Biomedical subjects

T Onitsuka

Publications and source records attributed to T Onitsuka.

At least 19 recordsLinked to original sources

PubMed2006

[New method for localization of the small ground-glass opacity lesion in resected lung].

A small lesion showing ground-glass opacity (GGO) by preoperative computed tomography (CT) is sometimes difficult to detect after lobectomy when it locates in the central part of the lobe. In order to facilitate to identify the lesion for marking pathological specimen, we developed a new method using CT. After surgery, the resected pulmonary lobe was expanded with airflow through the bronchial stump and the target lesion was examined with CT. The laser beam of the CT on the surface of the lung is used as a guiding line for cutting. Through the application of this method for 2 clinical cases, it was found to be possible to exactly identify the GGO lesion from the surface of the resected lung enabling to visualize a fresh surface of the lesion like a CT image with minimal destruction of the structure.

Aged↗

PubMed2006

[pN0 stage IA lung cancer downstaged from pN2 IIIA by induction therapy; report of a case].

A 75-year-old male of adenocarcinoma in non-small cell lung cancer (NSCLC) was diagnosed to be p-staged IIIA by a preoperative mediastinoscopy. After the induction chemotherapy of cisplatin (80 mg/m2, day 1, 4 weeks, 2 cycles) plus docetaxel hydrate (60 mg/m2, day 1, 4 weeks, 2 cycles), we performed lobectomy and lymph nodes dissection. The postoperative pathological results showed no metastasis of the resected lymph nodes. The postoperative stage has been down to be pN0 IA from pN2 IIIA. After the adjuvant therapy of docetaxel hydrate (60 mg/m2, day 1, 4 weeks, 2 cycles), the postoperative serum carcinoembryonic antigen level has been normalized without a recurrence for more than 2 years. A pathological staging with a mediastinoscopic diagnosis for the suspected clinical IIIA-staged NSCLC should bring us a good assessment of the induction therapy.

Adenocarcinoma↗

PubMed2006

Risk factor analysis for ascending aorta and aortic arch repair using selective cerebral perfusion with open technique: role of open-stent graft placement.

AIM: The present study was designed to identify risk factors that may induce adverse outcome defined as permanent neurological dysfunction and mortality after aortic arch surgery using selective cerebral perfusion by logistic regression analysis and to reveal the role of open stent-graft placement. METHODS: One hundred and nineteen consecutive patients underwent ascending aorta and/or aortic arch operation with open technique between 1995 and 2005 were examined. Ascending aorta and/or hemiarch was replaced in 28 patients, total arch in 75 patients, and proximal or distal aortic arch replacement in 16 patients. Open stent-graft placement was used in 25 patients. RESULTS: The in-hospital mortality rate was 9.2%. Permanent neurological dysfunction occurred in 10 patients (8.4%). Thoracotomy (P=0.0331) and cardiopulmonary bypass time (P=0.0238) were significant risk factors for permanent neurological dysfunction. Preoperative shock (P=0.0266) was significant independent risk factor for mortality. Emergent operation (P=0.0454), thoracotomy (P=0.0232), and cardiopulmonary bypass time (P=0.0379) were significant independent risk factors for adverse outcome. The duration of selective cerebral perfusion was not associated with adverse outcome. Open stent-graft placement has no need of thoracotomy for aneurysm extending descending thoracic aorta and time variables concerning the operation were significantly shorter in the patients with open stent-graft placement than in patients with standard operation for total arch replacement. RESULTS: Thoracotomy was significant risk factor for adverse outcome after aortic arch repair using selective cerebral perfusion. Total arch replacement with open stent-graft placement can avoid the need of thoracotomy and reduce time variables concerning the operation to improve the surgical

Adult↗

PubMed2006

[Surgical treatment for traumatic tracheobronchial injuries].

