Biomedical subjects

R Tsuchiya

Publications and source records attributed to R Tsuchiya.

At least 19 recordsLinked to original sources

PubMed1997

Thoracoscopic evaluation of histologically/cytologically proven or suspected lung cancer: a VATS exploration.

To evaluate the diagnostic value of video-assisted thoracic surgery (VATS), VATS exploration was performed in 135 patients with histologically/cytologically proven or suspected lung cancer. In 31 patients with pulmonary nodules suspected to be lung cancer, VATS exploration was intended to determine their histology by wedge resection. A histological diagnosis was made in all of the patients: 12 lung cancers (38.7%), 12 inflammatory granulomas (38.7%), four hamartomas (12.9%), and three others. VATS exploration (staging) was performed in 116 surgical candidates with documented lung cancer, including the 12 patients diagnosed by VATS wedge resection. Inoperable factors were demonstrated by this procedure in five patients (4.3%): malignant effusion without dissemination in three, malignant effusion with extensive dissemination in one, and extensive dissemination without effusion in one. Furthermore, N2 nodal metastasis at Botallo's ligament was demonstrated by this procedure in two patients, which met the eligibility criteria for a clinical study. Although the documented number of patients was relatively small, VATS exploration obviated the need for painful thoracotomy, selecting better treatment and for evaluating eligibility criteria for prospective clinical trials. The results suggest that this procedure is useful in candidates for lung cancer surgery.

Biopsy, Needle↗

PubMed1997

Video-assisted lobectomy in the elderly.

STUDY OBJECTIVES: Video-assisted lobectomy for pulmonary malignancy seems to have potential merits, especially in compromised patients such as the elderly. This study was undertaken to assess the feasibility of this new approach in this special age group. PATIENTS: Video-assisted lobectomy was attempted in eight patients older than 78 years of age with preoperatively diagnosed T1N0 or T2N0 lung carcinomas of peripheral origin. In one patient with squamous cell carcinoma, the tumor was diagnosed after surgery as metastasis from tongue carcinoma. The patients ranged in age from 78 to 85 years (average, 81.3 years). RESULTS: The procedure was completed successfully in six patients (75%), while the other two patients underwent lobectomy after conversion to open thoracotomy because of bleeding from the pulmonary artery at the hilum in one and extensive pleural adhesions in another. Among the six patients who underwent video-assisted lobectomy, there were no operative deaths or serious complications attributable to this technique, although two patients had prolonged air leakage for 7 and 11 days, respectively. CONCLUSIONS: This approach, which is feasible even in patients older than 80 years, is likely to offer a benefit to such patients if they are selected properly. During this procedure, the possibility of wound extension in case of an intraoperative accident must always be borne in mind, especially in elderly patients. The advantage of this approach remains undetermined in this special age group.

Aged↗

PubMed1997

[Extended resection for lung cancer].

Only one third of the patients with lung cancer can be identified as operative candidates. For the other two thirds operation was not indicated, because they have advanced lung cancer with distant metastases or locally advanced lung cancer invading neighboring organs. The results of surgery of lung cancer depend on TNM staging. Resection of stage IIIA, IIIB and IV were not indicated because these gave poor 5-year survival rates. However, a few 5-years survivors without any evidence of recurrence of lung cancer have been reported recently. Chest wall resection and tracheal carinal resection became standard operations because they given a 5-year survival rates of 30% and 34% respectively. Left atrium resection also becomes a standard operation with 22% of 5-year survival rate. Resection of superior vena cava is applied for locally advanced cases with or without invasion to the tracheal carina. Resection of vertebra and main pulmonary artery are being tried with careful and exact evaluation of the extent of primary tumor and invading organs using information provided by new diagnostic equipment.

Heart Atria↗

PubMed1996

Pulmonary resection for metastatic colorectal cancer: experiences with 159 patients.

