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Biomedical subjects

T Naruke

Publications and source records attributed to T Naruke.

At least 37 records · Page 2Linked to original sources
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↗
PubMed1994

[Video-assisted thoracic surgery (VATS) for intrathoracic tumors].

Owing to the advent of new thoracoscopic instrument and technique, video-assisted thoracic surgery (VATS) has become a new standard in the resection of intrathoracic tumors. Thoracoscopy can be used as both exploratory and therapeutic means. Included as the indication for VATS resection are as follows: benign and malignant lung tumors such as lung cancer, metastatic lung tumor, and etc., benign mediastinal tumors, and benign pleural tumors. Still the indication for VATS resection for malignant disease, especially for lung cancer, is not defined. Further improvement is required in the resectional technique and instruments.

Endoscopy↗
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↗
PubMed1992

Correlation of L-myc RFLP with metastasis, prognosis and multiple cancer in lung-cancer patients.

For further study of the correlation of L-myc restriction-fragment-length polymorphism (RFLP) and metastasis of lung cancer to lymph nodes or other organs at the time of surgery, L-myc RFLP was analyzed in 252 Japanese lung-cancer patients. A close correlation between L-myc RFLP and metastasis was confirmed in this large number of patients (p = 0.01). The correlation was particularly pronounced in cases of adenocarcinoma and squamous-cell carcinoma. Poor prognosis (additional metastases after surgery) was observed in lung-cancer patients with L-S (identified as long and short bands produced with EcoRI) and S-S type L-myc RFLP. In addition, the death rate of lung-cancer patients with the L-S and S-S types was greater than that of those with the L-L type. Lung-cancer patients of the L-S and S-S types had almost 4 times higher incidence of multiple cancer in the lung, pharynx and other organs than those with the L-L type. Our results indicate that, in patients with lung cancer, genetic disposition with respect to the L-myc gene influences the extent of metastasis, the incidence of multiple cancers and prognosis.

Combined Modality Therapy↗
PubMed1992

Survival for clinical stage I lung cancer not surgically treated. Comparison between screen-detected and symptom-detected cases. The Japanese Lung Cancer Screening Research Group.

To assess the extent of overdiagnosis bias in lung cancer screening, clinical Stage I lung cancer cases detected by chest radiograph examination, with histologic or cytologic evidence of malignancy and not treated by surgical operation, were followed up for more than 10 years. Of 1297 screen-detected and 1297 symptom-detected cases collected from 20 institutions, 42 screen-detected and 27 symptom-detected cases satisfied the study criteria. In about half of the cases, the patients had no contraindication for surgical treatment, but they refused surgical procedure. All such patients from the screen-detected and symptom-detected groups died within 122 and 67 months, respectively, of diagnosis. Among the screen-detected and symptom-detected cases, 80% and 81%, respectively, of the patients died of lung cancer. The median survival time was 25 and 13 months for those in the screen-detected and symptom-detected groups, respectively. The difference in survival was statistically significant between the two groups, which indicated the effect of lead time and length-biased sampling. Analysis of the causes of death other than lung cancer showed that there was no difference in the observed cumulative rates of deaths of other causes between the two groups, and these figures were almost the same as those expected from the general population. This indicates that overdiagnosis bias would be minimal in screen-detected lung cancer cases detected by chest radiograph examination.

Aged↗
PubMed1992

A case-control study for evaluating lung-cancer screening in Japan. Japanese Lung-Cancer-Screening Research Group.

In order to evaluate the efficacy of lung-cancer screening, a case-control study was conducted using the data from 50 areas where population-based lung-cancer screening programmes have been operated by local municipalities. In most areas, chest X-ray examinations for all participants and sputum cytology for high-risk participants were offered annually. Case series consisted of 273 deceased lung-cancer cases. For each case, 2 to 5 controls (a total of 1,269 controls) were collected from those who were alive at the time of diagnosis of the corresponding case, matched by sex, age, smoking status and type of health insurance. Cases and controls were limited to a high-risk group for males and a non-high-risk group for females. Screening histories, which were obtained from the list of screenees, were compared between case and matched controls for the identical calendar period before the time of diagnosis of the case. The odds ratio of dying from lung cancer for those screened within 12 months vs. those not screened was 0.72 (95% confidence interval 0.50-1.03; p = 0.07). The odds ratio increased towards unity, as the length of time in which screening histories were compared increased. After adjusting for some other variables, which appeared to be associated with the opportunities of chest X-ray examination, the estimated odds ratio did not change. These results suggest some benefits from lung-cancer screening in terms of reduction of lung-cancer mortality and should be subject to further research.