Tracheobronchial injury is a relatively rare but often fatal condition due to the injury from the neck to the chest. Different clinical features depend on the site of injury. We experienced 5 cases of tracheobronchial injury; cervical trachea in 2, thoracic trachea in 1, tracheal carina in 1, left main bronchus in 1. Three cases were caused by blunt trauma by traffic accident and 2 cases were due to penetrating injury (stab wound and gunshot wound). Thoracotomy with primary repair for 3 (simple repair, bronchoplasty, pneumonectomy) and cervicotomy for 2 (end-to-end anastomosis) were performed. One patient with severe associated injury died of multiple organ failure after surgery. Accurate diagnosis and the appropriate treatment in the early stage is essential in the treatment of tracheobronchial injury.

Adult↗

PubMed2005

Prognostic determinants for lung cancer patients with preoperative high serum carcinoembryonic antigen levels.

BACKGROUND: Several reports have indicated that preoperative high serum carcinoembryonic antigen (CEA) levels are associated with poor survival after surgical resection in lung cancer. METHODS: 82 consecutive lung cancer patients with preoperative high serum CEA levels (> 5 ng/mL) were included in this study. Postoperative serum CEA level was also measured. Prognostic indicators were evaluated. RESULTS: Among patients with a preoperative high serum CEA level, a serum CEA level higher than 10 ng/mL, pT status, pN status, and positive pleural lavage cytology findings were unfavorable prognostic indicators, whereas age, gender, smoking status, histologic subtype were not. Postoperative serum CEA levels of all but 2 patients decreased, however those of 28 patients did not return to normal range. Our result showed that patients with postoperative high serum CEA level had poor prognosis. Multivariate analysis demonstrated that pT status, pN status, and postoperative high serum CEA level was an independent prognostic determinant. CONCLUSIONS: In lung cancer patients with preoperative high serum CEA levels, pT status, pN status, and normalization of serum CEA level after surgery are significant prognostic determinants.

Adenocarcinoma↗

PubMed2005

Inflammatory cytokine gene expression in different types of granulomatous lesions during asymptomatic stages of bovine paratuberculosis.

The granulomatous lesions in bovine paratuberculosis have been classified into two types, i.e., the lepromatous type and the tuberculoid type. To clarify the immunopathologic mechanisms at the site of infection, we compared inflammatory cytokine gene expression between the two types of lesions. Samples were obtained from noninfected control cows (n = 5) and naturally infected cows (n = 7) that were diagnosed by enzyme-linked immunosorbent assay (ELISA) and fecal culture test. Although none of the infected cows showed clinical signs, tuberculoid lesions were observed in five cows (tuberculoid group) and lepromatous lesions in two cows (lepromatous group). Among the cytokines examined by reverse transcription-polymerase chain reaction (RT-PCR), Th2-type cytokines interleukin-4 (IL-4) and IL-10, and Th1-type cytokine IL-2 were expressed more significantly in the lepromatous group than in the tuberculoid (P < 0.01) and noninfected groups (P < 0.05). No statistical differences were observed in the expression of interferon-gamma, IL-1 beta, TNF-alpha, and GM-CSF among lepromatous, tuberculoid, and noninfected groups. Expression of proinflammatory cytokine IL-12 mRNA, however, did not differ among the three groups; IL-18 was expressed at lower levels in the lepromatous group than in the tuberculoid group and the noninfected group (P < 0.0001). Moreover, the number of cells in which IL-18 mRNAs were detected by in situ hybridization was markedly decreased in the lepromatous group. These results indicate that the formation of lepromatous-type lesions or tuberculoid-type lesions may be influenced by alterations in Th1/Th2-type cytokine production and that IL-18 may play an important role in a Th1-to-Th2 switch in paratuberculosis.

Animals↗

PubMed2005

[Clinical assessment of the thoracic surgical diseases associated with von Recklinghausen's disease].

