Biomedical subjects

I Fukai

Publications and source records attributed to I Fukai.

At least 55 records · Page 3Linked to original sources

PubMed1996

Pediatric and adult tracheobronchomalacia.

Twelve cases of tracheobronchomalacia (TBM) cases were reviewed: five were pediatric, and seven were adult, two of which were due to relapsing polychondritis (RPC). In pediatric TBM, the malacic segments were short. Resection of the malacic segment in one case and laryngotracheoplasty with autologous costal cartilage in one case were unsuccessful. However, aortopexy gained good results. Two cases managed conservatively experienced gradual improvement of their symptoms. In adult TBM, plication of pars membranacea was not effective in one case. The insertion of a stent was minimally effective in one case, and distinctly in one polychondritic case. The other four cases managed conservatively have deteriorated gradually. From these findings, a new classification system is proposed.

Adult↗

PubMed1996

[A case report of discordant lymphoma composing Hodgkin's disease and non-Hodgkin's lymphoma occurring simultaneously in mediastinum].

A 30-year-old man with discordant lymphoma, composing Hodgkin's disease and non-Hodgkin's lymphoma occurring simultaneously in mediastinum, is described. The coexistence of these two diseases is very infrequent and difficult to be treated. It has classically been considered as coincidental. Nevertheless, recent researches have referred the relationship between these two disease and possibility of transformation with each other.

Adult↗

PubMed1996

[Clinical study of nineteen thymic carcinomas].

Nineteen cases of thymic carcinoma treated in our hospital (mean age 60.0 years, seven males and twelve females) were studied clinically. Thirteen cases (68.4%) had subjective symptom; for example, chest pain, face edema or cough. Two cases (10.5%) had the associated diseases; one had gammaglobulinemia, the other one had Cushing syndrome and hypogammaglobulinemia. The histological subtypes were eleven squamous cell carcinomas (SCC) (57.9%), three undifferentiated carcinomas, two small cell carcinomas, one papillary adenocarcinoma and one lymphoepithelioma-like carcinoma. The 5 year survival rate of all cases was 42.7%. The 10 years survival rate was 21.4%. The median survival time was 56.1 months. There were one Stage I case, nine stage III cases, four stage IVa cases and five stage IVb cases. More than stage III cases were eighteen (94.7%). Five cases of stage IVb were T2N1M0, T3N1M0, T3N0M1 and T4N0M1. The 5 year survival rate of SCC was 65.6%, and that of the other subtypes was 14.3%. The cases resected completely were only eight cases (42.1%), and the 5 year survival rate of these was 70.0%. On the other hand, the rate of five cases resected incompletely was 53.3%. Metastasis occurred in 12 cases (63.2%). Metastasis occurred frequently in pleura, lymphnode, lung, bone and liver. The radiotherapy for SCC was effective and the 5 year survival rate was 83.3%. Furthermore, there were some long survivors in the cases undergone incomplete resections by postoperative radiotherapy jointly. On the other hand, the chemotherapy was not effective in our series. However, it was reported recently that the regimen including cisplatin was effective. So it was impressed that the combined therapy including surgery radiotherapy and induction chemotherapy would be important to obtain better results.

Adenocarcinoma, Papillary↗

PubMed1996

[Clinical considerations from sixteen cases with mediastinal malignant lymphoma].

Sixteen cases with mediastinal malignant lymphoma were treated in our department and a correlation made between the prognosis and other factors: first symptom, maximum diameter of the tumor, type of operation, pathological subtype, clinical stage. First symptom and compressed or invasive symptom with mediastinal mass were not related to prognosis. The cases with bulky tumor over 10 cm in diameter showed a tendency toward poorer prognosis. Complete or incomplete resection did not have significant effect. The cases of Hodgkin's disease had relatively good prognosis. Classification of clinical stage (Ann Arbor classification) did not show significant correlation with prognosis and may be inadequate for staging of mediastinal malignant lymphoma. Surgical treatment may be adapted for mediastinal Hodgkin's disease and early stages of thymic malignant lymphoma.