Adult↗
PubMed1992

Closure of fenestra in Clagett procedure: use of rectus abdominis musculocutaneous flap.

Empyema developed in a 62-year-old man after right pneumonectomy for lung cancer. According to the Clagett procedure, an open window thoracostomy was made with two ribs removed. After 5 weeks, primary closure of the fenestra was attempted. Because the fenestra was too large to be primarily closed, a rectus abdominis musculocutaneous flap was successfully transposed to cover the chest wall. There was no evidence of recurrence of empyema during 11 months' observation after closure. In patients with a large fenestra and with little tissue left for closure, the rectus abdominis musculocutaneous flap could be of great help in completing the Clagett procedure.

Abdominal Muscles↗
PubMed1992

Efficacy of lung cancer screening; comparison of results from a case-control study and a survival analysis. The Japanese Lung Cancer Screening Research Group.

A case-control study to evaluate the efficacy of lung cancer screening conducted by us showed that lung cancer screening may reduce the mortality of the disease up to 28%. Assuming this efficacy is unbiased, and that the screening rate is 51.6%, which was observed in the control group in the above study, the number of lung cancer deaths prevented by screening in the study period was calculated to be 47 for males and females combined. In the same study population, screen-detected lung cancer patients (N = 207) in the same study period were followed and the 7-year survival rate (46.9%) was compared to the 5-year survival rate (11.3%) obtained by the Osaka Cancer Registry, in which screen-detected lung cancer patients were only 1.8%. The number of lung cancer deaths prevented by screening, estimated by the difference in the above two survival rates, was 74 (95% confidence interval; 55-93). The number of lung cancer deaths prevented by screening estimated from the case-control study was significantly lower than that estimated from the survival analysis. This indicates that the efficacy of lung cancer screening estimated by the case-control study was within the range that could be explained by the actual long-term survivors among the screen-detected patients in the study population.

Adult↗
PubMed1992

Bronchopleural fistulas associated with lung cancer operations. Univariate and multivariate analysis of risk factors, management, and outcome.

During a 28-year period, 52 bronchopleural fistulas developed after pulmonary resection of 49 primary and three recurrent lung cancers at the National Cancer Center Hospital, Tokyo. During the same period there were 2359 pulmonary resections for primary lung cancer; the prevalence of bronchopleural fistula was 2.1%. Multivariate analysis on 15 variables in the most recent 1360 resections revealed significant risk factors for bronchopleural fistula: wider resection such as pneumonectomy, residual carcinomatous tissue at the bronchial stump, preoperative irradiation, and diabetes. Univariate analysis further recognized a risk in preoperative bronchial arterial infusion and the postsurgical stage of lung cancer. Six patients were not treated. Apart from chest tube drainage in seven patients, surgical repair was attempted in 39, direct resuture of the stump in 16, wrapping in 25, thoracoplasty in 31, completion pneumonectomy in 6, and other treatments. Despite various treatments, 37 patients (71.2% mortality) died from fistula-related complications (such as regurgitation of infected pleural fluid through the fistula and airway/intrathoracic bleeding). Even for patients whose fistulas were cured and who were discharged, the average hospital stay was 189 days. Further investigation is necessary to answer whether prevention by flap coverage is of any benefit.

Adult↗
PubMed1992

Carcinoid tumor of the lung: clinicopathological study of 32 cases.