We reviewed the clinical courses of 159 patients between February 1967 and May 1995 for the purpose of examining the survival of patients who had pulmonary resection for metastatic colorectal cancer. The cumulative survivals at 5 years and 10 years were 40.5% and 27.7%, respectively. Fifteen patients (10%) were alive more than 10 years after the thoracotomy without any evidence of recurrence. The cumulative survival at 5 years for 39 patients who had hepatic metastases before thoracotomy was 33%. There was a statistically significant difference in survival between patients with extrapulmonary metastases and those with only intrapulmonary metastases before thoracotomy. The number of pulmonary metastases and the presence of hilar or mediastinal lymph node metastases affected postthoracotomy survival. There was no significant difference in survival on the basis of sex, age, location of the primary cancer, size of the pulmonary tumors, mode of operation, or disease-free interval. Surgical treatment for pulmonary metastases from colorectal cancer in selected patients, even those who had hepatic metastases before thoracotomy, might improve prognosis.

Adult↗

PubMed1996

Lymph node involvement, recurrence, and prognosis in resected small, peripheral, non-small-cell lung carcinomas: are these carcinomas candidates for video-assisted lobectomy?

To determine the clinicopathologic characteristics of peripheral non-small-cell carcinomas, the cases of 337 patients undergoing major pulmonary resection with complete lymphadenectomy were retrospectively reviewed with regard to lymph node involvement, recurrence, and prognosis. All of the tumors were 3.0 cm or less in diameter and were categorized as T1 (318 patients) or T2 (19). Eighty-eight patients (26.1%) had lymph node involvement: 32 (9.5%) at N1 nodes, 55 (16.3%) at N2 nodes, and 1 (0.3%) at N3 nodes. Although the prevalence of lymph node involvement did not differ significantly with tumor histologic type, it was quite low in squamous cell carcinomas 2.0 cm or less in diameter. Of the 56 N2/3 metastases, 14 (25%) occurred in a "skipping" manner, and all but one had a nonsquamous histologic makeup. Of the 213 patients with a follow-up period of 5 years or more, 59 patients (27.7%) showed cancer recurrence. This occurred at a distant site in 67.8% of the cases. Five-year survival rates based on nodal status were 91.9% (NO), 61.8% (N1), 44.5% (N2), and 0% (N3). Because of the relatively high prevalence of lymph node involvement, complete hilar/mediastinal lymphadenectomy should be routinely done regardless of tumor histologic type and size, as long as patients are at good risk. However, in squamous cell histologic types, mediastinal lymphadenectomy might be dispensable if the tumor is less than 2.0 cm in diameter, or if the hilar node is proved to be tumor-free on pathologic examination of the frozen section during operation. Although video-assisted major pulmonary resection currently has limited application, this new technique may represent a surgical option in resection without complete lymphadenectomy.

Adenocarcinoma↗

PubMed1996

AFP-producing squamous cell carcinoma of the lung in an adolescent.

We report a case of primary lung cancer in a 16-year-old boy. A histologic diagnosis of squamous cell carcinoma was made by bronchoscopic biopsy before surgery. The serum alphafetoprotein (AFP) level was markedly elevated at 193 ng/dl. Preoperative and postoperative evaluation revealed no evidence of scrotal mass. We performed right pneumonectomy with combined resection of the invaded portion of the left atrium under extracorporeal circulation. Despite the rapid improvement in the patient's general condition after surgery, the AFP level continued to increase without a transient decrease and reached 3160 ng/ml on the 23rd postoperative day. When the patient was readmitted because of dyspnea and headache on the 36th postoperative day, hypercalcemia of 13.9 mg/dl was noted, and this was resistant to subsequent treatment. The patient died on the 46th postoperative day.

Adolescent↗

PubMed1995

Gene trap capture of a novel mouse gene, jumonji, required for neural tube formation.

A mouse mutation, termed jumonji (jmj), was generated by a gene trap strategy. Expression of the trapped gene (jmj gene), as monitored by X-gal staining, was detected predominantly at the midbrain-hindbrain boundary and in the cerebellum, depending on the stage of development. All embryos homozygous for the jmj mutation died before embryonic day 15.5. Some, but not all, of the homozygotes developed an abnormal groove in a region just anterior to the midbrain-hindbrain boundary on the neural plate at embryonic day 8-8.5 and showed a defect in neural tube closure in the midbrain region. Analyses of jmj cDNA revealed that the jmj gene is novel, conserved among vertebrates, and disrupted by vector insertion in the jmj homozygotes. The amino acid sequence deduced from the cDNA shared a portion of significant homology with human retinoblastoma-binding protein RBP-2 and with a putative protein encoded by human gene XE169 that escapes X-chromosome inactivation. These results suggest that jmj gene is essential for normal morphogenesis of the neural tube.