Adolescent↗

PubMed1995

Rupture of congenital peripheral pulmonary aneurysm.

A 58-year-old man presenting with solitary aneurysm of a peripheral pulmonary artery was treated by left lower lobectomy. Histologically, the aneurysmal wall showed medial hypertrophy with the loss of smooth muscle fibers, without evidence of a mycotic process or inflammatory exudate. The aneurysm appeared to be congenital in origin.

Aneurysm↗

PubMed1995

Subclavian artery branch ligation reduces hemorrhage during resection of pulmonary aspergilloma.

Treatment of a 71-year-old woman with recurrent massive hemoptysis secondary to an aspergilloma and pleural aspergillosis is reported. Branches of the subclavian artery were ligated using an anterior approach before performing the thoracotomy, and pleuropneumonectomy was accomplished after ligation of the costal arteries. This technique provided a relatively bloodless field and minimized blood loss.

Aged↗

PubMed1995

Differential diagnosis of thymic carcinoma and lung carcinoma with the use of antibodies to cytokeratins.

There are few specific pathologic findings that can be relied on to distinguish primary thymic carcinomas from lung carcinomas with mediastinal extension or showing metastasis to the anterior mediastinum. The immunohistochemical reactivity on frozen sections of thymic carcinomas and lung carcinomas, which are histologically similar to each other, was examined with the use of monoclonal antibodies to cytokeratins 7 and 13. Among keratinizing squamous cell carcinomas, all thymic carcinomas reacted with antibody specific for cytokeratin 7 (9/9, 0%), whereas no staining reaction was seen in lung carcinomas (0/5, 0%) (p < 0.01). This finding can be used as a diagnostic aid in primary thymic keratinizing squamous cell carcinomas to expedite treatment and prognosis. Cytokeratin 7 and cytokeratin 13 monoclonal antibodies reacted with almost all cases of thymic carcinoma. Applications of monoclonal antibodies specific for certain cytokeratins, especially 7 and 13, may be helpful in the diagnosis of other subtypes of thymic carcinomas.

Antibodies, Monoclonal↗

PubMed1995

Esophageal tracheobronchoplasty for membranous laceration caused by insertion of a dumon stent--maintenance of oxygenation by percutaneous cardiopulmonary support.

A 39-year-old man, whose airway was narrowed due to relapsing polychondritis, sustained a tracheobronchial injury during intubation with an internal stent. In the posterior membranous trachea and left main stem bronchus, a 5-cm longitudinal tear extended across the carina. Oxygenation was maintained by percutaneous cardiopulmonary support (PCPS) before and during the operation. An original esophageal tracheobronchoplasty for repair of the membranous laceration is described. Currently, the patient is asymptomatic 16 months after the surgery.

Adult↗

PubMed1995

Mediastinal malignant epithelioid schwannoma.

A case of mediastinal malignant epithelioid schwannoma (MES) is reported. The tumor probably arose in the vagal nerve, and the trachea was involved. A few months after excision of the primary tumor, multiple metastases appeared in lung, cervical spine, and neck lymph nodes. Microscopically, the tumor showed a highly cellular area resembling melanoma or carcinoma. Immunolabeling was done for S-100 protein, keratin, and melanoma-associated antigen. Examination of the entire lesion and in situ characteristics of the tumor involving the vagal nerve were helpful in making the correct diagnosis. Mediastinal MES, to our knowledge, has not been reported to date in the English-language medical literature.

Adult↗

PubMed1995

[A case of near total tracheal obstruction from recurrent esophageal carcinoma].

We have treated a 58-year-old man with almost complete tracheal occlusion arising as a result of recurrence of esophageal cancer. Although laser photoresection using partial cardiopulmonary bypass was desirable, neither laser nor cardiopulmonary bypass was available in our hospital. It was then decided to resect the tumor by forceps. In order to prevent bleeding from tumor during such emergency procedure, intratumoral injection of ethanol was preceded and tracheal lumen could be opened successfully. He was managed by insertion of a Dumon silicone stent seven days after the emergency. The result was satisfactory for maintaining the patency of the airway where the stent was placed. Unfortunately the patient died 113 days after the insertion of Dumon silicone stent from massive hemoptysis, which might resulted from the rupture of vessel feeding the tumor or the perforation of aorta involved by the tumor.

