[Possibility for rational mediastinal dissection in non-small-cell carcinoma of the lung].
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Carcinoma, Non-Small-Cell Lung↗
Biomedical subjects
N Tsubota
Publications and source records attributed to N Tsubota.
[Genetic analysis and clinical significance of heterotopic hCGbeta production in lung cancer].
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Aged↗
[Sleeve lobectomy for tuberculous bronchial stenosis: a case report].
We describe a patient with tuberculous bronchial stenosis who was subjected to bronchoplasty. The patient was a 33-year-old man who had stenosis of the left main bronchus. Because the lesion was associated with bronchomalacia, previous balloon dilatation therapy had failed. At thoracotomy, the left upper lobe was found not to be saved for the tuberculous lesion. Although there were many inflamed nodules in the left lower lobe due to repeated episodes of pneumonia, we decided to save it using bronchoplasty expecting its respiratory functional recovery. He ran uneventful course postoperatively and his lung function improved. We conclude that bronchoplasty may prove effective for patients with tuberculous bronchial stenosis associated with bronchomalacia; and thus, to avoid pneumonectomy, bronchoplasty should be attempted even if the reconstructed lung is mildly inflamed.
Adult↗
Skip metastasis and hidden N2 disease in lung cancer: how successful is mediastinal dissection?
Out of 703 consecutive patients who underwent lung cancer surgery from 1986 to 1994, 562 were studied with an emphasis on lymph node metastasis. Skip metastasis was defined as metastasis to the upper mediastinum without involvement of the carinal, hilar, or intrapulmonary nodes. Twenty-nine patients had skip metastasis, accounting for 17% of the 175 with N2 disease. Except for one patient with a huge tumor, there was no lower-lobe disease. Patients with N2 disease nodes were categorized into the following groups: (1) 32 with false negative N2 that could not be detected macroscopically on the specimen; (2) 64 with true positive N2, detected macroscopically on the specimen; and (3) 79 patients with obvious N2. Positive carinal nodes were found in 12 of 70 N2 patients who underwent upper lobectomy, and in 60 of the (105) remaining N2 patients who had other types of surgery. We conclude that upper mediastinal dissection should be carried out in patients with adenocarcinoma in the upper lobe, because skip and undetectable metastasis are not rare. However, dissection of the carinal nodes with upper-lobe tumors, and of the upper mediastinum with lower-lobe tumors, can be omitted when the gross and frozen section findings are negative in the upper mediastinum and both the carinal and hilar nodes.
Carcinoma, Non-Small-Cell Lung↗
Purification of pepsinogens from human urine and electrophoretic analysis by caseogram print.
Pepsinogen (PG) A and C were purified from human urine, and analyzed by a highly sensitive detection method, "caseogram print". Purification was achieved by a series of conventional chromatographies and FPLC. A relatively large amount (13.2 mg) of PGA was purified from about 20 liters of urine. Purified PGA was separated by a Mono-Q column into each of its isozymogens. The elution order (PGA-5, 4+3, 2) corresponded to the order of electrophoretic migration. Although the concentration of urinary PGC was very low, a trace amount was purified and visualized by electrophoresis. The urinary and mucosal PGCs migrated at the same position, and urinary PGC was detected as two isozymogens similarly to mucosal PGC, suggesting that urinary and mucosal PGCs may be essentially identical.
Chromatography, Gel↗
Modification of human neuron-specific enolase for application to radioimmunoassay.
A recombinant human neuron-specific enolase (R-NSE), isolated from Escherichia coli, could not be used in an RIA system because of instability upon labeling. To apply R-NSE to RIA and to simplify the purification procedure, the N- and C-terminals of R-NSE were modified by tyrosine- and histidine-tagging, respectively. SY-NSE, containing one additional tyrosine residue, was obtained from both soluble and insoluble fractions. More derivatives tagged by two or four tyrosine residues were expressed, but only in the insoluble fraction. SY-NSE and SY-NSE.H6 (containing six histidine residues at C-terminal of SY-NSE) purified from the soluble fraction were applicable to the RIA system, indicating that the addition of a tyrosine residue at the terminal is effective if the antigen is unstable during labeling.
Base Sequence↗
[Effect of timing of granulocyte-colony stimulating factor administration on leukopenia induced by systemic chemotherapy in patients with non-small-cell lung cancer--multi-center randomized crossover study].