Type I neurofibromatosis (NF-I), also referred to as von Recklinghausen's disease, is an autosomal dominant disease characterized by neurofibromas and abnormal cutaneous pigmentation (café-au-lait spot). We studied retrospectively the 8 cases operated in our hospital between January 1979 to December 2002, which were complicated with von Recklinghausen's disease and a thoracic surgical disease. The patients were 6 males and 2 females and the age from 16 to 70 (the averaged age was 36 +/- 22). The thoracic diseases were consist of mediastinal tumors (n = 7) and esophageal cancer (n = 1). The operative procedures were tumorectomy (n = 6), subtotal esophagectomy (n = 1), and pericardial cystectomy (n = 1). The mediastinal tumors were neurofibroma (n = 3), malignant schawannoma (n = 1), ganglioneurinoma (n = 2), and pericardial cyst (n = 1). Malignant neoplasms were recognized in 2 cases (25%). The postoperative survival was 10 months for malignant schwannoma, and 8 months for esophageal cancer, and the others were alive. For 1 case of neurofibromas, there was observed to be the reoperated one after the postoperative recurrence. von Recklinghausen's disease are apt to be complicated with thoracic surgical neoplasms, it should be required a careful and systemic exploration especially for malignant neoplasms.

Adolescent↗

PubMed2005

[Primary lung cancer; assessment of the disclosed 5-year survival rate by the Internet website].

The disclosed 5-year survival rate for lung cancer in the Internet website represents a various difference by each institution. The better inferiority of the survival has been listed in a table to compare with other institutions and has been reported in magazines and media with a lack of an enough inspection, i.e., with a sufficient considering of a risk adjustment such as patient's background, operative policy, postoperative adjuvant therapy, and statistical background. We report our outcome of the surgical treatment for primary lung cancer. Of 875 patients treated for lung cancer in our department for 23 years between January 1980 and December 2002, 115 patients containing of 42 cases in 1997 and of 48 ones in 1992 and of 25 ones in 1987 were selected and the accumulated survival analysis was treated by Kaplan-Meier method. Eighty males and 35 females were between 15 and 80-year-old (average 63.2 +/- 11.4). The pathological classification was adenocarcinoma (n=69), squamous cell carcinoma (n=32), and others (n=14). The operative procedures were pneumonectomy (n=14), bilobectomy (n=12), lobectomy (n=85), and wedge resection (n=4). The survival time was from 29 days to 182 months (median survival time was 1471+/- 1180 days, the averaged time was 49 months). The 5-year survival rate was 41.4 +/- 9.1% (n=25) in 1987, 35.6 +/- 6.2% (n=48) in 1992, and 56.0 +/- 7.0% (n=42) in 1987, respectively (log-rank test, p = 0.2555). The 10-year survival rate was 24.1 +/- 7.9% in 1987 and 8.5 +/- 3.6% in 1992, respectively. The 5-year survival rate was as follows: IA 81.0 +/- 8.6% (n=20), IB 73.7 +/- 10.1% (n=19), IIA 57.1 +/- 18.7% (n=7), IIB 55.6 +/- 16.6% (n=9), IIIA 28.6 +/- 7.6% (n=35), IIIB 15.4 +/- 10.0% (n=13), IV 16.7 +/- 10.8% (n=12), respectively. The 5-year survival rate was as follows: male 42.8 +/- 5.3% (n=80), female 63.2 +/- 7.3% (n=35), respectively (p = 0.0147). In regard to the histological classification, the 5-year survival rate was as follows: adenocarcinoma 47.2 +/- 5.9% (n=69), squamous cell carcinoma 50.8 +/- 8.9% (n=32), respectively (p = 0.9012). As a rule of the disclosure on the internet website, we report our survival data by accompanying with minimum parameters such as, patient's background, pathological types, gender, pathological stages, and mean survival rate with standard error. When we compare the 5-year survival rate with other institutes, in considering of a risk adjustment, we would carefully have to estimate the determined survival rate with a standard error.

Adenocarcinoma↗

PubMed2005

[Surgery for the thymoma combined with pure red cell aplasia and myasthenia gravis].

