Biomedical subjects

S Nawata

Publications and source records attributed to S Nawata.

At least 37 records · Page 2Linked to original sources

PubMed1996

Disadvantages of muscle-sparing thoracotomy in patients with lung cancer.

At our institute patients with lung cancer had traditionally undergone lobectomy with mediastinal lymph node dissection using a standard posterolateral approach. The considerable morbidity associated with the standard posterolateral thoracotomy led us to investigate an alternative muscle-sparing approach. A prospective, randomized study of 30 patients with primary lung cancer (stage I or II) was performed to compare the following: operative field size, number of dissected lymph nodes, surgery time, postoperative pain, shoulder range of motion, and pulmonary function test results between patients who underwent either standard thoracotomy (SP group, n = 15) or the muscle-sparing thoracotomy (MS group, n = 15). The procedure should provide enough operative field size to access to mediastinum. Compared with the standard posterior thoracotomy, the muscle-sparing thoracotomy supplied a smaller operative field (218 +/- 31 versus 165 +/- 41 cm2) and required more surgery time (87 +/- 13 minutes) than the standard posterior thoracotomy (66 +/- 12 minutes). There were no significant differences in the number of dissected mediastinal lymph nodes. During the early postoperative days, pain and restriction of shoulder flexion were significantly less in the MS group than in the SP group. There were no significant differences in pulmonary function between the two groups. In terms of the operative field there is a marked disadvantage with the muscle-sparing incision compared with standard thoracotomy. The operative field is significantly smaller than with a standard thoracotomy, requiring more time to dissect the mediastinum; however, the pain is less and shoulder range of motion is superior to what is seen after standard thoracotomy during the early postoperative period. We conclude that there is no overall advantage to using the muscle-sparing incision in patients with lung cancer.

Female↗

PubMed1996

Isolated lung perfusion with FUDR in the rat: pharmacokinetics and survival.

BACKGROUND: Although surgical resection remains the mainstay of treatment for metastatic pulmonary colorectal cancer, 5-year survival approaches only 30% to 40%. We have developed a model of isolated left lung perfusion (ILP) with FUDR (2'-deoxy-5-fluorouridine) for the treatment of pulmonary colorectal metastases. FUDR ILP toxicity and pharmacokinetics were evaluated and compared with continuous intravenous infusion in the rat. METHODS: Toxicity was first evaluated in F344 rats (n = 17) after left ILP (20-minute perfusion at 0.5 mL/min) with 21 mg/mL (n = 11), 28 mg/mL (n = 2), 35 mg/mL (n = 2), and 70 mg/mL (n = 2) of FUDR. Animals were followed up and weights recorded for 14 days postoperatively before a right pneumonectomy was performed to evaluate the effect of FUDR perfusion on left lung function. In the second study, 32 rats (n = 8/group) underwent: systemic FUDR (intravenous), or ILP with 7, 14, and 21 mg/mL respectively (ILP 7, ILP 14, and ILP 21 groups). Left lungs and serum were analyzed for FUDR and 5-fluorouracil by high-performance liquid chromatography. RESULTS: Rats perfused with doses of FUDR greater than 21 mg/mL died perioperatively. All animals perfused at 21 mg/mL survived until day 14, and 8/11 survived a right pneumonectomy. Rats that survived ILP resumed normal weight gain and grooming habits within 1 week. Pharmacokinetic evaluation demonstrated that ILP at 21 mg/mL maximally elevated total lung FUDR and 5-fluorouracil levels (508.5 +/- 96.4 micrograms/g lung) in comparison with the ILP 14, ILP 7, and intravenous groups (299.1 +/- 44.8, 116.0 +/- 21.1, and 7.5 +/- 4.1 micrograms/g lung, respectively) (p < 0.05). Serum FUDR levels were 10.5 +/- 6.8, 1.3 +/- 0.5, 2.31 +/- 1.1, and 1.2 +/- 0.4 microgram/g lung (p = not significant) for intravenous, ILP 7, ILP 14, and ILP 21 groups, respectively. CONCLUSIONS: Isolated left lung perfusion with FUDR is well tolerated to a maximum dose of 21 mg/mL and results in significantly higher FUDR and 5-fluorouracil lung levels with low serum levels compared with intravenous treatment. These higher pulmonary levels may offer advantages in the treatment of pulmonary colorectal metastases.

