[A case report of the surgical treatment in thoracic empyema due to metastatic lung cancer].
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Biomedical subjects
Publications and source records attributed to K Iuchi.
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The clinical significance of the flow velocity of the superior vena cava (SVC) in old myocardial infarction (OMI) with severe left ventricular dysfunction were evaluated using pulsed Doppler echocardiography. The subjects consisted of 10 patients with OMI (averaged left ventricular ejection fraction: 0.37 +/- 0.11) and 10 age-matched normal controls. Among the patients, eight had extensive anterior infarction and two had both anterior and inferior infarctions. During normal respiration, the peak SVC flow velocities in systole (S) and diastole (D), and the D/S ratio were measured. To evaluate right ventricular diastolic function, we measured the peak velocity across the tricuspid orifice in early diastole (rapid inflow: T-R) and the atrial contraction phase (T-A), and the ratio T-A/T-R during quiet expiration. In the normal controls, S was greater than D, both during expiration and inspiration. During inspiration, S, D and the D/S in the normal controls increased, with a greater increase in D than in S. In the patients, however, D and the D/S did not increase during inspiration. T-R was less and the T-A/T-R was greater in the patients with OMI than in the normal controls. These findings of tricuspid flow velocity revealed impaired diastolic filling of the right ventricle in patients with OMI. In conclusion, the impaired diastolic filling of the right ventricle in patients with OMI might be one of the causes of the abnormal response of the SVC flow velocity during normal spontaneous respiration.
Malignant lymphomas developing in tissue affected by a long-standing severe inflammatory process of nonautoimmune nature are presented. Two men and a woman aged 50, 58, and 73 years, were admitted after 22 to 30 year histories of pyothorax resulting from artificial pneumothorax for the treatment of pulmonary tuberculosis or tuberculous pleuritis. The diagnoses at admission were chronic pyothorax associated with a lung mass. Microscopically, tumors diffusely or locally proliferated with thickened pleura were present. A histologic examination showed that all the tumors were diffuse non-Hodgkin's lymphomas (NHL) of immunoblastic type with (one case) or without (two cases) plasmacytoid differentiation. Immunohistochemistry on paraffin sections revealed restricted expression of immunoglobulin light chains in one case showing plasmacytoid differentiation. A review of the literature showed that malignant lymphomas of this type have been reported exclusively from Japan but never from Western countries.
The acute effects of OPC-8212, a newly synthesized orally effective inotropic agent, were assessed clinically. Eleven patients with moderate congestive heart failure received a single mean dose of 6.5 mg/kg body weight of the drug. Eight hours after administration, the cardiac and stroke work indexes increased by 11% (p less than 0.01) and 20% (p less than 0.005), respectively, with concomitant decreases in the diastolic pulmonary artery (25%, p less than 0.005) and right atrial pressures (33%, p less than 0.01). There were no significant changes in blood pressure or heart rate. The contractile state of the left ventricle was also assessed by the shift of the Starling curve. To construct the function curve, lower body negative pressure was used to regulate the venous return to the heart. An inotropic effect of the agent was confirmed by the shift of this function curve upward and to the left, even when an augmentation of the cardiac output was masked by the marked reduction in preload. The hemodynamic and clinical effects of OPC-8212 were encouraging and the drug appears to be promising for the treatment of congestive heart failure.
A series of 6-fluoro- and 6,8-difluoro-7-(azole substituted)-1,4-dihydro-4-oxo-3-quinolinecarboxylic acids were prepared. Structure-activity relationship studies indicated that the antibacterial potency was better when the 6,8-substituents were fluorine atoms and the 7-substituent was either 1-imidazolyl, 20, or 4-methyl-1-imidazolyl, 25. From the results of studies on pharmacokinetic profile and toxicity, 20 and 25 were found to possess excellent antibacterial activities and to show high blood levels after oral administration to mice with low toxicity.
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The survival rates of 380 resected cases of lung cancer in our hospital were analyzed according to curability and histological cell type. The overall 5-year survival rate for stage I a cases was 64.5%, that for stage I b 52.3%, and that for stage II 26.7%. However, there were distinct differences in survival rates between stages I a-II with mediastinal lymph node dissection and those without mediastinal lymph node dissection. Of these 380 tumors, many were advanced (for instance, stage III tumors comprised 180 cases). T3 tumors had better prognosis (40.7% showing 5-year survival) than N2 tumors (26.7% showing 5-year survival). Among stage III tumors, squamous cell carcinoma (T3: 41%, N2: 36.7% showing 5-year survival) had a better prognosis than adenocarcinoma (T3: 16.1%, N2: 21.4%). T3N2 tumors, however, had such a poor prognosis that the value of surgery in these cases seemed questionable. Adjuvant therapy should therefore be evaluated accurately in future to improve prognosis. It was stressed that a randomized controlled study would be needed to evaluate the effectiveness of adjuvant therapy.
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The operative results in a series of 92 patients with chronic empyema were reviewed. Of these, 46 had empyema with an underlying fistula, and 46 had empyema without fistulization. Twenty-one underwent decortication, 65 were treated by our technique, and six were treated by a modification of the Eloesser technique. These techniques were employed with priority given in the order just cited. Our technique involves decortication of the visceral peel and obliteration of the dead space by collapsing of the parietal wall without rib resection. Cure was obtained with decortication alone in 20 of 21 patients. Sixty of 65 patients treated by our technique were cured without deformation of the thoracic cage. In all patients treated by the modified Eloesser technique, obliteration of the empyema cavity was achieved secondarily by thoracoplasty combined with a pedicled muscle flap. Postoperative pulmonary function studies demonstrated a significant improvement in vital capacity and forced expiratory volume in 1 second in patients treated by decortication or by our technique. With the modified Eloesser technique, in contract, pulmonary function tended to decline.
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