Biomedical subjects

I Miyazaki

Publications and source records attributed to I Miyazaki.

At least 487 records · Page 27Linked to original sources

PubMedDate not supplied

The surgical management of parasternal recurrence of breast cancer.

Although parasternal recurrence of breast cancer can be adequately controlled by radiation therapy, at times, surgical excision is more effective. In this paper, a new technique for the radical resection of the parasternal portion of the chest wall, including dissection of the internal mammary and supraclavicular lymph nodes, is proposed. Between 1977 and 1984, eleven patients with parasternal recurrence were treated in our department. Five of these cases underwent this kind of operation and four of them are still alive without further recurrence; the remaining patient developed skin metastasis postoperatively. One patient refused radiation therapy but, in any case, radiation therapy failed to control the parasternal recurrences in the other five patients. This new operation is a rational and effective mode of treatment for parasternal recurrence.

Adenocarcinoma↗

PubMedDate not supplied

The modified extended mastectomy using the trap-door method as a staging operation.

The choice of operation for breast cancer must be directed towards giving the best chance of local control of the disease. Extended radical mastectomy may be beneficial for patients with internal mammary lymph node metastases, although it has remained controversial. The anterior chest defect created by extended radical mastectomy should be avoided in patients with no metastasis in the internal mammary lymph nodes. This paper, proposes a new technique of modified extended mastectomy using the trap-door method as a staging operation and an intermediate operation between modified radical mastectomy and extended radical mastectomy. In this operation, the axillary dissection could be performed by reflecting the pectoralis major muscle and the internal mammary lymph nodes could be dissected by reflecting the parasternal chest wall in trap-door fashion. In cases in which the metastasis is histologically found in the internal mammary content, extended radical mastectomy by sternal splitting is preferred.

Breast Neoplasms↗

PubMedDate not supplied

Regional lymph node metastases in well-differentiated thyroid carcinoma.

The status of regional lymph node metastases was assessed in 171 patients with thyroid cancer who underwent a variety of thyroidectomy procedures with regional lymph node dissection at Kanazawa University, from January 1979 to March 1986. The rates of regional lymph node metastasis in minimal and ordinary thyroid cancer were 57% and 84% respectively. Since the rates of lymph node metastasis were high not only in the central cervical compartment but also in the lateral jugular compartment, modified radical neck dissection in the ipsilateral neck is at least recommended in patients with these thyroid cancers. Furthermore, high frequencies of bilateral regional lymph node metastases were found in patients with obviously widespread involvement of the bilateral lobes, with cancer located in the isthmus, with clinically detectable bilateral or contralateral jugular lymph node metastases and with histological involvement in the contralateral paratracheal lymph nodes. Bilateral modified radical neck dissection is recommended in these patients.

Adenocarcinoma↗

PubMedDate not supplied

Breast conserving surgery and radiation in the treatment of operable breast cancer.

Breast conserving treatment (BCT) is an alternative to mastectomy, and prospective randomized trials have demonstrated that BCT and radical mastectomy result in similar actuarial survival rates. BCT should fulfil two criteria: (1) it should afford the same local control of disease as radical mastectomy, and (2) it should offer clear cosmetic and psychological advantages. This paper reviews the current status of BCT in the treatment of breast cancer. The choice of a narrow marginal tumor excision with aggressive radiation versus a wide resection with a small dose of radiation is discussed. Although the narrower marginal excisions, such as tumorectomy or lumpectomy provide the best cosmetic results, they may not provide adequate local control even when combined with aggressive irradiation. Wide resections such as quadrantectomy combined with a smaller dose of radiation, results in adequate local control, but less satisfactory cosmetic results. Although body image is better preserved by BCT, a clear enhancement of the psychological well being has yet to be established. Nevertheless, with further improvement in surgical, radiological and chemotherapeutic techniques, BCT likely will be the treatment of choice in more and more patients with operable breast cancer.