Animals↗

PubMed1996

Isolated lung perfusion with melphalan for the treatment of metastatic pulmonary sarcoma.

OBJECTIVE: Isolated lung perfusion allows the delivery of high-dose chemotherapy to the perfused lung and is an efficacious modality in the treatment of pulmonary metastases in the rat. Melphalan activity in this model was investigated. METHODS: TOXICITY STUDY: Maximum tolerated dose of melphalan delivered by means of isolated lung perfusion was determined by survival after contralateral pneumonectomy. PHARMACOKINETICS STUDY: Nineteen rats were treated with melphalan administered either by isolated lung perfusion (2 mg) or intravenously (2 mg or 1 mg). Lung, pulmonary effluent, and serum melphalan were analyzed by high-pressure liquid chromatography. EFFICACY STUDY: On day 0, 41 rats received an intravenous injection of 5 x 10(6) methylcholanthrene induced sarcoma cells. On day 7, rats either received intravenous melphalan (2 mg [n = 10]; 1 mg [n = 8]) or underwent left isolated lung perfusion with 2 mg of melphalan (n = 12). Isolated lung perfusion with buffered hetastarch in sodium chloride (Hespan, n = 11) was used as control. On day 14, pulmonary nodules were counted. RESULTS TOXICITY: Maximum tolerated dose of melphalan delivered buy means of isolated lung perfusion was 2 mg. PHARMACOKINETICS: Left lung melphalan level was significantly higher in the isolated lung perfusion group (62.2 +/- 34.3 microg/gm lung) than in the intravenous treatment groups (6.9 +/- 1.9 microg/gm lung and 3.3 +/- 0.9 microg/gm lung, respectively) (p = 0.0002). EFFICACY: Significantly fewer left lung nodules were found in animals receiving melphalan by means of isolated lung perfusion (7 +/- 10) than in the groups receiving intravenous melphalan (60 +/- 21) or buffered hetastarch by isolated lung perfusion (84 +/- 52) (p = 0.01 and p = 0.0001, respectively). CONCLUSION: Isolated lung perfusion with melphalan is safe and effective in the treatment of pulmonary sarcoma metastases in the rat.

Animals↗

PubMed1996

Tumor necrosis factor-alpha stimulates the production of squamous cell carcinoma antigen in normal squamous cells.

Squamous cell carcinoma (SCC) antigen, a tumor marker of squamous cell carcinoma, is also increased in several nonmalignant skin lesions, e.g. pemphigus. The aim of the present investigation was to determine if tumor necrosis factor-alpha (TNF-alpha), one of the important environmental factors, stimulated the production of SCC antigen in the normal squamous cells. The exposure of normal human epidermal keratinocytes to TNF-alpha (100 IU/ml) for 72 h greatly increased the SCC antigen production. The stimulatory effect of TNF-alpha (1,000 IU/ml) on the production of SCC antigen was also observed in the normal squamous epithelium tissue. These results would be helpful for understanding the increase of SCC antigen in several nonmalignant skin disorders.

Antigens, Neoplasm↗

PubMed1996

Prostacyclin analog OP2507 prevents pulmonary arterial and airway constriction during lung preservation and reperfusion.

