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Biomedical subjects

K Usuda

Publications and source records attributed to K Usuda.

At least 109 records · Page 6Linked to original sources
PubMed1990

Clinical and prognostic assessment of patients with resected small peripheral lung cancer lesions.

One hundred fifteen patients with small (less than or equal to 2 cm in diameter) peripheral lung cancer lesions underwent surgical treatment in the Department of Surgery, The Research Institute for Chest Diseases and Cancer, Tohoku University, Miyagi Prefecture, Japan. The authors investigated several prognostic factors of these cases. The 5-year survival rate of these 115 patients was 70%. Various factors such as histologic type, nodal involvement, pleural involvement, pathologic stage, and curativity of the operation were revealed to affect survival significantly. In patients with and without nodal involvement, there was no significant difference between the survival rate of patients with lung cancer lesions smaller than 2 cm and those with lesions 2.1 to 3 cm. However, the rate of lymph node metastasis was significantly different in the group with lesions smaller than 2 cm compared with those with lesions 2.1 to 3 cm (21% versus 43%, respectively).

Adenocarcinoma↗
PubMed1990

[Analysis of patients with resected small-size (less than or equal to 2 cm in diameter) peripheral type lung cancer lesions].

From 1953 to 1985, a total of 1289 patients with primary carcinoma of the lung underwent surgical treatment. Of these 116 (8.9%) had small-sized (less than or equal to 2 cm in diameter) peripheral type lung cancer lesions. This study had three purposes: 1) to analyse how small-sized lung cancer lesions were detected; 2) to evaluate the reliability of diagnosis of small-sized cancer lesions; and 3) to evaluate pre- and post-prognostic factors of such patients compared with patients with peripheral type lung cancer lesions 2.1-3 cm in diameter. Of the 115 patients with small-sized lung cancer lesions were detected in the course of mass surveys. Cytopathological diagnosis in 75% of the patients resulted from transbronchial brushing cytology. The 5-year survival rate of patients who underwent resection of small-sized peripheral type lung cancer lesions was 70% (2.1-3 cm; 52%). Various factors such as histologic type, nodal involvement, pleural involvement, pathological stage, and success of the operation were shown to significantly affect survival. A comparison of two groups, i.e., those with lesions smaller than 2 cm in diameter and those with lesions 2.1-3 cm in diameter, showed the rate of lymph node metastasis to be significantly different. Of the patients with peripheral lung cancer lesions smaller than 2 cm who underwent surgery, 21% had peribronchial, hilar, or mediastinal lymph node metastasis. On the other hand, lymph node metastasis was seen in 43% of cases with peripheral lung cancer lesions 2.1-3 cm in diameter who underwent surgery.

Humans↗
PubMed1990

[A study of lung cancer with presence of pleural effusion at the time of thoracotomy--cytologic evaluation of a relatively small amount of pleural effusion and prognosis after removal].

The cytologic evaluation of a relatively small amount of pleural effusion in lung cancer at the time of thoracotomy has not been previously considered, and prognosis after removal has not been clarified. In order to clarify these points, 99 cases of removed lung cancer with presence of pleural effusion at the time of thoracotomy were examined following cytology. Our study was conducted with regard to the amount and nature of pleural effusion, pleural effusion cytology, tumor development and its relation to prognosis. On the basis of this study a formula was developed relating the occurrence rate of cytologically positive pleural effusion with the development of tumor employing multivariate analysis, specifically the multiple regression analysis. 21% of these cases showed cytologically positive pleural effusion, indicating an absence of its correlation to the amount of pleural effusion; the conducting of cytology regardless of the amount of pleural effusion was found to be significant in determining the precise stage. The occurrence rate of cytologically positive squamous cell carcinoma was significantly few compared with those in other cell types. Regarding the pleural effusion of a relatively small amount, the prognosis after removal showed a relatively high three-year survival rate of 32% for those cases with negative pleural metastasis despite the positive showing of pleural effusion cytology, indicating the viability of surgery. From the occurrence rate of cytologically positive pleural effusion (Y) and the degree of pleural metastasis (X1)/the degree of pleural invasion (X2)/the degree of lymph nodes metastasis (X3), the following formula was obtained employing multiple regression analysis: Y = 0.344X1 + 0.050X2 + 0.034X3 + 0.075 (proportion 0.840).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1990

[Surgical experience of bronchogenic early squamous cell carcinoma detected by sputum cytology in lung cancer screening].

