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Biomedical subjects

N Tsubota

Publications and source records attributed to N Tsubota.

At least 91 records · Page 5Linked to original sources
PubMed1991

[Survey of attitudes among general practitioners regarding the introduction of a personal computer medical network system in community health care].

General practitioners (GPs) play an important part in community health care. Their opinion regarding introduction of a medical information network system using a personal computer and factors influencing the decision to introduce such a system were surveyed among 977 randomly sampled GPs. A response from 727 GPs was obtained. Based on a two stage selection method, 20 factors were selected as effective factors among the 73 factors surveyed, with the following results: (1) Responses to the question concerning the approval of system introduction were classified into three groups: "not necessary + too early to make a decision (DA)" (DA group), "approve (A)" (A group) and "undecided (UD)" (UD group). Each group had nearly equal numbers of respondees. (2) Significant effective factors were "experience with personal computers", "a desire to use a personal computer", "a desire to use a computer-diagnosis-system", "cost", and "a volition to operate a computer by himself". (3) The "A group" had high experience and affirmative opinions, while the "DA group" had low experience and negative opinions. The "UD group" also tended to respond with "do not know" regarding the factors. (4) Approval of system introduction requires providing basic knowledge on computers, opportunities for positive experience with computers, and practical examples of problem solutions in a general practitioner's work.

Adult↗
PubMed1991

[A case of a large invasive thymoma successfully treated by using a combination of artery infusion of CDDP and operation].

A 21-year-old male was admitted with SVC syndrome. Chest X-ray film showed an abnormal density on the upper mediastinum, that was recognized thymoma on the needle aspiration specimen. The large tumor, which extensively infiltrated the surrounding tissues (SVC, the right brachiocephalic vein, bilateral lungs and the pericardium) led us to choose preoperative chemotherapy. CDDP (cisdiammin-edichloroplatinum) was infused through the right IMA (internal mammary artery). After obtaining the major response the tumor mass was resected with adjacent structure accompised vessels reconstructions. Histological examination revealed totally necrosed tissue. Three years after initiation of therapy, the patient is doing well. The therapy with CDDP injection into selective IMA for invasive thymoma before operation was considered to be very useful utilized.

Adult↗
PubMed1991

[Changes in cardiopulmonary functional reserve after thoracic surgery assessed by treadmill exercise test].

The authors evaluated the effect of thoracic surgery on cardiopulmonary functional reserve using a three-minute incremental test on treadmill before and after operation in 148 patients undergoing thoracic surgery. Patients were divided into two groups according to the presence or absence of respiratory symptoms during the exercise test. In all patients, the number of cases with hypoxemia induced by exercise test increased postoperatively including all cases with pneumonectomy. The number of patients who halted the test because of respiratory symptoms (Group A) increased after operation (45 cases before (30.4%), 82 cases after (55.4%)). Most of them showed at least 10 Torr lower PaO2 levels than their basal levels during exercise. Before operation, patients in Group A (n = 45) showed significantly lower FEV1.0% than those who halted the test because of other symptoms (Group B, n = 103) (68.0 +/- 12.5% vs 76.0 +/- 9.7%, mean +/- S.E. p less than 0.05, Student's t-test). After operation, patients in Group A (n = 82) showed a significantly lower %DLco than those in Group B (n = 66) (71.4 +/- 14.3% vs 88.6 +/- 16.8%, p less than 0.05). Preoperative %DLco did not differ between the two groups. Consequently, postoperative decrease in %DLco was characteristic for patients with respiratory symptoms, suggesting that hypoxemia during exercise induced by reduction in diffusion capacity may be responsible for their respiratory symptoms. The anaerobic threshold (AT), and index of aerobic capacity, and symptomlimited maximal oxygen consumption (VO2 max (s.l)), VO2 at the end of exercise, fell to 78.4% and 79.1% of preoperative levels respectively one month after operation. Both indices recovered to 85% of preoperative levels at six months after operation. AT and VO2 max (s.l) values were expressed as a percent of predicted maximal VO2 values for age, body weight and sex (%AT, %VO2 (s.l)). The %VO2 max (s.l) was significantly lower in patients with pneumonectomy (n = 8) as compared with that in patients with lobectomy (n = 55) (51.1 +/- 6.4% vs 60.6 +/- 11.4%, p less than 0.05). Patients with thoracotomy (n = 35) only showed significantly higher %VO2 max (s.l) values (70.5 +/- 12.1%) than those of patients with lobectomy (p less than 0.05). The %AT did not show significant differences among different operative procedure groups. Despite a good preoperative correlation (r = 0.725) between %VO2 max (s.l) and %AT in all patients, there was no correlation between the indices postoperatively.(ABSTRACT TRUNCATED AT 400 WORDS)