BACKGROUND: The effects of OP2507 on lung preservation with cold Euro-Collins solution and during the reperfusion period were evaluated. METHODS: For this study, canine lungs were flushed with a 10 micrograms/ml OP2507 solution (n = 7) or saline solution (control group, n = 7) (0.1 ml/kg body weight) and stored in the same solution. Pulmonary arterial pressure, pulmonary vascular resistance, airway pressure, respiratory capacity, and wet to dry weight ratio of the lungs were measured before and after 24 hours of cold preservation and after a 60-minute reperfusion period. RESULTS: Treatment with OP2507 significantly attenuated increases in pulmonary arterial pressure, pulmonary vascular resistance, and airway pressure after preservation and during the reperfusion period. Oxygen tension in outflow blood also was maintained with OP2507 treatment throughout the experimental period, whereas it was depressed during the reperfusion period in the control group. By electron microscopy, there was little evidence of vascular endothelial damage, such as cell swelling, detachment of endothelial cells from the lamina, and attenuation of the cytoplasm, in both groups. However, the tight junctions between cells were observed more clearly in the control group than in the OP2507 group, suggesting more cell membrane damage in the control group. CONCLUSIONS: Pretreatment with OP2507 prevented pulmonary artery and airway constriction after 12 hours of cold lung preservation and a decrease of oxygen tension in outflow blood during a 60-minute reperfusion period.

Animals↗

PubMed1995

Serine protease inhibitor activity of recombinant squamous cell carcinoma antigen towards chymotrypsin, as demonstrated by sodium dodecyl sulfate-polyacrylamide gel electrophoresis.

Squamous cell carcinoma (SCC) antigen was tested, by sodium dodecyl sulfate-polyacrylamide gel electrophoresis, for its ability to inhibit the activity of serine proteases, i.e., trypsin, chymotrypsin and elastase. We demonstrated that the serine protease inhibitor (serpin) of SCC antigen is specific for chymotrypsin. Preincubation of chymotrypsin with recombinant SCC antigen inhibited chymotryptic digestion of gelatin and ovalbumin through the formation of sodium dodecyl sulfate-stable complexes. These findings promote understanding of the biological functions of SCC antigen as serpin in the stratification of the normal squamous cells and in the malignant behavior of the tumor cells.

Animals↗

PubMed1995

Tissue expression of Sialyl Tn antigen in gynecologic tumors.

OBJECTIVES: To investigate tissue expression of Sialyl Tn antigen (STN) in gynecologic tumors, and to compare with its appearance in blood circulation. METHODS: Surgical specimens were obtained from 24 patients with malignant gynecologic diseases, including 7 ovarian cancers, 13 cervical cancers, 3 endometrial cancers, and 1 vulval cancer. Control tissues were also obtained at surgery from 28 patients with benign tumors of the ovary or uterus. RESULTS: Anti-STN monoclonal antibody (TKH-2) positively identified 6 (86%) of 7 ovarian cancers, 11 (85%) of 13 cervical squamous-cell carcinomas, but none of 3 endometrial cancers. None of the 28 benign tissues, including 11 ovarian benign tumors, showed positive immunostaining for STN, except 1 with an ovarian chocolate cyst which showed weak staining for STN. No expression was found in normal squamous epithelium distant from the lesion. Serum STN antigen was positive in 4 of 7 ovarian cancers (cutoff = 39 U/ml), but only in 2 of 13 cervical cancers, and none in the 3 endometrial cancers. CONCLUSIONS: These findings indicate different behaviors in the appearance of STN in tumor tissue and blood circulation, and also suggest the possible applicability of STN to immunohistochemical diagnosis of squamous-cell carcinomas.

Antigens, Tumor-Associated, Carbohydrate↗

PubMed1995

[Experience of absorbable staple in lobectomy].