A retrospective study was conducted on 32 patients who had had bronchial carcinoid tumors between 1965 and 1989. The average age of the patients was 48.5 years, with a male to female ratio of 3.6:1. Of the 32 patients, 28 were diagnosed pathologically to have typical bronchial carcinoid tumors and the other four, atypical bronchial carcinoid tumors. Twenty-two of the 28 typical bronchial carcinoid tumors were classified as stage I, but only one of the four atypical bronchial carcinoid tumors was at stage I. Two typical carcinoid tumor patients and two atypical carcinoid tumor patients were found, pathologically, to have lymph node metastasis. The typical carcinoid tumors showed a more significant endobronchial polypoid growth than the atypical carcinoid tumors (P = 0.0138). The five-year-survival rate was 100% in patients with typical carcinoid tumors and 25% in those with atypical carcinoid tumors. The difference between the five-year-survival rate for the typical carcinoid and atypical carcinoid patients was statistically significant (P = 0.001).

Adult↗
PubMed1991

[Lung cancer screening--present status and the problems].

For the counter measure having been indicated against increasing mortality rate in lung cancer cases, indication of lung cancer screening was started in 1987 in line with the law of insurance established for old aged people. In order to decrease the death rate in cases with lung cancer, methods of the counter measure were established for early detection of lung cancer by Chest X-ray and sputum cytology as well as early operative indication. Although results of these procedures have suggested effectiveness attained by mass screening, standard of efficiency have not been same in all the areas, where the screening having been performed, but there has been difference between respective areas, therefore, in order to make the every result of mass screening carried out in areas similar, it is necessary to make the indication of mass screening being done with careful attention for lung cancer cases.

Female↗
PubMed1991

[Operation for preservation of lung function in lung cancer cases--study on bronchoplasty].

In the period between 1962 and 1989, there were 2,279 resected cases of primary lung cancer, out of which 134 cases (21 cases in stage I; 29 cases in stage II; 66 cases in stage IIIA; 9 cases in stage IIIB; 9 cases in stage IV) underwent bronchoplasty excluding carinal resection. Survival rate was 38.2% in these cases including one operative death. Five year survival rate was significantly better than 22.5% in 453 cases which underwent pneumonectomy. To preserve pulmonary function, enhance curability and extend scope of operative indication, bronchoplasty is a safe and valuable procedure for selected cases of squamous carcinoma and low-grade malignancy.

Bronchi↗
PubMed1991

[Bronchopleural fistulas developing after pulmonary resections for lung cancer predisposing factors, management, and prognosis].

During the past 28 years, 55 bronchopleural fistulas (BPFs) have developed after pulmonary resections for 52 primary and 3 recurrent lung cancers at the National Cancer Center Hospital, Tokyo. During the same period, there were 2446 pulmonary resections for primary lung cancer, the incidence of BPF being 2.1%. As an operative mode of initial resections, pneumonectomy (26 cases) was most common, followed by lobectomy (20 cases), bronchoplasty (8 cases), and stump resection for recurrence (1 case). The following predisposing risk factors for BPF development were identified: resection for locally advanced lung cancer (80.8%); residual carcinomatous tissue at the resected end of bronchus or anastomosis line (29.1%); hypoalbuminemia, diabetes, or steroid administration (20%); pre- and postoperative adjuvant therapy (49.1%). Seven cases received no treatment for BPF because of sudden deaths by massive airway bleeding (5 cases), worsening pneumonia (1 case), and spontaneous recovery (1 case). Remaining 48 cases underwent treatment; tube thoracostomy only in 7 cases and surgical interventions in 41 cases, one case of which was lost during rethoracotomy due to vascular rupture. Initial surgical interventions were composed of combinations of the following procedures; direct re-suture of fistula (16 cases); amputation of the stump and re-closure (3 cases); completion pneumonectomy (6 cases); reinforcement and wrapping of fistula (27 cases); thoracoplasty (29 case). Among these 40 surgical repairs, fistula was successfully closed in 11 cases. In 5 cases, the fistula closure could be achieved after subsequent surgical procedures. Direct re-suture was successful only in 4 cases. In spite of various kinds of treatment, overall prognosis was quite poor; 37 cases died of BPF-related complications (67.3% mortality).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