Breast Neoplasms↗

PubMedDate not supplied

The mode of lymphatic and local spread of pancreatic carcinomas less than 4.0 cm in size.

To clarify the mode of lymphatic and local spread of small pancreatic carcinomas, we studied the histopathology of 33 patients with invasive ductal adenocarcinoma of the head of the pancreas less than 4 cm in diameter. Microscopically, lymph node metastases were found in 72.7% (24 of 33) of the patients: 17 patients had lymph node metastases at the first barrier and 7 patients had lymph node metastases at the second barrier. Capsular invasion was present in 21.2% (7 of 33) patients, retroperitoneal invasion in 84.8% (28 of 33) patients. Invasion to the common hepatic artery was identified in 9.1% (3 of 33) patients, and invasion to the portal vein system in 24.2% (8 of 33) patients. In addition, five of the seven patients with lymph node metastases at the second barrier had spread to the periaortic lymph nodes. Thus, even patients with small pancreatic cancers which were macroscopically confined to the pancreas showed microscopic extrapancreatic tumor extension, especially invasion to the retroperitoneal tissues and to the periaortic lymph nodes. This suggests that an aggressive surgical approach, including complete resection of surrounding connective tissues in the retroperitoneum and extensive lymph node dissection, is necessary to improve the surgical therapeutic results even for small pancreatic cancers.

Adult↗

PubMedDate not supplied

The diagnosis of internal mammary node metastases of breast cancer.

It is important to know the status of internal mammary lymph node (IMN) in estimating the prognosis in patients with breast cancer and/or planning the treatment. In the first series of this study, the diagnostic value of internal mammary lymphoscintigraphy (IMLS) and that of parasternal sonography (PS) were evaluated in 57 patients. The overall diagnostic accuracy of IMLS was 72% and that of PS, 84%, compared with IMN metastases confirmed on a biopsy. In the second series, 23 patients who underwent extended radical mastectomy and were found to have IMN metastases, were examined for the sizes and locations of metastatic IMN. Minute metastatic lymph nodes not detectable by IMLS or PS were found in 9 (39%) of the patients. However, the incidence of metastases to the first and/or second intercostal spaces was 97% for the patients. We concluded that a biopsy of the first and second intercostal spaces is useful in providing the information of IMN status.

Adult↗

PubMedDate not supplied

Multivariate study of prognostic factors for differentiated thyroid carcinoma: the significance of histologic subtype.

We re-examined 239 patients with differentiated thyroid carcinoma (222 with papillary carcinoma and 17 with follicular carcinoma) especially for the clinico-pathologic entity of poorly differentiated carcinoma, and made univariate and multivariate analyses of the results to evaluate whether it would be of value in estimating the prognosis in thyroid cancer patients. In the univariate study, no significant difference was found in either survival and disease-free survival between papillary and follicular carcinomas, but between well differentiated and poorly differentiated carcinomas. In the multivariate study, however, the presence of poorly differentiated carcinoma did not appear to be an unfavorable prognostic factor. The sex, tumor size, and presence of distant metastases or grossly malignant residue in the neck after operation were, on the other hand, confirmed by the analyses to be important prognostic factors. We concluded that histologic subclassification may be less useful in estimating the prognosis in patients with differentiated thyroid carcinoma than other factors such as sex and the extent of the tumor.

Adenocarcinoma↗

PubMedDate not supplied

Analysis of hepatic recurrence of colorectal cancer after resection of hepatic metastases.

Forty patients with history of resected hepatic metastases of colorectal cancer were examined for pattern of recurrence. The 5-year survival rate was 41.3% for 40 patients. Recurrences of the malignancy were seen in 25 of the patients, with hepatic recurrence in 42.5% of them. The hepatic recurrence rate did not correlate with the lobar distribution of metastases or surgical methods. The pathological margins of less than 1 cm, 3 or more liver metastatic lesions, and the metastatic lesions of greater than 5 cm were at increased risk of hepatic recurrence. The recurrence rate was high, or 56% for aneuploid tumors, while it was 18.5% for diploid tumors.