Sixty-six chemotherapy-naive patients with non-small-cell carcinoma of the lung were given two courses of systemic chemotherapy consisting of mitomycin C, vindesine, and cisplatin. The effect of the timing of administration of grannulocyte colony-stimulating factor (G-CSF) on the incidence of neutropenic fever, the nadir leukocyte count, the duration of neutropenia ( < or = 1000/mm3), and the time needed for recovery from neutropenia was studied. Patients were assigned at random to begin receiving G-CSF (50 microns/m2, subcutaneously) either when the leukocyte count was less than or equal to 1000/mm3 (group I) or when it was between 1000/mm3 and 2000/mm3 (group II), in a crossover fashion. The nadir leukocyte count was lower in group I than in group II (859/mm3 and 1215/mm3, respectively). The duration of leukopenia (defined as a leukocyte count less than or equal to 1000/mm3) was greater in group I than in group II (1.5 days and 0.8 day, respectively), as was the time needed for recovery to a leukocyte count of 2000/mm3 (1.9 days and 1.6 days, respectively) (p < 0.05). No differences were found in the incidence of neutropenic fever (group I: 44%, group Ii: 45%), in the duration of fever (group I: 2.3 days, group II: 2.8 days), or in the duration of G-CSF use (group I: 6.3 days, group II: 6.8 days). There were no treatment-related deaths in either group. We conclude that when this type of combination chemotherapy is given for non-small-cell carcinoma of the lung, administration of G-CSF can be postponed without clinical problems until the leukocyte count is less than of equal to 1000/mm3.
Antineoplastic Combined Chemotherapy Protocols↗
[Complicated bronchoplasty for lung cancer--its significance in salvaging a few segments of lung].
We performed bronchial reconstruction by several unusual procedures and succeeded in preserving lung function, which was proven with spirometry and treadmill exercise test. Type 1 (n = 2): Anastomosis between the left main bronchus and upper segmental bronchus with lower lobectomy and lingulectomy. Type 2 (n = 2): Anatomosis between the left main bronchus and basal segmental bronchus with upper lobectomy and superior segmentectomy acompanied by vascular reconstruction. Type 3 (n = 4): Anastomosis between the right main bronchus and lower bronchus with upper and middle lobectomy, accompanied by vascular reconstruction in 2 cases. One patient required completion pneumonectomy but the others had uneventful postoperative courses and maintained better lung function than expected, although the amount of preserved lung tissue was limited. There may be a great difference in the postoperative quality of life if pneumonectomy can be avoided, even though the preserved segments are few. Surgeons should reconsider the choice of pneumonectomy for interlobar tumors invading another lobe, especially in the case of N0 or N1 squamous cell carcinoma.
Aged↗
[Rib cross thoracotomy for a huge thoracic lesion].
Panpleuropneumonectomy, resection of a huge tumor in the thorax or operation of thoracic aneurysm requires good view of the entire thorax. Two separate incisions of lateral thoracotomy would not usually provide a sufficient operative field. The procedure of rib cross thoracotomy is as follows: The 6th, 7th, 8th, 9th rib with the intercostal muscle and vessels are cut at mid axillary line and removed 1 cm length at each edge of the ribs. The posterior half of the 6th ribs is removed. Thorax is entered posterioly at the 5th intercostal space and caudally to the 9th rib at the axillary line and anteriorly at the same intercostal space. Two rib expanders are needed.
Humans↗
[Postoperative interstitial pneumonia in primary lung cancer patients--its causes and management].
Eight patients who developed interstitial pneumonia after surgery for primary lung cancer were reviewed to investigate its causes and the key points in treatment. These patients accounted for 1.8% of 633 operated lung cancer patients at our institution over the last 9 years. Risk factors such as bilateral recurrent laryngeal nerve palsy, preoperative chemoradiotherapy, and extensive mediastinal involvement were present in all of them. Pneumonia developed on the nonoperated side in all patients between the 2nd and 45th postoperative day (mean: 18 days). In most of the patients, faint reticular shadows initially appeared in the lower lobe of the nonoperated lung, rapidly spread to the upper lobe, and finally affected the whole lung. Among these eight patients, the initial five patients died because steroids were only administered after the pneumonia had become widespread, whereas the last three patients received early steroid therapy and were saved. The findings that 1) this pneumonia originated from the lower lobe of the nonoperated lung where blood flow is highest postoperatively, 2) the eosinophil count increased just before the onset of pneumonia, and 3) early steroid therapy and immunosuppressive therapy were effective suggest that an allergic or autoimmune mechanism may play some role in its development. When characteristic reticular shadows appear in the lower lobe on the nonoperated side in a lung cancer patient, even if not associated with any symptoms, an early diagnosis of interstitial pneumonia and initiation of steroid therapy is mandatory to ensure survival.
