Biomedical subjects
E Hata
Publications and source records attributed to E Hata.
[Extended extrapleural pneumonectomy by median approach for advanced malignant mesothelioma with right supraclavicular lymph node metastasis--a case report].
A 52-year-old woman of diffuse malignant mesothelioma of the right pleura with metastasis to right supraclavicular lymph nodes underwent extended extrapleural right pneumonectomy and neck dissection. For this resection we selected the new approach: median sternotomy with hemi-collar incision. Through this approach systematical dissection of the cervical-mediastinal lymph nodes was performed together with resection of the right lung, parietal pleura, the pericardium and the diaphragm. As a result of this en bloc resection, she is alive without recurrence for one year after the operation.
[The necessity of extended systemic dissection of the regional lymph node in radical operation for lung cancer].
Since 1979, 109 patients underwent bilateral mediastinal lymph node dissection through a median sternotomy as a routine procedure in the treatment of left lung cancer, because of the high possibility of contralateral mediastinal node involvement in cases of left lung cancer. The five-year survival rates of the initial 50 patients who underwent this operation from Oct. 1979 till Mar. 1988 were 76.5% in N0 (n = 17), 69.2% in N1 (n = 13), 50.0% in N2 (n = 10) and 20.0% in N3 (n = 10). The five-year survival rate of 7 patients with pT1-2 N2M0 disease was 71.4%. This survival rate was only slightly different from that of the pT1-2N0-1M0 group. From May 1985 till April 1993, 20 patients who had the cervical or the highest mediastinal lymph node involvement underwent cervical and bilateral mediastinal lymph node dissection through a cervical collar incision and median sternotomy. Two patients with the scalene node involvement (one each of right and left lung cancer) are surviving for five years or more after surgery. Extended ipsilateral mediastinal lymph node dissection (R2b) has been adopted as a routine procedure in the treatment of right lung cancer in our institute since 1990. The survival rate at forty months in 15 patients with N2 disease who underwent R2b operation was 51%. In 3 of these fifteen patients the anterior mediastinal lymph node metastases were revealed by post-operative pathological investigation.(ABSTRACT TRUNCATED AT 250 WORDS)
[Primary chondrosarcoma of the pulmonary artery].
A 69-year-old woman who had progressive dyspnea, edema and oliguria was diagnosed as primary sarcoma arising in the pulmonary trunk by preoperative examination. She received thoracotomy and total resection of the tumor in the pulmonary trunk utilizing cardiopulmonary bypass. A microscopical examination revealed that the tumor had the features of the chondrosarcoma originating in the pulmonary artery. There have been very few reports on chondrosarcoma in the pulmonary artery. It is reported that the prognosis of the sarcoma in the pulmonary artery is less favorable, however, this case had uneventfully postoperative course and no signs of recurrence one year after operation.
Complement receptors in atherosclerotic lesions.
Accumulation of cholesterol in the tunica intima of arteries is a feature of atherosclerotic development. Recently, the demonstration of oxidized LDL in atherosclerotic lesions considerably strengthened the possibility of its role in the atherogenesis in vivo. However, the mechanism of lipid accumulation in monocyte-derived macrophages has not yet been clarified. It has been reported that the complement system may be related to atherosclerosis. In this report, complement receptors in the atherosclerotic lesions obtained from autopsy sample were investigated. Initially C3b receptors were detected using sheep erythrocytes bearing human C3b (EAC1423b cells). EAC1423b cells adherent to only aortic sections showing intimal thickening, but not to intact artery. Second, immunostaining of consecutive aortic sections was performed. Apo B and C5b-9 complex were stained using the indirect immunoperoxidase method, and macrophage, C3b receptor (CR1) and C3bi receptor (CR3) were stained using monoclonal antibody in the alkaliphosphatase anti-alkaliphosphatase method. In the intact artery of 3 month old patient, antigen- specific staining were not observed. In intimal thickening and atheroma of older patients, consecutive sections suggested that complement receptor-expressing cells were macrophages. Staining for apo B antigen existed at extracellular site in the intima, and C5b-9 complex was observed in intima and partially in the media. The above data showed that macrophage complement receptors were expressed in the atherosclerotic lesions when the complement system was activated. We conclude that these data suggest that the complement system and complement receptors may be related to the uptake of LDL by macrophages.