Aneuploidy↗

PubMedDate not supplied

Recurrence and mortality in patients with differentiated thyroid carcinoma.

We examined the factors associated with increased recurrence and/or mortality of 195 patients with primary differentiated thyroid carcinoma. Of 171 patients who underwent at least, resection of the primary macroscopic tumor (curable), 26 patients (15%) developed recurrence and 6 of these patients died from the disease. Sixteen (67%) of 24 patients with initial distant metastasis or grossly malignant tumor residua in the neck after the operation (non-curable patients) died from the disease. In the curable patients, age, sex and tumor size correlated significantly with recurrence and/or mortality. When the characteristics of patients who died after recurrence were compared to those who survived after recurrence, however, only the patient's age correlated significantly with mortality. In the non-curable patients, the histologic subtype correlated significantly with mortality. It may be concluded, therefore, that the risk factors which affect mortality in differentiated thyroid cancer differ between curable and non-curable patients.

Adenocarcinoma, Follicular↗

PubMedDate not supplied

Intrabiliary pressure measurement by duodenal pressure loading for the evaluation of duodenal parapapillary diverticulum.

BACKGROUND/AIMS: We report a method of intrabiliary pressure measurement by duodenal pressure loading for evaluating the effects of duodenal parapapillary diverticulum. MATERIAL AND METHODS: Forty-eight patients with primary choledocholithiasis were investigated based on usual intrabiliary pressure measurement developed at our department. RESULTS: Ten of these patients with parapapillary diverticulum showed higher intrabiliary residual pressure (P) and biliary resistance (R) values than the remaining patients without diverticulum, but the difference were not significant. There were no significant differences in the frequency of patterns of the B zone angulation of the pressure curve between the two groups with and without parapapillary diverticulum. Intrabiliary pressure was measured while maintaining a manometer pressure of 250 mm H2O by infusing or aspirating physiologic saline. CONCLUSION: From the results of this measurement for 6 patients, when P and R values show increases of 50 mm H2O or more and 3.5 units or more, respectively, additional surgery for parapapillary diverticulum was considered to be indicated.

Biliary Tract↗

PubMedDate not supplied

Assessment of postoperative digestive function after pancreatico-duodenectomy: a comparison of reconstruction techniques.

BACKGROUND/AIMS: Malabsorption is a frequent complication following pancreatico-duodenectomy (PD) for pancreatic carcinoma. Gastrojejunostomy followed by Billroth I type of reconstruction (PD III) has been advanced to prevent this disorder. We compared postoperative digestion and absorption determined by 131I-triolein, D-xylose and pancreatic function diagnostant (PFD) after extensive PD followed by one of two reconstructive procedures. MATERIAL AND METHODS: Postoperative digestive and absorptive functions in patients operated by Child's method (PD II) were compared with patients in whom the stomach emptied proximal to the pancreas and bile duct (PD III). RESULTS: The absorption of D-xylose was significantly higher (1.24 +/- 0.36 g vs. 0.72 +/- 0.21 g) in the PD III group. No difference was noted in pancreatic endocrine secretion between the two groups. Biliary scintigraphy revealed increased bile secretion in the PD III group. CONCLUSIONS: These results suggest that PD III is superior to PD II following extensive PD.

Anastomosis, Surgical↗

PubMedDate not supplied

Correlation of the histological effects and survival after neoadjuvant chemotherapy on gastric cancer patients.