We examined the differences between absorbable staple and un-absorbable staple in inflammatory reaction during the early post-operative period in lung cancer patients. From october 1993 to august 1994, absorbable staples (GIA 75-.060; United States Surgical Co., Ltd.) or un-absorbable staples (Multifire GIS 60 Titanium (3.8mm); United States Surgical Co., Ltd.) were applied in 10 lung cancer patients each. Duration of air leakage, massive pleural effuion (more than 100 ml/day), and high fever (over 38 degrees C), as well as the changes of leukocyte counts in peripheral venous blood and C reactive protein were compared between the two groups. The absorbable staple group show a mildly increased inflammatory reactions than those of un-absorbable staple group, but those were not significant differences. Absorbable staple was shown to be completely absorbed until 6 months in animal model. Absorbable staple is thought to be superior to un-absorbable staple, instead of mildly increased inflammatory reaction during the early post-operative period.

Absorption↗

PubMed1995

[Clinical analysis of 130 cases of Siberian silicosis].

One hundred thirty patients with Siberian silicosis occurring under exposure to large amounts of dust at labor in a siberian mine were analyzed for 67 clinical and 122 laboratory data. Eighty-eight of 130 patients are now alive, but 42 have already died. When they started work, 122 of the patients were under thirty years of age. The duration of work was 7 to 12 months for 17 patients, 13 to 18 for 43, and 19 to 24 for 40. Seventy-six of 99 patients were initially diagnosed with lung tuberculosis and 23 with silicosis. Almost all patients have complained of respiratory symptoms such as shortness of breath, cough, sputum, and cyanosis. All of the pulmonary function tests including %VC, FEV1.0/FVC, V25/height, RV, TLC, and DLco showed abnormal values. The chest roentogenograms showed 3 of type 1, 22 of type 2, 55 of type 3, and 124 of type 4. Of 124 type-4, large opacities, 84 were type A, 28 B, and 12 C. Of 416 small opacities, 144 were type P, 191 Q, and 81 R. The complications and secondary changes that appeared with progression of the disease were lung emphysema, hilar and mediastinal lymphnode enlargement, egg shell calcification in lymphnode, and bulla or bleb.

Adult↗

PubMed1994

[Congenital esophago-bronchial fistula in adult--report of a case].

A 52-year-old man had been having cough on drinking water since 30 years. He coughed out blood 20 years ago. Chest roentgenogram showed the infiltrating shadow in the right lower lung field and the left hilum. Chest computed tomogram in the left atrium level showed fistulous communication between the bronchus and the esophagus and cavity lesion. Esophagogram showed fistulous communication between the bronchus (rt. B7) and the middle third of the esophagus. Bronchogram showed the stenotic lesion of the right B7a and B*. And abnormal bronchus was revealed and fistula was suspected. The orifice of the fistula was seen by esophageal endoscopy. Through the right posterolateral thoracotomy, fistelectomy and covering with pleural flap over the esophageal suturing site were performed. Histologic finding of the resected specimen revealed fistula's wall composing of smooth muscle lined with squamous cell layer. This case is categorized as Braimbridge type II. The postoperative course was uneventful and the patient is now in free of complaints at the 6th month's P.O.D.

Bronchial Fistula↗

PubMed1994

[Modified Naclerio-Langer method under thoracoscopic procedure for pneumothorax due to rupture of a large bulla].

We managed a patient with pneumothorax caused by a large bulla by so called modified Naclerio-Langer method under thoracoscopic procedure. A 76-year-old female was hospitalized with recurrent left pneumothorax. Uncer the right lateral position, 3 Surgi ports were inserted through 5, 7, 9th intercostal space. There was a large bulla, 10 cm in diameter, with rupture at the ventral side. The bulla wall was partially resected and many bronchiolar openings were seen at the caudal side. Gregarious bronchiolar openings were resected with Endo GIA. Two residual openings were closed with 3-0 Dexon suture. The base of bulla was pleuralised by suturing the edges of the removed cyst with running suture of 3-0 Dexon. Because no air leaks was detected, a chest drain was inserted. Operation time was 215 minutes and she was discharged on 20th postoperative day. This procedure is usefull and not invasive.

Aged↗

PubMed1994

[Mediastinal lymph node dissection improves survival rate in N2(-) non-small cell lung cancer patients].

