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Biomedical subjects

T Naruke

Publications and source records attributed to T Naruke.

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↗
PubMed1996

Retained sponge after thoracotomy that mimicked aspergilloma.

A 63-year-old man, who had had operation for the treatment of pulmonary tuberculosis 40 years before the present disorder, was admitted to our hospital with massive hemoptysis. Radiologic examinations showed a mass shadow with a crescent air sign resembling aspergilloma. Operative exploration showed a well-encapsulated retained surgical sponge between the middle and lower lobes. A bronchial fistula was present in the lower lobe. The appearance of the crescent air sign was caused by drainage of exudative effusion around the retained sponge. Intrathoracic retained surgical sponges associated with bronchial fistula should be included in the differential diagnosis of patients who have mass shadows with crescent air signs but no evidence of Aspergillus infection, and who have a history of thoracotomy.

Aspergillosis↗
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↗
PubMed1996

Failure to detect mutations in the retinoblastoma protein-binding domain of the transcription factor E2F-1 in human cancers.

The functions of the transcription factor E2F-1 are regulated by the RB protein through the RB-binding domain of E2F-1 and this factor is considered to be an important molecule that functions downstream of the RB protein. In order to determine whether E2F-1 that cannot bind to RB might be associated with various human cancers, we searched for mutations in the RB-binding domain of E2F-1 using samples of DNA from various clinical specimens obtained from 406 cancer patients (with lung, pancreatic, stomach, colon, esophageal, and hepatic cancers) by analysis of polymerase chain reaction-mediated single-strand conformational polymorphism. No mutations or deletions were detected in genes for E2F-1 from any of the tumor tissues examined. These results suggest that a mutation or deletion in E2F-1 that might affect binding of the RB protein is not involved in human cancers.

Base Sequence↗
PubMed1996

Peripheral lung cancer: screening and detection with low-dose spiral CT versus radiography.

PURPOSE: To compare low-dose spiral computed tomography (CT) with radiography of the chest for the screening and detection of small peripheral lung cancers in a high-risk population. MATERIALS AND METHODS: Posteroanterior and lateral radiographs and low-dose spiral CT scans were obtained twice a year from September 1993 to April 1995 in 1,369 individuals (a total of 3,457 examinations) who were at high risk for lung cancer. Low-dose spiral CT parameters were 120 kvP, 50 mA, 10-mm collimation, and 2:1 pitch. RESULTS: Peripheral lung cancer was detected in 15 of 3,457 examinations (0.3%). Among the 15 cases, the results of chest radiography were negative in 11 (73%), and the tumors were detected only at low-dose spiral CT. The detection rates of low-dose spiral CT and chest radiography were 0.43% (15 of 3,457 examinations), respectively. Fourteen (93%) of the 15 (exclusion of one pulmonary lung cancer) tumors were stage I. CONCLUSION: Low-dose spiral CT was superior to chest radiography in the screening and detection of peripheral lung cancer in high-risk individuals. Further large-scale studies are warranted, however, to clarify the efficacy and cost-effectiveness of low-dose spiral CT in a randomized, controlled population.

Adult↗
PubMed1996

[Early lung cancer].

The number of patients with early lung cancer, which is detected by screening high risk group for lung cancer using sputum cytology, or by screening using CT is increasing. Recent studies have shown that some histologic types of early peripheral adenocarcinoma have no lymph node involvement. In addition, the incidence of multicentricity of peripheral type of early adenocarcinoma, detected by meticulous evaluation of CT images, is not so low. Video-assisted limited resection may be feasible in such cases. In spite of the excellent results of surgical resection for the hilar type of early lung cancer, surgery is at risk in some patients because of underlying pulmonary dysfunction and of a high incidence of second primary lung cancers. Endoscopic photodynamic therapy or brachytherapy may be an alternative to surgery as standard treatment in selected cases.

Cytodiagnosis↗
PubMed1995

[Thoracoscopic surgery of lung cancer].