Adult↗
PubMed1991

[Metastases to the mediastinal lymph nodes in a series of two-hundred-consecutive operations for primary lung cancer].

We examined the characteristics of lymph nodes metastases to the mediastinum on cases of two-hundred-consecutive operations for primary lung cancer from October of 1987 to May of 1990, comparing the intraoperative macroscopic diagnosis of lymph nodes to the histologic reports. The purpose of this study is to know how important the mediastinal dissection is and how many cases resulting in vain are hidden behind it. Thirty three cases were excluded because of limited operation or other reasons. Remaining a hundred sixty seven cases were divided on the basis of lymph node metastasis into following 5 groups. Forty three cases (26%), of which N2 disease was correctly diagnosed macroscopically, true positive for N2, were classified into group A. Sixteen cases (10%), group B, in which we failed to detect N2 positive from dissected specimens during operation, was considered to be false negative for N2, thirty one cases of N1 disease (18%), were classified into group C and thirteen cases of N0 disease (8%) into group D with false positive of lymph node prediction for metastasis. Sixty four cases of N0 disease (40%) were classified into group E, true negative for N0 prediction, which were correctly detected by macroscopic appearance of lymph nodes. Nine cases had only mediastinal lymph nodes metastases without hilar and lobar lymph node. Almost of them with this skip phenomenon occurred in the patients with adenocarcinoma in the upper lobe. It could be concluded that we dissected the mediastinal lymph nodes in this series, salvaging one N2 disease of ten cases and wasting our efforts four cases of those cases, in vain.

Adenocarcinoma↗
PubMed1991

[Tracheobronchoplasty for functional restoration].

We have experienced 10 cases of terminal mediastinal tracheostomy (TMT), 7 cases of laryngotracheal anastomosis with subtotal resection of cricoid cartilage (LTT), 5 cases of sleeve or wedge segmentectomy (SS, WS) for lung cancer with low pulmonary function, and 5 cases of carinal reconstructions (CR) with one stomal anastomosis between left lobar bronchus and trachea after partial resection of carina for tuberculous stenosis of left main bronchus. Modified TMT which stomaplasty was constructed with cervical and anterior chest skin flap different from primary procedure by Grillo was performed in 3 cases without innominate artery rupture nor cicatricial stomal stenosis. LTT by Pearson's procedure caused telescoped anastomosis. Pulmonary function was reserved in all 5 cases of SS and WS. Salvaged left lung by single stomal CR in the cases of tuberculous stenosis functioned well. Two different approaches for subaortic arch anastomosis, namely Pull-down and Pull-up, were proposed in single stomal CR. Pull-down provided excellent exposure of the carina without sacrifice of intercostal arteries. Indication of plasty was extended by TMT and LTT for upper limits of airway resection, SS and WS for limited operation against lung cancer, and single stomal CR for tuberculous stenosis of left main bronchus.

Bronchi↗
PubMed1990

[Reconstruction of the trachea invaded by advanced carcinoma of the esophagus, using the omental pedicle flap].