Carcinoma, Squamous Cell↗

PubMed1994

Thymectomy and malignancy.

Three hundred ninety patients who underwent thymectomy for myasthenia gravis (MG) were followed up to investigate the development of associated malignancies. There were 102 patients with thymoma and 288 without thymoma. Malignant neoplasms were detected in ten patients, four of whom already had the tumor at the time MG was diagnosed. Thus, malignancy developed after thymectomy in six patients. Malignant fibrous histiocytoma (MFH) developed in three patients, as well as gastric cancer, gastric leiomyosarcoma, rectal cancer, liver cancer, lung cancer, breast cancer, and thymic carcinoid in one patient each. Nine of the ten malignancies developed in the thymoma group, and only one in the non-thymoma group. The predicted number of patients with malignancy was 2.63 in the thymoma group and 2.65 in the non-thymoma group. Our findings suggest that the presence of thymoma facilitates the occurrence of extrathymic malignancy, and that thymectomy never enhances the occurrence of malignancy but possibly inhibits it.

Adolescent↗

PubMed1994

[Hook approach for radical resection of invasive apical lung cancer].

The hook approach provides safe identification and a wide view of subclavian vessels and branchial plexus on both their extra-thoracic and intra-thoracic aspects by a long skin incision resembling a "hook" and by tilting the table and moving the arm. The hook approach permits dissection of fat pad including supraclavicular lymph nodes from the same wound. This approach is suitable for invasive apical lung cancers without involvement of sternum. A patient with invasive apical lung cancer who received combined resection of the subclavian artery, vertebral artery, lower trunk of brachial plexus, (C8, Th1), third and fourth thoracic vertebrae, and first 4 ribs is presented and details of the hook approach is described.

Humans↗

PubMed1994

[Chronic empyema associated with large cell carcinoma of lung: case report with review of the literature].

A 71-year-old female was seen with a complaint of chest pain and cough, and a history of tuberculous pleurisy and artificial pneumothorax 40 years ago. The diagnosis of empyema with carcinoma was made by chest X-ray and CT scans. The examination of lung function showed a restrictive disorder. The value of the predicted postoperative FEV1 0.75 l encouraged to perform operation. A left pleuropneumonectomy and combined resections of the invasive portion of the pericardium and left atrium was performed. Histological examination revealed large cell carcinoma of lung (pT 4 N 1 M 0). The literatures are reviewed concerning the thoracic malignant tumor arising in chronic empyema cavity on Japanese cases.

Aged↗

PubMed1993

Cytokeratins in normal thymus and thymic epithelial tumors.

BACKGROUND: Thymus consists of some distinct epithelial cells that contain different sets of cytokeratins (CK). Epithelium-derived tumors maintain the expression of some of the CK of the specific nontransformed cells. Therefore, it seems reasonable to hypothesize that thymic epithelial tumors may differentiate toward distinct subsets of intrathymic epithelial cells in terms of CK expression. METHODS: Eighty-one thymomas and 14 thymic carcinomas were studied immunohistologically using monoclonal antibodies specific for a single CK or a CK pair. RESULTS: Thymic epithelial neoplasms could not be distinguished from each other on the basis of the profile of CK expression because the degree of overlap was extensive. However, polygonal cell thymomas differentiate toward a CK13-positive cortical subset that is rare in normal thymus. Spindle cell thymomas differentiate toward a CK13-positive medullary subset. Mixed cell thymomas are comprised of a CK13-positive medullary subset and a CK13-negative medullary subset, both of which are typical in normal thymus. CK18 was expressed to a greater extent on the epithelium of thymic carcinomas than on that of thymomas. Polygonal cell thymomas more frequently were invasive than spindle and mixed cell thymomas. CONCLUSIONS: There is a possibility that the epithelium of polygonal cell thymomas is immature because it is a phenotypically unusual subset in normal thymus. A thymic carcinoma arising in a thymoma has been reported, although the relationship between the thymoma and the thymic carcinoma was not clear. Nevertheless, given the similar cellular differentiation of thymoma and thymic carcinoma, CK18-positive epithelium in thymomas may be transformed into thymic carcinoma cells in certain conditions.