UNLABELLED: Pure red cell aplasia (PRCA) and myasthenia gravis (MG) are respectively combined with thymoma, however, these 3 complications are extremely rare coexisted as a clinical triad. A 73-year-old female with mediastinal tumor found in 2000 was pointed out anemia in June 2002. As PRCA was diagnosed by the bone marrow examination, blood transfusion had been performed. By a chest computed tomography (CT), a thymoma in size of 7 x 5 cm in diameter was recognized in the anterior mediastinum. The serum level of anti-acetylcholine receptor antibody was elevated to be 35 nmol/l. MG was simultaneously diagnosed with a decreased power of neck muscle. The extended thymectomy was performed in August 2002, and pathological diagnosis disclosed a 'type AB' by World Health Organization (WHO) classification. After the operation, the decreased power of neck muscle had been improved, however, PRCA had not been remitted in the early-postoperative term. Blood transfusion had been required (2-4 units/1-2 weeks) for the postoperative 7 months' term. A cyclosporin (250 mg/day) as an adjuvant therapy was administered in April 2003. One month later, the patient's serum level of Hb had been over 10 g/dl without blood transfusion. The patient has been followed up with reducing the dose of cyclosporin. CONCLUSIONS: Surgery for a thymoma combined with PRCA and MG was effective for MG but not for PRCA in an early-postoperative term, however, a multimodality therapy with immunosuppressant as a postoperative adjuvant should bring a favorable outcome to patient's clinical data, and the postoperative long-observation must be critical in this case.

Aged↗

PubMed2004

[Thymothymectomy for the thymoma with pure red cell aplasia; report of a case].

UNLABELLED: We report a case of thymothymectomy for the thymoma with pure red cell aplasia (PRCA). A 31-year-old male with a general fatigue had a severe anemia (hemoglobin 3.1 g/dl) since November 1997. By the bone marrow examination, PRCA was diagnosed and treated with blood transfusion and immunosuppressive drug (cyclosporin: CYA) administration but anemia had not been improved. The chest computed tomography displayed a 3 cm in a diameter of thymoma located in the anterior mediastinum. The extended thymothymectomy had been performed in February 1998, pathological detection disclosed Masaoka classification stage I, type AB was diagnosed due to the World Health Organization (WHO) classification. PRCA had not obtained an immediate remission during the postoperative-early term, while, adjuvant therapy (CYA 300 mg/day) has been continued and it brought a complete remission of PRCA in August 2001 (after the postoperative 3 years and 6 months later). CONCLUSIONS: Even though only thymothymectomy for thymoma with PRCA showed no effectiveness for the postoperative-early remission of PRCA, however, the combination of thymectomy and the postoperative adjuvant therapy (CYA) should bring a better outcome, and the continuous follow-up would be required for a long postoperative term.

Adult↗

PubMed2004

[Bilateral lower lobectomies for pulmonary mucormycosis].

Mucormycosis is an extremely rare case of pulmonary mycosis, its prognosis is very poor, and known as an opportunistic infection among immunocompromised hosts accompanied with other primary chronic disease. We report here a case of bilateral lower lobectomies carried out by two-stage operation for pulmonary mucormycosis combined with diabetes mellitus (type I) and severe resistance to an antimycobiotics under biblicographical considerations. A 36-year-old female was diagnosed as a diabetes mellitus (type I), and has been administrated with an insulin injection in 1989 at the age of 22-year-old. The patient was suffered a dry cough in June and the bilateral abnormal shadows were pointed out by the chest X-ray film in November, 2002. By transbronchial lung biopsy, Mucor fungus was confirmed in grannulomatous lung specimen. Intravenous injection of amphotericin B could not be continued due to the unavoidable side-effects from this agent. As the lung mass shadow was enlarged increasing and strongly suggested an abscess, formation in its focus, and then the left lower lobectomy was performed as the first step of surgical treatment and the right lower lobectomy was done on the postoperative forty-fourth day as the second step. The postoperative prognosis was considerably uneventful. After bilateral lower lobectomies, the patient could try a walk and go upstairs with a moderate dyspnea. A possible surgical resection should be conducted for the pulmonary mucormycosis, when the medicinal therapy showed an uneffectiveness and/or an infectious lesion was shown as restricted lesion.

