 2.1 micrograms/ml in the STS (+) group and 2.4 micrograms/ml in the STS (-) group. This study indicated that the combination of CDDP and STS promotes urinary excretion of CDDP, and rescues the dysfunction of the proximal tubules.

Blood Urea Nitrogen↗
PubMed1986

Multiple sclerosing hemangiomas of the lung.

A case of multiple "sclerosing hemangiomas" of the lung is reported. A 48-year-old housewife had several coin lesions in the right lower lung field, which were detected in a mass survey examination. There were no definite symptoms or signs except for hemoptysis. The resected right lower lobe of the lung contained innumerable lesions varying in size from microscopic to 3.7 cm in diameter, all of which were diagnosed as "sclerosing hemangioma." Although larger nodules revealed hemorrhagic, solid, papillary, and sclerotic features, smaller lesions, particularly minute ones, tended to be composed only of epithelial cells arranged in papillary patterns and so-called pale cells in solid areas, both of which are suggested to be main components of sclerosing hemangioma. Some lesions were associated with tumorlet or adenomatous hyperplasia (or adenoma) probably of the type 2 epithelial cell. It is not certain from this case study whether the lesions were multicentric in origin or intralobar metastases from one primary lesion. The patient's postoperative course was uneventful, and there is no evidence of recurrence 2 years after surgery.

Female↗