Eighty-one patients of roentgenologically occult lung cancer (all men, and squamous cell carcinoma) were detected by sputum cytology in lung cancer screening of "Miyagi Program". Sixty-seven patients were resected surgically, and sixty-four of them underwent absolutely curative resection. In fifty-six patients, carcinoma did not penetrate the bronchial wall, and all of them were free from lymph node involvement. In eleven patients, carcinoma penetrated the bronchial wall, and three of them were proved to have lymph node involvement. For that reason, carcinoma which did not penetrate the bronchial wall and was free from lymph node involvement, was defined as early squamous cell carcinoma. Fourty-two early squamous cell carcinoma were located on segmental or more proximal bronchi, but twelve were located on subsegmental or more peripheral bronchi. Five-year survival of fifty-six patients with early squamous cell carcinoma were 91.8%, seven of fifty-six early squamous cell carcinoma patients were multicentric, which were detected synchronously in four cases, postoperatively in two cases, and both synchronously and postoperatively in one case. Two of three postoperatively detected cases were resected surgically and alive without cancer. These results indicate the validity of surgical treatment for roentgenologically occult squamous cell carcinoma. As the most serious prognostic problem is multicentricity, careful localization of primary lesion and postoperative intensive follow-up should be considered.

Aged↗
PubMed1989

Relationship between length of longitudinal extension and maximal depth of transmural invasion in roentgenographically occult squamous cell carcinoma of the bronchus (nonpolypoid type).

This study was designed to verify our hypothesis that there are two different growth types in roentgenographically occult squamous cell carcinoma of the bronchus. Serial blocks prepared from the entire bronchial tree of 83 resected specimens of occult carcinoma were used for the evaluation of the relationship between the length of longitudinal extension and the maximal depth of transmural invasion. We prepared a length-depth diagram of 92 lesions, including multifocal carcinomas, which confirmed that there are at least two types: Most of these lesions are of the creeping type, which shows a marked superficial growth; the minority are of the penetrating type, which shows a marked downward growth. The diagram suggests that occult carcinoma has a propensity either for longitudinal growth along the bronchial lumen or for transmural growth into the bronchial wall at the time of occurrence. It is likely that the penetrating type grows rapidly and becomes advanced in a short time. Identification of longer lesions of the creeping type is occasionally problematical both at bronchoscopy and at surgical treatment. The stump is usually positive for carcinoma unless frozen sections or imprint specimens of the margin of resection are examined, because it is frequently difficult to identify the proximal end of extension by bronchoscopy.

Bronchi↗
PubMed1989

Relationship of lymph node metastasis to primary tumor size and microscopic appearance of roentgenographically occult lung cancer.

We investigated the relationship of lymph node metastasis to primary tumor size and microscopic appearance in 92 resected specimens obtained from patients with roentgenographically occult lung cancer (ROLC) located at a site along the airway between the main bronchus and the sub-subsegmental bronchi. Most of the patients were discovered by mass screening. All were treated surgically after bronchoscopic localization of cancer. The bronchial tree of the resected specimens was serial-sectioned into 2-mm thick blocks from the margin of resection to the sub-subsegmental bronchi. Bronchial wall invasion was noted in some blocks of all the specimens. The length of longitudinal extension (LLE) was defined as the product of the thickness and the number of consecutive blocks involved, counting from the most proximal to the most distal block. LLE was used as primary tumor size. Hilar and mediastinal lymph nodes were examined in 84 patients who underwent lymph node dissection. No nodal involvement was found in 59 cancers with LLE of less than 20 mm. Of 25 cancers with LLE of 20 mm or more, six showed nodal involvement. Eleven in situ carcinomas and four cancers of the "suspicious for invasion" type showed no lymph node metastasis. We contend that no lymph node dissection is required when pulmonary resection is performed for patients with ROLC if it is in situ carcinoma, if it is of the "suspicious for invasion" type, or if the LLE is smaller than 20 mm.

Aged↗
PubMed1989

[Klippel-Trenaunay-Weber syndrome with papillary cystadenoma of the epididymis: a case report].

A case of Klippel-Trenaunay-Weber syndrome with papillary cystadenoma of the right epididymis is reported. A 7-year-old boy visited our clinic on October 19, 1985 with a tender right intra-scrotal mass (35 X 15 m) and pyuria. In spite of the initial treatment with antibiotics, the tumor grew larger in December, 1987. The patient underwent right orchiectomy on December 23, 1987. Macroscopically, the specimen measured 40 X 23 X 20 mm and weighed 17 g. Histological examinations demonstrated that the tumor was papillary cystadenoma of the right epididymis. The patient lacked the signs of von Hippel-Lindau disease since there were no abnormal findings on brain and abdominal computer tomographic scan, and retinae were normal on fundoscopic examinations.

Angiomatosis↗
PubMed1989

[Selective brushings for all branches of the bronchi: diagnostic values thereof in patients with roentgenographically occult lung cancer and borderline lesions].