Amino Acid Sequence↗

PubMed1995

Purification of canine alpha-fetoprotein and alpha- fetoprotein values in dogs.

Canine alpha-fetoprotein (AFP) was purified by a two step method. Anti-dog AFP antiserum was produced by immunizing rabbits with canine fetal serum proteins that failed to bind to an anti-dog whole adult serum affinity column. Canine AFP was then purified from amniotic fluid using affinity chromatography with anti-dog AFP antiserum. The bound protein was then eluted and further purified by passage through an anti-dog whole adult serum column. The non-binding protein's purity and specificity was confirmed by immunoelectrophoresis, double-diffusion, sodium dodecyl sulphate polyacrylamide gel electrophoresis (SDS-PAGE) and cross-reactivity with anti-human AFP. The molecular weight of canine AFP was approximately 66,000 by SDS-PAGE. Normal adult dogs had serum AFP levels of 7-63 ng ml-1. Levels of AFP were not altered by pregnancy but did show a small peak 2 days following parturition. Newborn puppies had serum AFP levels of 14.08 +/- 5.94 mg ml-1 at birth. By 1 week of age, serum AFP had fallen to 0.766 +/- 0.758 mg ml-1. AFP values in newborn puppies are thus considerably higher than those previously reported in humans, pigs and cattle.

Amniotic Fluid↗

PubMed1995

Pulmonary resection for metastatic soft tissue sarcomas.

The therapeutic results of pulmonary resection for metastatic soft tissue sarcomas were analyzed. From 1970 to 1992, 23 patients (15 male and 8 female) underwent 40 pulmonary resections for metastatic soft tissue sarcomas. Nine (39%) patients had multiple thoracotomies for recurrences (range, 2-6). The 5-year actuarial overall survival was 32% (median, 28 months). Statistical analysis showed that age, gender, location of primary tumor, histology, site of pulmonary metastasis, tumor doubling time, or chemotherapy did not impact on survival. Significant prognostic factors associated with improved survival (p < 0.05) included a disease-free interval, and completeness and extent of the initial pulmonary resection. Patients with disease-free intervals > or = 12 months survived longer (5-year survival, 48.5%) than patients with disease-free intervals < 12 months (12%). Patients who could be rendered free of disease at their initial thoracotomy, without extended chest-wall resection, achieved a better outcome (5-year survival, 44%) than the others (5-year survival, 0%).

Actuarial Analysis↗

PubMed1994

Malignant germ cell tumor of the mediastinum: a multimodality therapeutic approach.

Twenty-five patients with a malignant germ cell tumor of the mediastinum were treated at the National Cancer Center Hospital, Tokyo. Three patients had pure seminomas while 22 had a nonseminomatous histology. The treatment modalities consisted of surgery alone in 7 patients, surgery with chemotherapy and/or radiation in 14, and chemotherapy and/or radiation without surgery in 4. Cisplatin-based chemotherapy was administered in nine patients, one of whom successfully underwent high-dose chemotherapy with autologous bone marrow transplantation after resection of the tumor. A complete response was achieved in only five patients. The overall survival rate at 5 years was 33.5% and the median survival time was 51 weeks. Eight patients (32%), all of whom underwent surgery either with or without chemotherapy and/or radiation, were free of disease with a mean follow-up period of 439 weeks (72-1,120 weeks). The median survival times for 14 patients undergoing combined modality treatment, 7 patients undergoing surgery alone, and 4 patients undergoing chemotherapy and/or radiation were 83, 16, and 18 weeks, respectively.

Adolescent↗

PubMed1994

Extended resection of the left atrium, great vessels, or both for lung cancer.