[Minor thoracotomy for the treatment of spontaneous pneumothorax].
We have recently established the following therapeutic principles for spontaneous pneumothorax, and have obtained favorable results. 1. All patients, including those with a first episode, are subjected to thoracotomy. 2. The standard technique is minor thoracotomy through a skin incision of 5 cm which is aesthetically superior, except complicated cases with chronic obstructive lung disease in elderly patients or giant bullae. 3. Bilateral simultaneous axillary minor thoracotomy is applied to bilateral pneumothorax, whether synchronous or metachronous. 4. Thoracotomy is attempted by other approaches when we preoperatively suspect pulmonary bullae in the lung bases or diaphragm. In the past three years (1988 to 1990), 68 out of 70 cases (97.1%) of spontaneous pneumothorax admitted to our department were operated on. Of them, 55 cases (81% of all surgical cases) underwent minor thoracotomy. Pleural abrasion was performed in order to prevent postoperative recurrence of the pneumothorax. The 55 cases of minor thoracotomy consisted of 51 males and 4 females aged 27.6 years on average (range: 15 to 64). In 22 cases (40%), this was the first occurrence, combination with hemothorax was seen in 4 cases, and bilateral simultaneous axillary minor thoracotomy was performed in 11 cases (20%). The location of the bullae was the upper lobe (or upper segment) in 95.5%, the middle lobe (or lingula) in 6%, and the lower lobe (S6) in 20%.(ABSTRACT TRUNCATED AT 250 WORDS)
[Application of the Nd-YAG laser for surgical resection of pulmonary metastases].
We used Nd-YAG laser equipment for operations on pulmonary metastatic tumors in order to preserve the residual pulmonary functions simultaneously with local curability by utilizing the features of the contact and non-contact types of equipment. The subjects were patients showing no lymph node metastasis in the preoperative diagnosis. The equipment used was Nd-YAG laser model 6,000 with a surgical probe and contact tip attached. Thoracotomy was performed by a method involving minimum invasion in accordance with the tumor localization to prevent reduction of the postoperative respiratory function as much as possible. An incision was made in the pleura and lung using the contact tip with an output of about 25 Watts with the surgical margin separated sufficiently from the tumor, and the tumor was resected. Coagulative hemostasis was apt to occur in the small vessels. To eliminate postoperative hemostasis and residual tumors, non-contact type irradiation was performed at the surgical margin at an output of about 50-70 Watts. Finally, the pleura were sutured. This method has been used so far on 10 cases of pulmonary metastatic tumors, and in all cases, the amount of hemorrhaging during the operation was small, the operating time was short and the postoperative reduction in respiratory function was slight. In cases of bilateral multiple pulmonary metastases, as many as 30 resections were performed, but no recurrences have been seen in any of the cases to date. Although the usefulness of this method still cannot be confirmed because of the small number of cases involved, this method seems promising from the standpoints of local curability and preservation of pulmonary functions.
[A case of ulcerative colitis showing anti-Rh (e)autoantibody associated with autoimmune hemolytic anemia].
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Median sternotomy for high-risk patients with bilateral pulmonary disease: a case report.
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[Cervical and mediastinal node dissection four and a half years after operation for pulmonary adenocarcinoma].
Metastasis to bilateral mediastinal and cervical lymphnodes was noted in a 58 year old male four and a half years after left lower lobectomy of the lung with lymphnode dissection (R2a, P-T1N2M0) by posterolateral incision. This case was treated by dissection of the left cervical and bilateral mediastinal lymphnodes from left cervical and median sternal incisions. Metastasis to the right supraclavicular lymphnodes was noted 11 days after discharge, and additional right cervical dissection was performed with satisfactory results. These possible routes include the tracheobronchial lymphnodes and the carinal nodes, via the upper or anterior portion of the left main bronchus. The routes continue via the nodes surrounding the trachea and the right paratrachea to the cervical nodes. This case suggests the necessity of bilateral mediastinal dissection and the significance of cervical dissection in left lung cancer.