Selective brushings were conducted for all the respective segmental bronchi in both lungs of 105 patients with positive or suspected positive indications of lung cancer as revealed by sputum cytology. As a result, borderline lesions, 16 cases with 18 lesions and lung cancer, 51 cases with 58 lesions, were diagnosed. The percentage of localized lesions was 47.1% for Class III cases, 82.4% for Class IV cases and 100% for Class V cases; on the whole, identification was possible in 62.9% of all the cases. Comparison of the diagnoses made before and after all the branch brushings showed that, after the brushings, the rate of localization increased from 14.7% to 47.1%, and diagnosis of borderline lesions is also possible. Regarding the results obtained at the first examination, the rate of localization increased from 64.1% to 93.9%, and in particular, an improvement from 0% to 88.9% was noted for those cases where bronchoscopic findings had not been obtained. Based on the above results, it was concluded that the application of this brushing method is of value in the following cases: diagnosis of cases otherwise difficult to diagnose, detection of borderline lesions, and diagnosis of concurrent multiple primary lung cancer. In addition, this brushing method has made possible the detection of multiple intraepithelial lesions, leading to a more precise diagnosis of cells of the respiratory system in the near future.

Bronchi↗
PubMed1989

[Study of postoperative bronchopleural fistulas--analysis of factors related to bronchopleural fistulas].

Postoperative bronchopleural fistulas, although reduced in incidence, remain as a grave complication of pulmonary resection. In our department, cases of lung cancer have been rapidly increasing and those of infectious diseases have been decreasing. In light of this trend, the causes of bronchopleural fistulas may have changed, and thus we studied recent cases of postoperative bronchopleural fistulas from 1982 to 1986. Bronchopleural fistulas were seen in 5 (7.8%) of 64 cases of inflammatory diseases and in 19 (4%) of 481 cases of lung cancer. In lung cancer, bronchopleural fistulas were more frequently seen with advanced cases, especially in cases of residual tumors on the stump and in cases of intrathoracic use of anticancer drugs. The highest incidences of bronchopleural fistulas were seen with right pneumonectomy and right lower lobectomy. Bronchoscopic examination showed bronchopleural fistulas to be mainly located on the stump beside the residual lobe. When Sweet's procedure is employed, this is the point with the most tension on the stump. Clinical and retrospective analysis of preoperative data revealed the following factors to be significantly higher in cases of bronchopleural fistulas than in cases of non-bronchopleural fistulas: fever, use of steroid hormone, Haemophilus influenzae in sputum, elevation of erythrocyte sedimentation ratio and anemia. Such analysis of postoperative data showed the following factors to be significant: fever, use of steroid hormone, leucocytosis, tracheostomy and bronchoscopy for sputum suction.

Adolescent↗
PubMed1988

Electron microscopic observations in in situ and microinvasive bronchogenic squamous cell carcinoma.

Seventeen cases of resected in situ and microinvasive bronchogenic squamous cell carcinoma were studied by light and electron microscopy. No definite secretory differentiation was found in any case. Examination of the tumour cells in the basal layer for electron density of cytoplasm, intercellular spaces, and degree of development of cytoplasmic processes showed a variety of cells ranging from type I, where the cytoplasm was dark, development of cytoplasmic processes was good, and the intercellular spaces were large, to type III, where cytoplasmic processes and intercellular spaces were less well developed and the cells were mostly of clear cell type. The tendency to invasion was greater in type III than type I and there was also more marked cellular atypia, more extensive dissolution of basement membrane, a larger number of mitotic figures per 3000 cells in the basal layer, and greater enlargement of nuclear and cytoplasmic areas. A good rank correlation coefficient was obtained. Small dense-core granules were observed in some cases. These finding suggest the strong possibility that cell kinetics and cellular morphology are related to the development of squamous cell carcinoma.

Aged↗
PubMed1988

Roentgenographically occult bronchogenic carcinoma of non-polypoid type: histological patterns of longitudinal growth within the bronchus.