Adenocarcinoma↗

PubMed1993

Mediastinal abscess caused by a pyriform sinus fistula: report of a case.

A 13-year-old boy who originally presented with a left neck abscess rapidly developed a mediastinal abscess and empyema. Repetitive esophagography for the persistent mediastinal abscess revealed the existence of a pyriform sinus fistula. It was thought that infection of the pyriform sinus fistula precipitated a retropharyngeal abscess which continuously extended to the mediastinum. To our knowledge, no other such case has ever been reported and we present this unusual case herein, followed by a short review of the related literature.

Abscess↗

PubMed1993

Surgical therapy for apical invasive lung cancer: different approaches according to tumor location.

Thirty-one patients with apical invasive lung cancer were reviewed. The tumor occupied the anterior portion of the lung apex in four, the middle portion in one, the posterior portion in 17, and the entire apex in nine. Nine patients were treated by irradiation alone. Twenty-two patients underwent en bloc resection of the apical chest wall and the lung. Seventeen patients were operated on by different approaches: anterior and hook, according to the location of the lesion. Nine patients were operated on by the anterior approach and eight by the hook approach. Another five patients were operated on by the conventional postero-lateral approach. Lesions of the sternum and subclavian vessels and ipsilateral supraclavicular lymph nodes were resected by the anterior approach. Lesions of the vertebrae, brachial plexus, subclavian vessels and ipsilateral supraclavicular lymph nodes could be resected by the hook approach. The anterior approach was suited for lesions in the anterior portion or middle portion and the hook approach for lesions in the middle or posterior.

Adult↗

PubMed1993

[Tumor-node-metastasis classification for thymic epitherial tumors].

We applied the tentative TNM classification of thymoma to 24 cases of IV b thymoma, 59 cases of thymic carcinoma, and 26 cases of thymic carcinoma (109 cases in total). This classification was useful in these cases because cases could be divided into different grades (e.g. N 0, N 1, N 2, N 3) of the factor N (lymph node metastasis) without any shift to particular grades. Based on this finding, we hereby propose a TNM classification of thymic epitherial tumors which was prepared by slightly modifying the tentative TNM classification of thymoma.

Carcinoid Tumor↗

PubMed1992

The distribution of epithelial membrane antigen in thymic epithelial neoplasms.

Thymic carcinomas arising within a thymoma have been reported, but the relationship between thymoma and thymic carcinoma is poorly understood. Epithelial membrane antigen (EMA) is known to be an effective marker for establishing the epithelial nature of neoplastic cells, and it is reported that staining of tumors is clearly related to the degree of tumor differentiation. Eighty-one thymomas (59 noninvasive, 22 invasive) and 14 thymic carcinomas were studied immunohistologically using antiepithelial membrane antigen (anti-EMA) monoclonal antibody. Thymic carcinomas tended to express much larger quantities of EMA than thymomas, and instances of EMA-positive thymoma were seen significantly more often in invasive thymomas than in noninvasive ones (P < 0.05). However, EMA positivity was also associated with gland-like structures, which were not necessarily associated with malignant disease. Nevertheless, in view of the concept that thymoma and thymic carcinoma show a similar cellular differentiation, EMA-positive epithelial cells in thymoma with no relation to gland-like configurations might represent a pool of cells having a latent potential for malignant disease and might be transformed into thymic carcinoma cells under certain conditions. Immunolabeling for EMA appears to be a useful tool for determining the degree of malignant disease among thymic epithelial neoplasms.

Adult↗