Adult↗

PubMed2003

Prognostic significance of bcl-2 expression in resected pN2 non-small cell lung cancer.

AIMS: The prognosis of non-small cell lung cancer with pathologic mediastinal lymph node involvement (pN2) is poor, we wished to study the expression of p53, bcl-2 by immunohistochemistry in a series of such patients. METHODS: Clinicopathologic factors were investigated in relation to prognosis in 60 patients with resected pN2 non-small cell lung cancer. RESULTS: The 5-year survival rate was 21.7%. Positive staining for p53, and bcl-2 was found in 29/60 and 12/60, respectively. Patients with bcl-2 positive tumor had a more favorable survival than those with bcl-2 negative tumor (P=0.0054). The expression of p53 was not related to patients' survival. Multivariate analysis showed that Bcl-2 expression and single N2 station were independent prognostic factors. CONCLUSIONS: Patients with bcl-2 positive tumors may comprise a favorable prognostic subgroup in pN2 non-small cell lung cancer.

Adult↗

PubMed2003

The meaning of the turning point of the index of motor current amplitude curve in controlling a continuous flow pump or evaluation of left ventricular function.

In this series, we investigated the meaning of the t-point of index of motor current amplitude (ICA) curve from a point of view of flow rate on in vitro and in vivo studies. On mock circulation loop and left ventricular assist device (LVAD)-equipped pigs, we detected the t-point and compared the pump flow at the t-point with the simultaneous cardiac output. The pump flow at the t-point showed high correlation against the simultaneous cardiac output for in vitro or in vivo study. By detection of the t-point of the ICA curve and measuring or estimating the pump flow at t-point, the cardiac output may be assessed without any sensor in various cardiac conditions.

Animals↗

PubMed2003

[Ruptured aortic arch aneurysm with hemorrhagic cardiac tamponade; report of a case].

The ruptured aortic arch aneurysm with cardiac tamponade is rare and has severely high mortality. We report a case of ruptured aortic arch aneurysm with cardiac tamponade. A 66-year-old man who had syncope attack was transferred to city hospital. Brain computed tomography (CT) showed no significant lesion and he admitted to our hospital for suspecting of aortic dissection. Chest CT showed ruptured aortic arch aneurysm and pericardial effusion. Emergent operation was done on the same day. It was found that the hematoma beneath the tunica adventitia existed at the distal arch and extended to the ascending aorta. Cardiac tamponade was caused by rupture of subadventitial hematoma in pericardial space. Aortic arch replacement was performed using selective cerebral perfusion under deep hypothermia. Postoperatively, he had no cerebral complication and was discharged uneventfully.

Aged↗

PubMed2003

[Clinical study on the surgical cases of the ruptured thoracic aortic aneurysm].