Thoracoscopic surgery is a dream that was realized by the remarkable progress achieved in the video equipment system and the development of advanced surgical tools, in particular the endoscopic stapler. The main reasons for the rapid and wide introduction of thoracoscopic surgery are that patient injury is much less than with the traditional chest operation, there is no need for blood transfusion, the physical and mental loads on the patient are much less, and recovery from surgery is much faster. When performed by a skilled surgeon, it is a safe surgical operation, and this surgical technique may become applicable to about one-half of thoracic surgery. The application of robotics and the use of artificial satellites in the sector of thoracoscopic surgery may be possible in the future.

Female↗
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

Tumor doubling time and prognosis in lung cancer patients: evaluation from chest films and clinical follow-up study. Japanese Lung Cancer Screening Research Group.

A study was made of the relation between tumor doubling time and prognosis in lung cancer patients. Tumor doubling time was calculated in 237 patients from two serial chest x-ray films. The mean doubling time was 166.3 days, with 221.6 days for adenocarcinoma, 115.2 days for squamous cell carcinoma, 67.5 days for large cell carcinoma, 86.3 days for small cell carcinoma and 225.2 days for others. The patients were divided into three groups in a log-normal distribution of tumor doubling times 109.6 and 252.4 days. The patients with a doubling time of less than 109.6 days were classified as 'rapid growing', those with a doubling time of more than 252.4 days as 'slow growing' and those with a doubling time in between as 'intermediate growing'. The five-year survival rates were 23.3% for 81 'rapid growing' patients, 36.7% for 81 'intermediate growing' patients and 43.3% for 75 'slow growing' patients, with statistically significant differences between groups 'rapid growing' and 'intermediate growing' of P < 0.05 and between groups 'rapid growing' and 'slow growing' of P < 0.01. The five-year survival curves for those who underwent curable resections were 42.4% for 36 rapid growing patients, 53.7% for 31 'intermediate growing' patients and 70.1% for 43 'slow growing' patients. The difference between rapidly growing and slowly growing tumors was statistically significant (P < 0.05). Patients with the more rapidly growing tumors showed a tendency to have a poorer prognosis. It was confirmed that the doubling time of a tumor is an independent factor in the prognosis of lung cancer patients.

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↗
PubMed1993

Prognostic significance of pleural lavage cytology immediately after thoracotomy in patients with lung cancer.

Pleural lavage cytology immediately after thoracotomy was performed in 467 patients with lung cancer who had little or no pleural effusion. Forty-two patients (9.0%) had positive results. The positivity of pleural lavage cytology was significantly related to the degree of pleural extension of the tumor, microscopic pleural dissemination, cytologic results of minimal pleural effusion, pathologic stage, presence of lymphatic permeation or vascular invasion, and cell type (adenocarcinoma was predominant). The 3-year survival of the patients having negative and positive results of cytology were 68.7% and 22.9%, respectively. The prognosis of the group with positive results was as poor as that of patients with stage IIIB or IV disease. Pleural lavage cytology is an important prognostic factor that indicates microscopic exfoliation of cancer cells into the pleural cavity, that is, subclinical malignant pleural effusion.

Humans↗
PubMed1993

What are the risk factors for arrhythmias after thoracic operations? A retrospective multivariate analysis of 267 consecutive thoracic operations.

Two hundred sixty-seven operations performed consecutively at the National Cancer Center Hospital, Tokyo, in 1990 were reviewed to define the prevalence, type, clinical course, and, especially, risk factors for arrhythmias after thoracic operations. Arrhythmias were identified in 63 operations (23.6%) and were more prevalent in several subgroups of patients than in others--those with lung cancer, pneumonectomy, mediastinal lymph node dissection, and those older than 70 years of age. Supraventricular tachycardias, of which atrial fibrillation was the most common, comprised 95.3% of the cases; bradyarrhythmia and ventricular ectopic beats were seen in only three and four cases, respectively. Arrhythmias were most likely to develop on the second day after the operation. Eighty percent of the arrhythmias disappeared within 3 days after onset, and sinus rhythm was finally restored with digitalis or other antiarrhythmic drugs in all patients except one, who had a myocardial infarction. Arrhythmias were not the direct cause of any of the seven in-hospital deaths. A multivariate analysis of 16 variables revealed that age and extent of pulmonary resection were significant risk factors. Despite these significant risk factors, arrhythmias after thoracic operations could be managed without special prophylaxis and were not closely related to higher mortality.

Aged↗