Aged↗
Assessment of urinary beta-core fragment of human chorionic gonadotropin as a new tumor marker of lung cancer.
BACKGROUND: Some patients with lung cancer have been found to have elevated levels of serum immunoreactive human chorionic gonadotropin (hCG)/hCG beta (IR-beta), but it is uncertain whether it would be valuable as a tumor marker. Recently, IR-beta has been demonstrated to consist of at least three different molecules, intact hCG, free hCG beta, and hCG beta-core fragment (beta-CF), in body fluids. In this study, the authors qualitatively analyzed IR-beta in the serum and urine of patients with lung cancer and assessed its clinical usefulness as a tumor marker. METHODS: Highly sensitive and specific enzyme immunoassays were established to measure intact hCG, free hCG beta, and beta-CF in the serum and urine of patients with lung cancer. RESULTS: Of 99 patients with lung cancer, almost half of the patients achieved positive values of IR-beta in the urine, although only 12 had elevated values of IR-beta in the serum. The greater part of the elevated urinary IR-beta was identified to be beta-CF by gel chromatography on Sephadex G-100 (Pharmacia LKB Biotechnology, Tokyo, Japan), leading the authors to assess its usefulness as a tumor marker for lung cancer. Based on the cutoff value (0.2 ng/mg of creatinine) from healthy subjects, the overall positive rate of urinary beta-CF for lung cancer was 48.5% (48 of 99 patients). The incidence of the marker increased with stage of disease, from 35.7% (15 of 42) in Stage I and 35.7% (5 of 14) in Stage II to 62.5% (20 of 32) in Stage III and 72.7% (8 of 11) in Stage IV. These positive rates exceeded or equaled those of the serum tumor markers, carcinoembryonic antigen, and squamous cell carcinoma (SCC)-related antigen, measured simultaneously in the same patients. The author were encouraged that there was no significant difference in the positive rates of urinary beta-CF between two major types of lung cancer: adenocarcinoma (49.2%) and SCC (45.2%). Immunohistochemical study revealed positive staining of IR-beta in the cancer tissues from 5 of 12 patients with elevated levels of IR-beta, in which most of the positive cases had the elevated levels of serum free hCG beta (> 0.5 ng/ml) and/or urinary beta-CF (> 1.0 ng/mg of creatinine). CONCLUSIONS: Ectopic production of IR-beta by lung cancer is not rare, and urinary beta-CF might be a potential tumor marker of lung cancer.
Adenocarcinoma↗
Treatment of tuberculous empyema with multiple fistulae by reexpansion of the affected lung and restoration of its function: report of a case.
We report herein the case of a patient in whom a calcified tuberculous empyema with multiple fistulae was successfully treated by a new surgical approach. Reexpansion of the affected lung which had calcified over 30 years was achieved by covering the multiple bronchial fistulae using the omentum without obliterating the empyema cavity. Although the patient presented with severe aspiration pneumonia, he made a complete recovery and is now leading a better quality of life than before. This new operative method is less invasive and can therefore be performed much more easily on critically ill patients than conventional methods.
Bronchial Fistula↗
One hundred and one cases of bronchoplasty for primary lung cancer.
The results of 101 consecutive bronchoplasties performed between 1979 and 1993, including 8 cases of pneumonectomy, 88 cases of lobectomy, 3 cases of segmentectomy, and 2 cases of bronchial resection, are herein reported. Squamous cell carcinoma was the most common disease (59%) followed by adenocarcinoma (30%) and other diseases (11%). Anastomosis was satisfactory in 96 cases. Among the five stenosed cases, local recurrence was found in two cases, and there were three benign strictures. Two of the three benign strictures were treated with bouginage. The pulmonary artery was concomitantly reconstructed in seven cases with satisfactory results. Preoperative chemoradiotherapy was performed in 15 advanced cases and was followed by acceptable surgical results. The 5-year survival rate, according to the postoperative staging of the 86 patients without induction therapy, was 86% in stage I (19 patients), 49% in stage II (21 patients), and 27% in stage IIIA (40 patients). The overall survival rate was 46% at 5 years. There were two indications for this procedure i.e., a positive resection margin in 59 cases and positive hilar nodes in 42 cases. Better survival was noted in patients with squamous cell carcinoma, stage I, and surgery was thus selected for a positive resection margin, and not for a positive node.