The prognosis of the ruptured thoracic aortic aneurysm is poor. Even if the surgical treatment was performed, the clinical outcome does not sufficiently satisfy us. Between January 1978 to July 1999, 171 cases of thoracic aortic surgery were operated in our department, in which 12 patients were with the ruptured thoracic aortic aneurysm without acute dissection. The aneurysm was located in ascending aorta (2), aortic arch (6), descending aorta (3), and thoracoabdominal aorta (1). The aneurysm was ruptured into thorax (4), pericardium (2), mediastinum (3), lung (2), and esophagus (1). The operative procedure was artificial vascular graft replacement (9), patch closure (2), and aneurysmal interposition (1) [bypass with ascending aorta to abdominal aorta)]. The operations were performed during hypothermic circulatory arrest with antegrade selective cerebral perfusion (6), under total (1) or partial complete extracorporeal circulation (5). The hospital death was 33% (4/12). The causes of death were cerebral complication (2), sepsis (1), and multiple organ failure (1). The 12 patients were divided into 2 groups: group A; 8 cases with alive; group D; 4 cases with hospital death. We compared and analyzed the perioperative factors of these 2 groups. On intraoperative factors, operation time (minute) demonstrated a significant difference (498 +/- 129 in group A v.s. 851 +/- 227 in group D, p < 0.05). No significant difference was observed between the groups on extracorporeal circulation time, aortic clumping time, selective cerebral perfusion time, systemic circulatory arrest time, intraoperative blood loss, and blood transfusion. The postoperative major complication was revealed in 6 cases (50%, 6/12), cerebral infarction (3), sepsis (2), and hoarsness (1). In conclusions, to make an effort to shorten an operative time as possible, and to prevent the postoperative neurological dysfunction under selective cerebral perfusion, those efforts should contribute to a good postoperative outcome for the ruptured thoracic aortic aneurysm.

Aged↗

PubMed2003

[Study of surgical treatment with omental flap transposition for chronic empyema].

It is difficult to determine what kind of appropriate operations should be applied for which phase of chronic empyema would be administered, especially for a surgical management. We report that the postoperative outcomes of the treatment should be recommended for chronic empyema with the aid of omental flap transposition. Seven cases of chronic empyema (the averaged age was 66.1 +/- 7.5, 6 males and 1 female) in our hospital were operated during from June 1993 to January 2001. The disease-carrying time was 3 to 16 months and the inflammation findings at the admission were positive in all cases. The cause of chronic empyema was pneumonia (n = 3), plombage for tuberculosis (n = 2), and postlobectomy empyema (n = 2). As the first-stage of treatment for empyema cavity, intrathoracic tube drainage and lavage were performed for all cases. The operative procedures were described as below; one-stage operation with both thoracostomy and omental flap transposition was performed after the first-stage treatment (n = 2), simple thoracostomy (n = 1), and two-stage operation with thoracotomy and omental flap transposition (n = 4). Three of the 4 cases with two-stage operation could be completely treated for 1 month interval. However, the rest one case had not been able to be radically cured, which empyema had been extensively turned for the worse for one month after the two-stage operation. Thoracostomy had been redone, and it took 8 months to be cured. All cases could be finally recovered and discharged. On the priority of treatment for chronic empyema, at first, both thoracic tube drainage and thoracostomy should be performed as a first-stage operation, and if they could not be effective, after the combined inflammation was settled down, then the omental flap transposition should be considered as a two-stage operation.

Aged↗

PubMed2003

[Successful management of traumatic aortic valve insufficiency; report of a case].

A case of the successful management of traumatic aortic valve insufficiency is reported. A previously healthy 48-year-old man sustained multiple injuries in a traffic accident. One month after the accident, heart failure, derived from aortic insufficiency, was noted. Three years and 5 months after the injuries, aortic valve replacement was performed, and a large tear, approximately 7 mm in length, was found in the aortic right coronary cusp. This finding corresponded to the traumatic aortic valve insufficiency. Traumatic aortic valve insufficiency is rare, and early diagnosis may be difficult. Examinations for associated intracardiac injuries should be carefully undertaken.

Accidents, Traffic↗

PubMed2002

[Veno-venous ECMO for the respiratory failure after coronary artery bypass grafting].

We encountered a 60-year-old man with severe respiratory failure after CABG. The patient received veno-venous extracorporeal membrane oxygenation (ECMO) in which blood was drained from the right atrium through a cannula and was returned via a cannula in the left femoral vein. During ECMO, the flow rate was 2.8-3.0 l/min (about 40 ml/kg/min) and the assist was needed for 5 years. Veno-venous ECMO is a simple and effective therapy for acute respiratory failure unresponsive to conventional treatment.

Acute Disease↗