[A case of tumor thrombus in the right atrium after multimodal treatment of testicular tumor].
A case was reported concerning a successful removal of tumor thrombus extending into the right atrium through the left brachiocephalic vein and the superior vena cava. The patient was a 34-year-old man who underwent a left inguinal orchiectomy for immature teratoma of testis in June 1987. The operation was followed by another three operations for excision of lymph node metastases and five courses of cisplatin based combination chemotherapy. In December 1988, the chest CT scan film revealed filling defect in the superior vena cava and the right atrium. Thrombus was detected using echocardiography and angiography. He had no symptom, but multiple pulmonary infarcts were also detected. In February 1989, the operation was performed by means of cardio-pulmonary bypass. A soft yellowish thrombus attached to the left venous angle was removed with resection of the left brachiocephalic vein. Microscopic findings revealed that the thrombus was metastatic testicular teratoma. With further treatment after the operation, he has been disease-free for 14 months now. We conclude that in this case aggressive surgical management following chemotherapy had great value to control the disseminated testicular tumor.
[Surgical indication of T1-2N2-3M0 lung cancer based on the prognosis].
Effusion-type lung cancer with postoperative T1N2-3M0 and primary tumor diameter less than 3 cm was regarded as small sized progressive lung cancer. There were 8 cases of pT1N2-3, with a 3-years survival rate of 37.5%, and, 5 years survival rate of 25.0%. There were 5 cases of effusion-type lung cancer with primary tumor diameter less than 3 cm, who were treated with panpleuropneumonectomy. Their 3 years survival rate was 51.9%. In small sized progressive lung cancer in total, the 3 years survival rate was 40.7%, and the 5 years survival rate was 29.1%. In comparison there were 29 cases of pT2N2-3, with a 3 years survival rate of 40.9% and a 5 years survival rate of 37.0%. There was no significant difference concerning the survival rate between T1 and T2 groups, T2 and pleuropneumonectomy group, and between small progressive lung cancer group and T2 group. Therefore, there seems to be a less correlation between progressive lung cancer and T-factor disease prognosis. It was suggested to improve the prognosis by extending lymph node dissection even in progressive lung cancer.
Age at menarche and selected menstrual characteristics in young Japanese athletes.
Ages at menarche and selected menstrual characteristics in 204 nonathletes, 253 high school athletes, 386 college athletes, and 40 young top athletes of Japan were investigated by questionnaire. Data from the questionnaire have confirmed (a) the ascending trend of ages of menarche with advancement of training and competitive level, and (b) the diversity of mean age at menarche by sport in a given level. The menarcheal orders by sport in the literature have been found to be strikingly similar to those found in the present data. We offer the hypothesis that ages at menarche and selected menarcheal characteristics (a) are brought about by selection in the socialization process into sports participation, and (b) reflect the diversity of suitable physiques by sport. Also, the higher the training and competitive level, the more likely the occurrence of menstrual irregularity (cycle length and period duration) and/or dysmenorrhea (backache).
[Usefulness of dynamic thin section CT in detecting lymph node metastasis of lung cancer].
The diagnosis for metastatic lymph nodes of lung cancer by the conventional CT is done only by the size of nodes, therefore, its diagnostic accuracy is questionable. For the purpose of more qualitative diagnosis in order to elevate accuracy of metastatic nodes, we studied a new CT image (Dynamic Thin Section CT) by combining the Thin Section CT with the Dynamic CT, and reviewed on the image of histopathological positive nodes. Firstly, for the preoperative cases of lung cancer, the conventional CT was performed for the whole chest with 10 mm-thickness and 10 mm-interval. Secondary, among them, the Dynamic CT by bolus-injection at the sites of detected hilar and mediastinal lymph nodes was performed. For this method, the Thin Section CT with 2 mm-thickness was used, and the image-detected nodes were isolated by surgery. We studied 25 cases whose images were compared with the histological findings. By the conventional CT sensitivity were 35.7%, specificity 54.5%, and accuracy 44.0%, in regarding the shorter diameter over 1 cm as positive nodes, then under diagnosis were 36%, over diagnosis 20%. Morphological features were reviewed on the image of metastatic lymph nodes in the Dynamic Thin Section CT, and were (1) lump-like lymph nodes, (2) disappearance of the fatty plane around the lymph nodes or uneven and irregular margins, (3) irregular internal structures of enhanced lymph nodes. Moreover, small lymph nodes were clearly detected, and the size was exactly measured.(ABSTRACT TRUNCATED AT 250 WORDS)
[Noncardiac surgery in patients with ischemic heart disease].