The omental pedicle flap (OPF) was used for wrapping the plastic site of trachea involved in esophageal cancer in two cases. Though one of them developed an anastomotic dehiscence, the catastrophe was held off to the minimum. There were some disadvantages of the esophageal surgery for utilizing the omentum, compared to the other thoracic operations. It is the problem that the gastroepiploic artery should be shared to the gastric tube to some extent. But OPF was considered to be the best tissue in these particular cases.

Carcinoma, Squamous Cell↗
PubMed1990

[Successful use of an omental pedicled flap for obliterating empyema associated with a large bronchial fistula].

We transferred the omentum up into the thorax through the diaphragm and succeeded in obliterating the empyema with a large bronchial fistula. A 52 year-old man with 30 years history of empyema was referred because of purulent discharge through the cutaneous fistula starting one year before. Open thoracotomy revealed a round opening 13 mm in diameter to the cavity, which resulted from lobectomy performed 30 years before. After a month of dress changing pseudomonas aeruginosa in the empyema space disappeared. Thereafter radical operation was performed in order to close the fistula. The omental flap supplied by the right gastroepiploic artery was transferred into the empyema space. The flap was sutured to the orifice of the bronchial stump. The residual space was obliterated by the thoracoplasty using the chest wall with ribs and lateral side of the empyema wall. Postoperative course was uneventful and bronchoscopy at two months after the operation revealed that the bronchial mucosa developed and covered over the large bronchial fistula.

Bronchial Fistula↗
PubMed1990

[Intrapleural minocycline for postoperative air leakage and control of malignant pleural effusion].

Minocycline pleurodesis with intrapleural pretreatment of lidocaine (150 mg) was performed on 19 patients. Minocycline was instilled into the pleural space for postoperative air leakage in 12 patients and control of malignant pleural effusion in 7 patients. Postoperative air leakage persisted longer than seven days was indicated instillation of minocycline (300 mg) with thoracostomy drainage. Satisfactory results were obtained in 11 of the 12 patients (92%) treated with this method. In 7 patients to control malignant pleural effusion, only one of these patients had recurrence of pleural effusion. Seventeen patients of all 19 subjects were free of pain following pleurodesis. None of these patients had a side effect of lidocaine. In conclusion of instillation, minocycline with thoracostomy drainage is a safe and an effective technique.

Adult↗
PubMed1990

Concomitant repair of congenital tracheal stenosis and complex cardiac anomaly in small children.

Severe obstructive lesion of the trachea combined with complex congenital cardiac anomaly has generally been regarded as a fatal disease. Herein we report the successful concomitant repair of severe tracheal stenosis and complex cardiac anomaly with the use of cardiopulmonary bypass in two cases. The first patient was a 5-year-old boy with tetralogy of Fallot associated with a localized intrathoracic tracheal stenosis caused by complete cartilaginous rings. Tracheal resection and end-to-end anastomosis combined with total correction of tetralogy of Fallot was performed with the aid of cardiopulmonary bypass. The second patient was a 5-month-old girl with a pulmonary artery sling, scimitar syndrome, and extensive tracheal stenosis. The patient underwent definitive correction of cardiac lesions and complete tracheal reconstruction with a cartilaginous graft with the aid of cardiopulmonary bypass. Utmost care was paid to avoid contamination during the operation. Both of the patients are doing well at present without any signs of complication, 2 years 5 months and 1 year 10 months after the operation, respectively. We advocate concomitant repair of both lesions, with cardiopulmonary bypass, in the surgical managements of infants and small children who have a difficult and otherwise fatal combination of complex congenital cardiac anomaly and severe intrathoracic tracheal stenosis.

Cardiopulmonary Bypass↗
PubMed1990

[Diagnosis of invasion to thoracic aorta and superior vena cava in lung cancer; comparative studies on CT and MRI in resected or autopsied cases].