The effect of mediastinal lymph node dissection on survival rate in clinical N2(-) non-small cell lung cancer patients was assessed. N2(-) was evaluated by both pre-operative computed tomography studies and physical examination during surgery. Systematic mediastinal lymph node dissection, including nodes #1, 2, 3, 3a, 3p, 4, 7, 8 and 9 was performed in 27 patients (T1 or 2, N0 or 1, M0) since 1987 (dissected group). Survival rate and complications were compared with those in 21 patients treated before 1986, in whom mediastinal lymph nodes were not dissected (non-dissected group). 1, 3 and 5 year survival rates in the dissected group were 92.6%, 74.9%, and 74.9%, respectively, which were significantly higher than those in the non-dissected group (71.4%, 61.9% and 41.3%, respectively). Mediastinal lymph node metastases were detected histologically found in three patients, 11% of the dissected group. Respiratory complications showed a significantly higher incidence in the dissected group (p = 0.001). However these complications did not increase the mortality rate in that group. Among elderly patients over 70 years old (8 patients in the dissected group, 7 in the non-dissected group), survival rates were similar in the two groups. In conclusion, systematic mediastinal lymph node dissection significantly improved the survival rate in clinical N2(-) non-small cell lung cancer patients.

Aged↗

PubMed1993

[Chondrosarcoma of the trachea--report of a case].

A case of chondrosarcoma of the trachea in a 64-year-old man was reported. He was pointed out of benign tracheal tumor in September 1988. He was transferred to our hospital in September 1991 with respiratory distress attributable to asthma-like attack after bronchoscopic examination. Under right posterolateral thoracotomy, 1.7 cm length (3 rings) of the mediastinal trachea was resected and the trachea was reconstructed by end-to-end anastomosis with 3-0 Maxon interrupted sutures. The pathological diagnosis was a moderately well differentiated chondrosarcoma (grade II) of the trachea. Postoperative clinical course was uneventful without serious anastomotic complications. No local recurrence was seen 1 year after operation. It is necessary to follow meticulously the patients with chondrosarcoma of the trachea after surgery because of its low grade malignancy.

Chondrosarcoma↗

PubMed1993

[Acute massive pulmonary embolism--report of a case].

A 72-year-old female, who had received medication for hypertension and angina pectoris was hospitalized with complaining of an abrupt dyspnea. Roentgenogram of the chest revealed no abnormal findings except cardiac enlargement. An electrocardiogram showed overloading of the right ventricle. Arterial blood gas analysis of room air showed 55.4 mmHg of PaO2, 25.5 mmHg of PaCO2 and 7.30 of PH, respectively. Acute and massive pulmonary embolism was diagnosed by an emergent pulmonary arteriography. Despite intensive treatment such as infusion of urokinase and heparin for four days, thrombus was still detected in the left main pulmonary artery by a transesophageal echocardiography. By the result of ineffective conservative therapy, embolectomy was performed under cardiopulmonary bypass. However mechanical respiratory support was required for a long time due to the right heart failure, she is doing well for a year after the operation.

Aged↗

PubMed1991

[Two-dimensional and Doppler echocardiographic evaluation of intrauterine blood flow dynamics in the fetuses with a ventricular septal defect].

In nine fetuses with ventricular septal defect (VSD), intracardiac blood flow was observed with color Doppler ultrasound. Interventricular shunt velocity, maximum systolic velocity in the ascending aorta and pulmonary artery, trans-atrioventricular blood flow velocity, and the flow pattern in the inferior vena cava were also measured with pulsed Doppler ultrasound. The cardio-thoracic ratio and ejection fraction were measured by B- and M-mood ultrasound. In all four fetuses with isolated VSD a bidirectional shunt was demonstrated. In the three normal developed fetuses time analysis showed a right (RT)-to-left (LT) shunt during systole and a LT-to-RT during diastole with maximum systolic velocities of 61cm/s, 42cm/s and 68cm/s. In the five fetuses with complexed cardiac malformation, two fetuses had a unidirectional shunt and three fetuses had a bidirectional shunt, which was a LT-to-RT during systole and a RT-to-LT during diastole. These studies indicate that although the systolic pressure in the right ventricle is slightly higher than that in the left, the pressure is almost the same in both ventricles. The presence of unidirectional shunting or a different time relationship from that of normal fetuses in bidirectional shunting would necessitate a careful check for other cardiac malformations.

