Biomedical subjects

H Iwanami

Publications and source records attributed to H Iwanami.

At least 19 recordsLinked to original sources

PubMed1997

[Assessment of surgery for primary lung cancer with dissemination or malignant effusion of pleura (T4 advanced lung cancer)].

Twenty-four cases of primary lung cancer with dissemination or malignant effusion of pleura detected preoperatively or intraoperatively were surgically treated at our hospital. Mean survival time (MST) and two-year survival rate (2 YSR) were analyzed on their resected cases and non-resected cases with similar lesion. MST and 2 YSR of 19 cases with lobectomy, 5 cases with pneumonectomy including pleuropneumonectomy and 15 cases with no surgical procedure were 2.77 +/- 0.60 years, 53.4%, 1.51 +/- 0.50 years, 26.7% and 0.99 +/- 0.15 years, 6.7%. MST and 2 YSR of 13 cases with lymph node dissection under R 1 and 6 cases over R 2 on lobectomy group were 1.99 +/- 0.38 years, 37.5% and 5.66 +/- 1.71 years, 66.7%. These findings suggested that lobectomy with lymph node dissection of R 2 over may be a beneficial treatment of lung cancer with dissemination or malignant effusion of pleura.

Aged↗

PubMed1996

[A case of lung adenocarcinoma: detection and resection of the metastatic lesion was managed effectively by serum CEA level].

This patient, a 53-year-old male, has had back pain and an abnormal shadow was detected in the right lung field on December 1989. He was admitted to the hospital for the further examination. On the diagnosis of lung cancer with high serum CEA level operation was performed on February 1990. As a results of pathological examination, histological type was adenocarcinoma and pathological stage was pT3N0M0 stage IIIA. After operation the serum CEA level was decreased immediately but it was gradually increased once again. And then 14 months later right adrenal metastasis was detected by abdominal CT with high serum CEA level and resection was performed. Similarly a solitary lymph node metastasis located in abdomen was detected and resected with high serum CEA level 28 months after second operation. In this case detection and resection of the metastatic lesion was managed effectively by serum CEA level. The patient had a good operative course and is alive 76 months after first operation without any evidence or recurrence.

Adenocarcinoma↗

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↗

PubMed1993

[A rare case of intrapulmonary sequestration in left upper lung field diagnosed before surgery].

This case is a 30-year-old male who was indicated abnormal shadow in the left upper lung field by chest X-ray film. The aortography was carried out because pulmonary sequestration was suspected by chest CT-scan etc. From the result, rare pulmonary sequestration in the left upper lung field was diagnosed because patterns with inflow of an abnormal artery from descending aorta into the left upper lung field and perfusion of it into the upper pulmonary vein were observed. The wedge resection was performed. The specimen was slightly hard on the whole, and many cartilages or multiple nodules were observed on the cut surface. Histopathologically, normal pulmonary structure was disappeared, and hyperplasia of the lymphatic nodule was remarkably observed in the interstitium, and cystic wall was covered by ciliated cylindrical epithelium.

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

[An experience of laser therapy of lung cancer complicated with hemophilia A].

We applied an endoscopic Nd-YAG laser therapy for an early hilar lung cancer complicated with hemophilia A in a patient of 62-year-old male. Abnormality was pointed out by means of sputum cytology. But, no shadow of tumor was observed by chest x-ray films and computed tomogram. By a bronchoscopy, a mild irregular mucomembrane and stenosis without tumor were exhibited. By means of cytological diagnosis of an abrasive-washing specimen of that region, the presence of squamous cell carcinoma was proved. Also, he was diagnosed as factor VIII deficient hemophilia A. So we performed him a laser therapy in place of the operation and with an intrabronchial arterial infusion. After the laser treatment, the conditions progressed better without any recurrence but about one and a half years later, an intrapulmonary metastasis occurred. Then, radiation and chemotherapy have been applied and at present, the patient is in a good state although under the tumor-bearing condition.

Carcinoma, Squamous Cell↗

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

[Resected cases of middle lobe primary cancer].

Of 200 lung cancer lesions resected in our hospital, there were 15 cases (7.5%) with middle lobe origin. The histological types were adenocarcinoma in 13 patients (4 patients with alveolar cell carcinoma), squamous cell carcinoma in one and large cell carcinoma in one. These patients were classified into two groups according to the type of operation they received and each group was evaluated. Group I (resection of the middle lobe) included 8 patients. Each one of Stage IIIB and Stage IV received the operation to improve their symptoms. The six patients of Stage I received only middle lobectomy as absolute curable cases. Group II (resection of the middle and lower lobes) included 7 patients, who had preoperative diagnosis of stage III. Two of them were postoperatively found to be cases of Stage I and Stage II. Although it was still short-term, the follow-up evaluation proved that these patients survived without local recurrence and distant metastasis, except for two with pleural dissemination and one with cerebral metastasis, who had received lobectomy as palliative operation. No difference was observed between the two groups receiving different types of operation.

Adenocarcinoma↗

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