The diagnostic accuracy of invasion to the thoracic aorta (n = 23) and the superior vena cava (n = 22) on CT and MRI was compared to operative or autopsied finding in lung cancer. MRI was slightly superior to CT in its ability to diagnose tumor invasion to them. It is noteworthy that this invasion could be easily demonstrated by multiplanar MRI. In conclusion, because CT or MRI has diagnostic weak point respectively, these modalities should be combined adequately corresponding to the areas of tumor invasion.

Aorta, Thoracic↗
PubMed1989

Adult pigment type (Peiffer) of sudanophilic leukodystrophy. Pathological and morphometrical studies on two autopsy cases of siblings.

Two autopsy cases of siblings with the adult pigment (Peiffer) type of sudanophilic leukodystrophy (SLD), which demonstrated the full-blown stage (case 1) and early stage (case 2) of demyelination, were examined. Numerous brown pigments deposited in demyelinated cerebral areas were characterized histochemically and ultrastructurally as lipofuscin and ceroid. Under the electron microscope formation of blebs due to myelin splitting associated with deposition of multilamellar myeloid bodies within them was a prominent feature in the demyelinated cerebral areas of case 2 as compared with case 1. However, various features of myelin degradation such as thinning, partial or complete circumferential myelin loss, and deposition of electron-dense material on the interperiodic lines were found in both cases. Blebs occurred in all layers of myelin, and axons were compressed by these blebs or the hydropically swollen inner lips of oligodendroglias. Oligodendroglias were relatively well preserved in the demyelinated and nondemyelinated areas in case 2, although the cytoplasm was hydropic. Many spheroids were present in demyelinated areas and were irregularly distributed in both cases. The peripheral nerves in case 1 presented essentially the same changes as those in the brain, although those in case 2 were not affected. Morphometrically, the results showed that hypomyelination was not the mechanism for this pigment type of SLD. One possible cause may be an accelerated ageing of the metabolic process of myelin turnover.

Astrocytes↗
PubMed1989

Statistical survey of tracheobronchoplasty in Japan.

In a survey of 142 hospitals in Japan, 1562 operations involving tracheobronchoplasty, 565 involving tracheoplasty, and 992 involving bronchoplasty were found to have been done from 1954 to 1984. The number of operations showed a steep increase from 1965 and reached more than 200 a year by 1984. This increase comes from larger numbers of bronchoplasty procedures being performed for lung cancer (58.8% in toto) and of tracheoplasty procedures for thyroid cancer (9.7% in toto). Fifty-seven operative modes could be classified, in which bronchial anastomosis was most frequent (62.1%), followed in order by tracheal anastomosis (18.0%), and tracheobronchial anastomosis (5.9%). Complications, encountered in 16.9% in toto, resulted in death in 22.3%, with fistula bleeding in all and anastomotic stricture in 47.7%. Anastomotic stricture alone had a higher mortality rate than anastomotic stricture combined with recurrent palsy (p less than 0.01). The tracheal anastomosis mode had a higher complication rate than that of the bronchial anastomosis mode (p less than 0.01). Among the 57 modes, the complication rates were lower than those of each stem mode in the following: suture of the tracheal wall (p less than 0.05), tracheal patch grafting (p less than 0.01), sleeve resection of the right main bronchus (p less than 0.02), and sleeve lobectomy of the right lower lobe (p less than 0.001). Complication rates were higher than those of each stem mode in these procedures: prosthetic replacement of the trachea (p less than 0.001), sleeve resection of the right main bronchus (p less than 0.05), and the montage-type carinal reconstruction (p less than 0.05) modes. The tracheal anastomosis mode was classified into two categories, standard and extensive. The latter showed complication rates higher than the former (p less than 0.01), tracheoplasty (p less than 0.0025), and the tracheal anastomosis stem mode (p less than 0.0025). Complication rates have decreased with time, being 21.8% with the tracheal anastomosis mode and 10.8% with the bronchial anastomosis mode in the past 9 years.