BACKGROUND/AIMS: The surgical results for patients with stage IV gastric cancer are very poor. This study was performed to clarify the morphologic changes and survival after neoadjuvant chemotherapy for the stage IV gastric cancer patients. MATERIAL AND METHODS: Forty-three patients with stage advanced gastric cancer were treated with preoperative PMUE therapy by a combination use of cisplatin 75 mg/m2, mitomycin C 10 mg/body, etoposide 150 mg/body and UFT 400 mg/day. Among them, 32 patients underwent gastrectomy. Resected specimens were precisely examined histologically, and the histologic changes were correlated with clinical response and survival. RESULTS: Histologic manifestations of neoadjuvant chemotherapy included coagulation necrosis of cancer cell, appearance of the giant cell with foamy degeneration, extracellular mucin pools, aggregates of foamy histiocytes and/or stromal fibrosis. Histological responses were obtained in 24 (75%) of 32 primary tumors, 13 (81%) of 16 liver metastases, 20 (76%) of 28 lymph node metastases and 3 (18%) of 17 peritoneal disseminations, respectively. Clinical responses were observed in 21 (49%), but there was no statistical survival difference between clinical responders and nonresponders. In contrast, histologic responders survived significantly longer than non-responders. CONCLUSIONS: These results indicate that the grading of the histologic changes is a good prognosticator of patients treated with neoadjuvant chemotherapy, and yields an important information for the selection of postoperative chemotherapy.

Adenocarcinoma↗

PubMedDate not supplied

Controversies in the surgical management of differentiated thyroid carcinoma.

We reviewed the literature related to the surgical management of differentiated thyroid carcinoma (DTC), and examined ongoing controversies regarding treatment. DTC has a relatively indolent biologic behavior, but it tends to spread to the thyroid and/or regional lymph nodes even in the early stages of the disease. On the other hand, surgical resection is the most effective treatment for DTC, but the extent of surgical resection has been controversial. The impact of surgery has been considered to be only minor in the prognosis of the majority of patients, unless grossly malignant residue is left behind. Nevertheless, in some patients the disease follows an aggressive course culminating in death. For such high-risk patients, a more extensive operation should be performed. Therefore, it may be concluded that the extent of surgical resection should depend on the basis of the biologic behavior of the DTC rather than the extent of cancer involvement in the thyroid and regional lymph nodes.

Adenocarcinoma, Follicular↗

PubMedDate not supplied

Postoperative adjuvant locoregional chemotherapy in patients with hepatocellular carcinoma.

BACKGROUND/AIMS: Hepatocellular carcinoma (HCC) recur frequently in HCC patients with invasive factors such as vascular invasion and intrahepatic metastasis and its prevention is important in obtaining better surgical survival. MATERIAL AND METHODS: Palliative resection with locoregional therapy for multinodular HCC was performed to prevent postoperative complications in patients with poor hepatic reserve. Disease-free survival (DFS) and survival for these patients who underwent hepatic resection for noninvasive HCC, and for invasive HCC with or without adjuvant chemotherapy were analyzed to determine the effects of adjuvant chemotherapy. Survival of palliative resection for HCC was analyzed to determine the effect of reduction surgery. RESULTS: DFS and survival of patients with adjuvant chemotherapy was better than those of patients without adjuvant chemotherapy, but not significantly (DFS; p = 0.0508, survival; p = 0.0570), and the survival of patients without adjuvant chemotherapy was almost equal to that of patients who underwent palliative resection. Adjuvant chemotherapy was effective in improving survival, but the effect was not satisfactory. CONCLUSIONS: Palliative resection was effective in treating multinodular HCC. Further trials are required to improve the surgical survival of patients with HCC.

Antineoplastic Agents↗

PubMedDate not supplied

Clinical and histologic determinations of adequate breast resection in breast-conserving surgery. A review.