Bronchi↗
The superiority of exercise testing over spirometry in the evaluation of postoperative lung function for patients with pulmonary disease.
Thoracic surgeons have often been embarrassed by the discrepancy between an improvement in symptoms and the unchanged or even worse results of spirometry in postoperative patients with either bullae or inflammatory lung disease. Forty-four patients with lung diseases, who underwent a total of 47 operations, were categorized as follows: 12 cases of empyema, 16 cases of giant bulla (undergoing surgery a total of 19 times), 4 cases of bronchiectasis, and 12 cases of other miscellaneous diseases. All patients were tested preoperatively and again 4-6 months after surgery on both the spirometer and treadmill exercise tests. The forced vital capacity (FVC) and forced expiratory volume (FEV1.0) results were as follows: the empyema group 1.82 +/- 0.52 liters preoperatively to 1.93 +/- 0.69 liters postoperatively and 1.47 +/- 0.44 liters to 1.56 +/- 0.53 liters, respectively; and the giant bulla group, 3.49 +/- 0.96 liters to 3.35 +/- 0.77 liters and 2.35 +/- 0.96 liters to 2.48 +/- 0.69 liters, respectively. However, the exercise time was prolonged in the empyema group from 6.00 +/- 3.77 min to 8.33 +/- 3.80 min (P < 0.01) and in the giant bulla group from 11.83 +/- 3.71 min to 12.92 +/- 2.84 min (P < 0.05). It was thus concluded that exercise testing should be chosen for the postoperative evaluation of patients with inflammatory pulmonary disease and giant bullae, especially if any discrepancies are seen between spirometry and performance status, because on the basis of our results, it appears that the benefits obtained by surgery are best measured by the dynamic values of exercise testing and not by the static values of spirometry at rest.
Adult↗
Evaluation of pericardial mesothelioma by Ga-67 and MRI.
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Adult↗
Turbidimetric latex agglutination inhibition immunoassay for primidone.
We have developed a quick, highly sensitive immunoassay method for drugs by latex agglutination inhibition. An antiserum against primidone (PRM) was obtained by immunizing rabbits with PRM-bovine serum albumin conjugate. PRM-rabbit serum albumin conjugate sensitized latex was agglutinated with diluted antiserum, and the agglutination was inhibited by free PRM quantitatively. Turbidity of the agglutination suspension was measured by spectrophotometry as absorbance. Larger latex gave higher sensitivity than the smaller, because its agglutination was inhibited more intensely by free PRM. The assay values of this method were correlated well with those obtained by an enzyme immunoassay method.
Animals↗
Simultaneous occurrence of three primary lung cancers.
We present a patient with three lung cancers composed of adenosquamous carcinoma, adenocarcinoma, and squamous cell carcinoma. Marked response was obtained in squamous cell carcinoma components following chemotherapy, but not in adenocarcinoma components. Even multiple malignant lesions of the lung might have a chance to be controlled by a combination of chemotherapy and surgery.
Adenocarcinoma↗
Atypical bronchoplasty to lung cancer and benign bronchial disease.
Twenty-one cases of atypical bronchoplasty were selected from a series of 125 tracheobronchoplastic procedures by the same surgeon between 1979 and 1993 and were reviewed to assess the indications and technical problems. The procedures were classified as follows: Type A (3 cases) was anastomosis between the right main and lower bronchi with upper and middle lobe resection. Type B (4 cases) was anastomosis between the left main and upper segmental bronchi with resection of the lower lobe and lingula or between the left main bronchus and the basal bronchus with resection of the upper lobe and superior segment of the lower lobe. Type C (5 cases) was resection of the right lateral wall of the trachea with various types of lung resection. Type D (4 cases) was sleeve segmentectomy. Type E (2 cases) was bronchial reconstruction without lung resection. Type F (3 cases) was miscellaneous procedures. All these procedures except one achieved favorable results. It is emphasized that lung-preserving surgery must always be considered under strict observation using frozen section study, even if an unusual procedure is required. If lung tissue has to be resected, as little as possible should be removed.
Adult↗