Adolescent↗
PubMed1989

[Surgical treatment of stage III and IV thymoma].

During past 15 years, 39 cases of thymoma were underwent surgical intervention. In these cases, invasive type, so called stage III and IV in Masaoka's classification were 19 cases. This report documents the results of extended operation in 19 patients treated for malignant thymoma. All patients had neoplasm which invaded adjacent structures; superior vena cava, pericardium, and lung. Eight patients had disseminated lesions in the pleural or pericardial cavities. All patients were underwent surgical exploration through median sternotomy (18 patients) or left thoracotomy (1 patient). Our surgical management to malignant thymoma is to have complete resection, even if tumor invades the great veins. Of 8 patients, superior vena cava and left innominate vein were resected with tumor and reconstructed with ringed PTFE. Mediastinal pleura and pericardium should be widely opened and intrapericardial or intrapleural disseminated lesions should be removed as far as possible. Malignant thymoma could be resected completely applying technique of vascular surgery. Good results were expected when tumor was resected with invading adjacent structures completely. Reoperation to the recurrent tumor is also important.

Humans↗
PubMed1989

[Successful simultaneous repair of tetralogy of Fallot and congenital tracheal stenosis in a 5-year old child].

Congenital cardiac anomaly combined with severe obstructive lesion of airway remains a surgical challenge. A case of 5-year old child with tetralogy of Fallot associated with congenital tracheal stenosis (cartilagenous ring) was reported. The patient had history of cyanosis and stridor since age 3 months and had been hospitalized repeatedly for recurrent respiratory distress. The diagnosis was first established and emergent Blalock-Taussig shunt was carried out during first admission at age 1 year and 7 months. On the fourth admission at age 5 year, a definitive surgical intervention was decided following re-evaluation of the patient by cardiac catheterization, bronchoscopy and bronchography. Trachea and heart were exposed through cervical collar and presternal skin incision and median sternotomy. Tracheal resection and end-to-end anastomosis combined with total correction of tetralogy of Fallot was carried out under cardiopulmonary bypass. Utmost care was paid to avoid contamination during the operation. He was extubated at 9th postoperative day and has been free from symptom 9 months after the operation.

Cardiopulmonary Bypass↗
PubMed1989

[A case of concomitant surgery of advanced valvular disease and lung cancer under cardiopulmonary bypass].

We successfully performed a concomitant operation in a patient with severe valvular heart disease with a giant left atrium and a pulmonary cancer. The operation was done via a median sternotomy under cardiopulmonary bypass. The patient was a 62-year-old man with congestive heart failure, NYHA class III. The CT ratio was 76%, and the volume of the left atrium estimated by a CT scan was above 900 ml. An abnormal shadow was recognized in the left upper lung field. Mitral valve replacement with St. Jude Medical valve (31 mm), and tricuspid annuloplasty with a Bex Reducer were performed. After an autonomous cardiac rhythm and a decrease in the size of the left atrium were confirmed, we went on to remove the upper lobe of the left lung under cardiopulmonary bypass. Twelve months postoperatively, the patient was doing well. For a complex case such as the present one, we recommend lobectomy via a median sternotomy using cardiopulmonary bypass as the technique of choice. This method assures good hemodynamic control and provides improved visibility of the pulmonary hilus.

Cardiopulmonary Bypass↗
PubMed1989

[A case of mesothelioma of the pleura with pneumothorax].

A 49-year old man underwent an operation for pneumothorax, during which a tiny tumor on internal surface of the thoracic wall was extirpated. As the tumor proved to be malignant mesothelioma postoperatively, it was planned to be followed up strictly after discharge, but the patient did not visit for 6 months after discharge. When he was admitted again because of cough and fever, the mesothelioma had already disseminated diffusely in the whole thoracic cavity. So he underwent total pleuropneumonectomy, but died 49 days after operation.

Humans↗