From January 1983 to December 1988, 4679 patients with operated under general anesthesia in our institute: 161 patients involved suspected ischemic heart disease (IHD patients) by history or electrocardiogram. Eight of 161 patients (5.0%) experienced fatal or life-threatening cardiac complications. On the other hand, only two non-IHD patients (0.03%) experienced complications. IHD patients had a significantly higher incidence of complications compared with non-IHD patients. Forty-five IHD patients had not undergone coronary cineangiogram (CAG) before noncardiac operations and six of them (13.8%) experienced complications. They had a significantly higher incidence of complications compared with other IHD-patients who had received CAG. Fifty-five IHD patients who had already been treated by coronary bypass grafting (CABG) or by percutaneous transluminal angioplasty experienced only one complication. We conclude that CAG should be more actively performed for IHD patients because prior CABG or PTCA is suspected to decrease cardiac complications in IHD patients. However, IHD patients must be managed as carefully as possible.
The role of ifosfamide and cyclophosphamide in the multi-modality treatment after surgery for cure for small-cell bronchial carcinomas (SCLC).
For the optimisation of the therapy for small cell bronchial carcinomas (SCLC), surgery is used to eliminate the primary tumor and its regional lymph nodes and chemo- and radiotherapy for the general treatment of micrometastasis. After patho-histological examination of the operation specimen, randomization for two arms is performed for a standard chemotherapy (CAV) or a sequential chemotherapy using three different drug combinations. Thereafter all disease-free patients receive prophylactic cranial irradiation (PCI). Preliminary evaluations in December 1987, of 112 patients from 19 cooperating departments show that the survival rate projected for 2 yr of 43 patients at stage pT1-3 N0 M0 is 76%, of 43 patients at stage pT1-3 N1 M0 it is 63% and of 26 patients at stage pT1-3 N2 M0 it is 38%.
[CT findings of post-pneumonectomy patients].
CT findings following pneumonectomy were studied in 28 cases with lung cancer. A total of 53 CT images were evaluated in 13 right pneumonectomy cases and 15 left pneumonectomy patients. The postpneumonectomy pleural space (PS), thoracic space of the operated site (TS) and the thoracic space of the non-operated site (CTS) were measured at 3 slice levels of the brachiocephalic level, subcarinal level and lower pulmonary vein level, using a digital planimeter. There was no significant difference in the TS/CTS ratio, between the right pneumonectomy group and the left pneumonectomy group, but the PS/TS ratio in the left pneumonectomy group was smaller than that in the right pneumonectomy group (p less than 0.01). The PS/TS ratio in both groups and the TS/CTS ratio in the right pneumonectomy group were decreased with time. In the left pneumonectomy group, the TS/CTS ratio was greater in the median sternotomy group that of the posterolateral thoracotomy group (p less than 0.01). Residual pleural effusion was accompanied with a thin circulating lesion along the outer surface. This lesion had been reported as thickening of the parietal pleura, but it could be detected in the case of panpleuropneumonectomized state. Additionally, in some cases, the parietal pleural imaging could be separated from the circulating lesion. So, this structure was thought to be mainly composed of organized effusion. CT images could detect some parts of the episodes in post operated thorax, because of the lack of the information with the sagittal direction. However, the recognition of the common changes and images on CT after the operation might be helpful for the follow-up of the patients.