Microscopy of the serial block-sections of the entire bronchial tree of all the resected specimens of roentgenographically occult bronchogenic carcinoma revealed new findings with respect to the histological patterns of longitudinal growth within the bronchial wall. Twenty-seven lesions which were non-polypoid on gross appearance with longitudinal extension of 16 mm and above were classified into the following four categories. (A) In standard superficial extension, transmural invasion by carcinoma became shallower and the area involved on section became smaller gradually from the site of the origin of carcinoma to the proximal and distal ends. (B) In intraepithelial extension, carcinoma was confined within the epithelium throughout the bronchi involved except at and near the site of the origin at which it penetrated the basement membrane. (C) In lymphatic extension, carcinoma extended from the site of the origin to the proximal and distal ends in a dual pattern so that it extended longitudinally within the epithelium in parallel with an invasion into the lymphatic vessels in the lamina propria and submucosa. At the site of the origin carcinoma invaded down to the level of the submucosa or adventitia. (D) In massive extension, a massive invasion by carcinoma from the site of the origin to the proximal and distal ends, and a simultaneous invasion and destruction by carcinoma of the epithelium, basement membrane, lamina propria, submucosa, and of adventitia in places were demonstrated. There was no marked difference in bronchoscopic finding among (A), (B) and (C). The length of the lesion as estimated by histology was different from that observed at bronchoscopy. Bronchoscopic examination was not always successful in determining the line of resection precisely. Therefore it is indispensable to examine frozen sections and/or imprint specimens of the margin of resection.

Bronchi↗
PubMed1988

[Interstitial pneumonia after CMC (CDDP, MMC, CPM) therapy].

Six patients receiving CDDP, MMC, and CPM chemotherapy for adjuvant chemotherapy after a resection due to lung cancer developed interstitial pneumonia. They were re-admitted for dyspnea, shortness of breath, and dry cough from 80 to 118 days from start of their treatment. On re-admission, their chest radiographs showed reticular infiltrates, and their laboratory data showed severe hypoxemia. The pathological findings of a transbronchial lung biopsy showed a thickening of the alveolar septa. Steroid therapy resulted in a complete resolution in one patient and a partial resolution the 5 others. One year later, two patients had died, one patient remains in complete resolution, but a shortness of breath still exists in the remaining three patients. Considering the disadvantages of that shortness of breath can cause to daily life, we should be more cautious about administering antineoplastic agents for adjuvant chemotherapy to patients with a cancer in an early stage.

Aged↗
PubMed1988

[The surgical treatment of hypospadias and related problems].

Of 33 patients with hypospadias operated on consecutively by a single surgeon between 1977 and 1986, 27 had undergone a 2-stage Belt-Fuqua procedure and 6 were repaired using several types of a one-stage method. The over-all success rate was 64%. Meanwhile, a fistula developed in 6 patients, meatal stenosis in 3; the over-all complication rate was 36%. A comparative review of late complications is presented. Efforts should be made to achieve excellent functional as well as cosmetic results.

Adolescent↗
PubMed1988

A quantitative cytologic study of sputum in early squamous cell bronchogenic carcinoma.

The abnormal cells (atypical squamous cells and cancer cells) in the sputum of 12 in situ and 20 early invasive squamous cell carcinomas were studied quantitatively and compared with the cells in 12 borderline cases and 11 frankly invasive squamous cell carcinomas, In in situ and early invasive squamous cell carcinomas, the mean nuclear diameters were larger and multinucleated cells and distinct nucleoli were more frequent than in borderline cases. Furthermore, the mean cellular diameters and the number of abnormal cells per slide were smaller, the distinct nucleoli were less frequent and acidophilic cytoplasms were more frequent than in frankly invasive squamous cell carcinomas. The results indicate that (1) in situ and early invasive squamous cell carcinomas are generally distinguishable cytologically from borderline cases and from frankly invasive squamous cell carcinomas and (2) the cytologic differentiation between in situ and early invasive squamous cell carcinomas is quantitatively insufficient.

Carcinoma, Bronchogenic↗
PubMed1987

Histogenesis and characterization of minimal bronchogenic carcinoma observed in heavy smokers.

The present article describes the results of observations of 11 lesions in 8 cases of roentgenographically occult in situ or microinvasive squamous cell carcinoma with a size of 4 X 4 mm or less which were detected by detailed histologic investigations of 59 cases of occult bronchogenic carcinoma. The 59 cases were discovered mainly by mass screening for the detection of early lung cancers using chest x-ray combining sputum cytology for heavy smokers. The resected specimens were processed with the method of serial block sectioning. All the serial blocks of these minimal carcinomas were observed in detail to confirm the presence or absence of carcinoma and of morphological changes of the bronchial epithelium contiguous to carcinoma. Adjacent to carcinoma, there were normal bronchial epithelium in three lesions, squamous metaplasia with marked atypia in four, basal cell hyperplasia in two, and markedly atypical basal cells without hyperplasia in two. An inference on histogenesis of bronchogenic squamous cell carcinoma was drawn from the detailed observations as follows: (1) A carcinoma develops in the area of squamous metaplasia with marked atypia; (2) A carcinoma arises from markedly atypical basal cells with or without prior hyperplasia. Even in such small-sized carcinomas, there is a difference in type of invasion within the bronchial wall. One is the creeping type which shows a marked horizontal growth and the other is the penetrating type which shows a marked downward growth.

Aged↗