One hundred one patients with locally advanced lung cancer underwent combined resection of the lung and the left atrium with or without the great vessels. A single additional organ was resected in 92 patients, two organs in 8 patients, and three organs in 1 patient. The left atrium was resected in 44 patients, the superior vena cava in 32, the adventitia of the aorta in 21, the aorta in 7, and the pulmonary artery in 7. The most important factors affecting survival defined by multivariate analysis were postoperative pneumonia, complete resection, postoperative bleeding, and lymph node metastasis (p < 0.05). Thirteen patients survived 3 years or more and 10 of the 13 survived 5 years or more. The 5-year survival rate for all patients, including 8 with operative death, was 13%, and the median survival time was 9.2 months. The 5-year survival and median survival time were 19% and 13.8 months after complete resection and 0% and 6.5 months after incomplete resection (p < 0.01). The 5-year survival and median survival time for patients with pathologic stage IIIA, IIIB, and IV were 16.8% and 16.8 months; 18.3% and 9.8 months; and 0% and 5.4 months, respectively. There was a significant difference between stages IIIA plus IIIB and stage IV (p < 0.05). The 5-year survival after left atrium resection was 22%. Extended resection was worthwhile for the patients undergoing complete resection and without postoperative complications.

Adenocarcinoma↗

PubMed1994

Computed tomography-guided coil injection and thoracoscopic pulmonary resection under roentgenographic fluoroscopy.

To remove a small, chest roentgenogram-negative, computed tomogram-positive nodule, we developed a novel technique of thoracoscopic pulmonary resection. This technique consists of the computed tomography-guided coil injection of a metallic coil and subsequent thoracoscopic resection under roentgenographic fluoroscopy. During the thoracoscopic resection, the fluoroscopic image was a valuable aid in determining the location of the nodule and in ensuring that the stapler was applied with a sufficient distance from the coil. Because this technique helps to determine the exact location of the nodule regardless of its depth from the pleural surface, even a minithoracotomy for direct palpation can be avoided.

Adenocarcinoma↗

PubMed1994

Thymic carcinoma: proposal for pathological TNM and staging.

Recently, Yamakawa et al. following Masaoka's clinical staging of thymic epithelial tumors, proposed a TNM classification and staging system for thymic epithelial tumors including thymoma and thymic carcinoma. The present authors consider that division of thymomas into circumscribed types (either encapsulated or non-encapsulated but confined to within the thymus) and those invasive to adjacent organs or structures is sufficiently practical, and that a staging system is applicable to thymic carcinoma, carcinoid tumors and germ cell tumors of the anterior mediastinum, which are more malignant than thymoma. Therefore, the utility of the Yamakawa/Masaoka TNM and staging system was evaluated and a modification proposed based on experience with 16 thymic carcinomas. Although there were no cases at stage II, the survival curves obtained using the proposed modified system were more clearly separated between stages I and III or IV and between stages III and IV than the curves obtained using the Yamakawa/Masaoka system. However, the differences were not significant because of the small number of cases included. A statistically significant difference was noted between the survival curves for patients who underwent complete and incomplete surgical resection of the tumor. The utility of this proposed TNM and staging system must be evaluated by other investigators, since no cases of small cell carcinoma, lymphoepithelioma-like carcinoma, sarcomatoid carcinoma and clear cell carcinoma were included in this series, all of which are considered to have high-grade histology. An evaluation of carcinoid tumor and germ cell tumor of the anterior mediastinum must also be made.

Adult↗

PubMed1994

Assay of ornithine carbamoyl transferase activity: modification for application to bovine serum.

An assay procedure for ornithine carbamoyl transferase (OCT), which is known to be a liver-specific enzyme, was modified to be adaptable to bovine serum. The concentration of carbamoyl phosphate and the pH of the reaction reagent solution shifted to 60 mM and 7.2, respectively. These modifications contributed to the augmentation of assay sensitivity. The day-to-day reproducibility was 7.9% (coefficient variation) for serum with high OCT activity and 14.8% for normal bovine serum. The activity was stable for 3-4 months by the storage at -20 degrees C and at least 6 months at -80 degrees C. The OCT activity and other biochemical components including aspartate aminotransferase and gamma glutamyl transpeptidase were measured in sera from 164 dairy or raising cows reared at 7 farms. The normal level of OCT activity in sera from these cows ranged from 9.2 to 25.1 U/l (mean +/- 2SD). By comparison between the farms, the highest mean value of OCT activity was found in a farm where cows were suspected to have some kind of latent liver disease from the data of other biochemical parameters. We conclude that the OCT activity is a very useful diagnostic indicator of liver disease in cattle.

Animals↗

PubMed1994

[Principles for adjuvant and neoadjuvant chemotherapy].