Patient selection is an important consideration in breast-conserving therapy (BCT), and is dependent on the clinical and histologic determination of disease extent. In order to provide adequate local control without compromising cosmetic outcome, the amount of breast tissue that must be excised in BCT needs to be individualized. Nuclear magnetic resonance (NMR) imaging can provide better information than mammography or ultrasonography for assessing multifocal and multicentric disease in the breast. However, they will play a limited role in breast cancer staging until NMR imaging-directed sterotaxic biopsy becomes available. On the other hand, the histologic status of the surgical margins as well as certain features of the tumor including the presence of intraductal components is predictive of the extent of breast cancer. It is reasonable to evaluate and obtain clear margins when performing BCT. However, further investigation of new preoperative imaging and intraoperative staging modalities for assessing multifocal and multicentric disease is necessary.

Biopsy↗

PubMedDate not supplied

A new technique for variable-load cholangiomanometry. Implication for biliary tract surgery.

BACKGROUND/AIMS: Variable-load cholangiomanometry was performed to obtain data on terminal biliary function during the surgical treatment of cholelithiasis. The decision of whether or not to perform a definitive biliary drainage procedure was based on the results of this test. MATERIAL AND METHODS: The rate of perfusion was reduced in four steps from 15.3 ml/min to 1.2 ml/min, and the resultant perfusion pressures were plotted. The gradient produced by the straight line was considered the resistance, R. The baseline pressure without perfusion was regarded as the static pressure, P. RESULTS: A review of 444 patients with cholelithiasis who underwent intraoperative cholangiomanometry during the past 11 years led to the following indications for definitive biliary drainage: (1) R > 10 units and P > 200 mm H2O, (2) if only R or P is elevated, priority is given to R, and (3) if the elevation of R or P is borderline, the presence of a type I curvature in the segment of low flow rate is an indication for surgery. CONCLUSION: By performing an intraoperative cholangiomanometry concrete indications for a biliary drainage procedure can be defined.

Cholelithiasis↗

PubMedDate not supplied

A new classification of Mirizzi syndrome from diagnostic and therapeutic viewpoints.

BACKGROUND/AIMS: A new classification of Mirizzi syndrome was developed based on our experience with 30 cases. MATERIAL AND METHODS: Using diagnostic and therapeutic criteria, four distinct entities were identified. Type I characterized by stenosis of the common hepatic duct due to a stone impacted in the cystic duct or the neck of the gallbladder. Type II is characterized by fistulization of the common hepatic duct as a result of a stone embedded in the cystic duct or the neck of the gallbladder. Type III is defined by hepatic duct stenosis due to a stone of the confluence, and Type IV by hepatic duct stenosis as a complication of cholecystitis in the absence of calculi impacted in the cystic duct or the neck of the gallbladder. RESULTS: Of the 30 patients there were 14 Type I, 2 Type II, 6 Type III, and 8 Type IV patients. Distinctive cholangiographic features were identified. CONCLUSION: The therapeutic approach differs from each of the four distinct pathologic entities.

Adult↗

PubMedDate not supplied

A comparison of the complication rate for three pancreaticojejunostomy techniques.

BACKGROUND/AIMS: A variety of techniques for pancreaticojejunostomy have been employed with introduction of safer anastomosing methods in our department as an extended excision of the pancreas was performed. In this study, complications associated with the various techniques of pancreaticojejunostomy were investigated in order to find a safer anastomosing method. METHODOLOGY: The extent of excision and complication rate of three types of pancreaticojejunostomy (impaction method, subserosal anastomosis and non-division procedure) were investigated in 64 patients who underwent pancreatoduodenectomy for diseases of the pancreas and biliary system. The end-to-side anastomosis of the pancreas and jejunum without division of the jejunoserosal tunica muscularis (non-division method) is an anastomotic method with a low risk of suture insufficiency. RESULTS: The incidence of secondary complications in the patients with suture insufficiency was higher than that in the patients with leakage of pancreatic juice. Once leakage of pancreatic juice and suture insufficiency occurred, the incidence of secondary complications was high after extended excision. CONCLUSIONS: From these results, the non-division method was found to be a safe anastomosing method. After an extended excision is performed, intraperitoneal drainage is necessary.

Bile Duct Neoplasms↗