Blood Circulation↗

PubMed1991

[Recurrent thymic carcinoid tumor--report of a case].

A previously operated 62-year-old male with recurrent thymic carcinoid tumor was reported. This patient underwent resection of the thymic carcinoid tumor through left thoracotomy 7 years ago. Although the postoperative clinical course was uneventful, an anterior mediastinal tumor on the patient's chest was discovered after an X-ray examination due to a traffic accident in July, 1989. With the diagnosis of recurrent thymic carcinoid tumor, he underwent an excision of the anterior mediastinal tumor and residual thymus. He also underwent partial resection of the pericardium, mediastinal pleura, and left upper lobe of the lung. 42 cases with thymic carcinoid tumor that have been reported in the Japanese literature were reviewed. A perusal in the relevant literature suggested that total thymectomy was advisable because partial thymectomy was associated with a high risk of local recurrence and metastases.

Carcinoid Tumor↗

PubMed1991

[Thymic undifferentiated carcinoma with resection of superior vena cava: report of a case].

A case of a 75-year-old woman with thymic undifferentiated carcinoma was reported. Thymic carcinoma infiltrated the right pleura, epicardium, and superior vena cava. Total thymectomy with resection of the right pleura, epicardium, and superior vena cava was performed. The superior vena cava was reconstructed with a ringed Goretex. The patient received the chemotherapy such as CDDP, VDS and MMC, and also received radiation therapy (total 5,000 rad). The postoperative clinical course was uneventful. The definition and therapy of thymic carcinoma is unclear. We think that complete resection of carcinoma is necessary even if cancer infiltrates the superior vena cava.

Aged↗

PubMed1990

[Risk factors influencing lymph nodes metastasis in lung cancer with stage I, II or IIIA].

The purpose of this study was to assess the risk factors involved in the intrapulmonary, hilar and mediastinal lymph nodes metastases in seventy-eight patients with stage I, II or IIIA lung cancer postoperatively, which were resected from 1978 to 1988. In the histological type, the incidence of the mediastinal lymph nodes metastases in adenocarcinoma was higher than that in other types, such as squamous cell carcinoma and large cel carcinoma. In addition, the incidence of mediastinal lymph nodes metastases in the papillary type was significantly higher than that in the tubular type (p less than 0.05). The incidence of mediastinal lymph nodes metastases increased as invasion into the lymphatic duct and/or vessel was demonstrated (p less than 0.01, p less than 0.05). The proximal type, in which the cancer spread to the secondary segmental bronchus, metastasized to the hilar lymph nodes more frequently than the distal type, in which the cancer was located in the bronchus distal to the third segmental one. Although there was no significant relationship between the site of the cancer and the incidence of the metastatic lymph nodes, the hilar and superior mediastinal lymph nodes (#1-4, 3a, 3p) metastases were demonstrated regardless of the lobe in which the cancer was located. The primary tumor located in the left lower lobe of the lung tended to metastasize to the inferior mediastinal lymph nodes (#8, 9). Twenty-five out of 33 patients with the lymph nodes metastases had hilar metastatic lymph nodes. However, the mediastinal lymph nodes metastases were proved in 5 patients without any intrapulmonary and hilar lymph nodes metastases. No relationship between the histological differentiation, size of tumor, pT factor and the incidence of lymph nodes metastases was found.

Adenocarcinoma↗