Early systemic therapy, either immediately after treatment of the primary tumor with surgery (adjuvant chemotherapy) or as initial treatment before local control (neoadjuvant chemotherapy) has been carried out to attempt to eliminate occult micrometastatic disease. The principal goal of adjuvant/neoadjuvant treatment is to increase the effectiveness of treatment over what can be obtained from surgery alone. The primary endpoint of interest is survival. Disease- or recurrence-free survival is often used as a surrogate measure of survival. Adjuvant/neoadjuvant chemotherapy studies generally employ regimens that have appeared most active against the same tumor in advanced stages. The doses and schedules used in the adjuvant setting have also paralleled those for advanced disease. Recently, a prospective randomized study of adjuvant chemotherapy in the patients with breast cancer have shown that the increase of dose intensity of chemotherapy lead to improved disease-free and overall survival. Moreover, prospective randomized studies are needed to support timing decisions for adjuvant/neoadjuvant chemotherapy. While awaiting the appearance of more effective drugs and more sensitive staging techniques, we should continue to investigate variations of dose and schedule of adjuvant/neoadjuvant chemotherapy.

Antineoplastic Agents↗

PubMed1993

Hyperbaric oxygen therapy in the treatment of refractory peripancreatic abscess associated with severe acute pancreatitis.

Five patients with peripancreatic abscesses associated with severe acute pancreatitis were treated by hyperbaric oxygen therapy (HBO). In 3 patients, the course after surgical mobilization of the pancreas and drainage of the pancreas bed was complicated by peripancreatic abscesses. HBO was conducted under a pressure of 2.8 atmospheres for two hours daily. Four of the 5 patients showed a progressive improvement in their condition. In one patient who failed to respond despite seven sessions of HBO, Pseudomonas aeruginosa was isolated from the discharge, and resection of necrotic tissue and drainage were performed. The main effects of HBO were the alleviation of high spiking fever, the improvement of white blood cell count and serum amylase levels, and the reduction of the abscess size. We recognized HBO to be a successful treatment for peripancreatic abscess associated with severe acute pancreatitis and better results were obtained than in cases that did not receive HBO.

Abscess↗

PubMed1993

Heterotopic autotransplantation of a pancreas segment with enteric drainage after total or subtotal pancreatectomy for chronic pancreatitis.

Four patients with chronic alcoholic pancreatitis and one patient with idiopathic chronic pancreatitis, who had total or subtotal distal pancreatectomies for persistent pain, underwent simultaneous autotransplantation of a pancreas segment to preserve the pancreatic function. The segment was autotransplanted heterotopically to the iliac fossa with anastomosis of the splenic vessels to the iliac vessels to prevent reinnervation, and the pancreatic duct was anastomosed to the intestine to preserve exocrine function. Postoperatively, the patency of the graft vessels was confirmed by angiography in every patient. Complete pain relief has been obtained in all patients with a followup duration of 4-89 mo. Except for one patient who had been treated preoperatively with insulin injections for diabetes, the patients remained normoglycemic without exogenous insulin administration and demonstrated satisfactory insulin secretion during a 75-g oral glucose tolerance test. An exocrine pancreatic diagnostant test using p-aminobenzoic acid yielded nearly similar levels to the preoperative value for all patients. Heterotopic autotransplantation of the pancreas segment appears to be effective for preserving pancreatic function, as well as providing permanent pain relief for patients with chronic pancreatitis who require extensive resection of the pancreas.

Adult↗

PubMed1993

Thoracoscopy for staging of lung cancer.

The recent advancements in diagnosis and treatment of thoracic disease have been made mostly in line with advancements in endoscopic equipment design and refinement of thoracoscopic surgery techniques. Between March 1992 and February 1993, video thoracoscopic procedures were performed in 50 patients. Twelve of the 50 patients were diagnosed with lung cancer. Thoracic staging was performed in 6 patients (clinical diagnosis of suspicious intrapulmonary metastasis, 3 patients; intrapulmonary metastasis and/or lymph node metastasis, 1 patient; interlobar pleural effusion, 1 patient; and pleural dissemination, 1 patient). There were no complications or mortality associated with these procedures. Our initial experience has indicated that thoracoscopic staging for lung cancer is a safe and effective procedure.

Adenocarcinoma↗