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Biomedical subjects

K Kusajima

Publications and source records attributed to K Kusajima.

At least 19 recordsLinked to original sources
PubMed2002

[Multiple primary lung carcinoma].

Of 692 patients who underwent operations for primary lung carcinoma between January 1980 and August 2001, 21 (3.0%) were considered to have a second primary lung carcinoma, which was synchronous in 14 cases (2.0%) and metachronous in 7 cases (1.0%). Five-year survival rate for patients with synchronous and metachronous disease from initial treatment of carcinoma were 66.7% and 100%, respectively. Survival after the development of a metachronous lesion was 80.0% at 5 years. Eight of the synchronous second tumors (57%) were detected by preoperative radiography or bronchoscopy, and 3 (21%) were detected during the operation. Adenocarcinoma comprised 81% of all multiple primary lung carcinomas, 86% of synchronous carcinomas and 57% of metachronous carcinomas. It is important to carefully examine a synchronous lesion before and during the operation of a primary lung carcinoma and to perform close follow-up surveillance for early detection of a metachronous lesion. The outcomes of surgical treatment for either synchronous or metachronous multiple primary lung carcinomas are satisfactory. Precise staging is important for the treatment of multiple lung carcinomas, and an aggressive surgical approach should be considered for early-stage carcinomas.

Adult↗
PubMed2002

[Long-term results of the operation for the aortic arch aneurysm].

Between October, 1991, and October, 2001, 60 patients underwent aortic arch replacement with or without an aortic arch branched graft for atherosclerotic arch aneurysms. Their mean age was 70.1 +/- 8.6 years. Eight (13.3%) patients were operated on an emergency basis because of rupture or impending rupture of aneurysms. All operations were performed with hypothermic extracorporeal circulation. Selective cerebral perfusion for cerebral protection during aortic arch repair and systemic circulatory arrest during distal graft anastomosis was used in 56 patients. Mean selective cerebral perfusion time was 86.1 +/- 12.1 minutes. A total of 14 concomitant procedures were done. Overall in-hospital mortality was 3.3%. Postoperative temporary and permanent neurologic dysfunction were 1.6% and 1.6%. Long-term follow-up was 100% complete. There were 6 late deaths with the cumulative survival rate was 74.6 +/- 8.8%. A subsequent aortic operation was necessary for the treatment of an aortic abnormality distal to the arch in 6 patients. Reoperation free rate was 85.2 +/- 5.8%. In conclusion, cerebral protective effect of antegrade selective cerebral perfusion and total arch replacement with an aortic arch branched graft could substantially reduce in-hospital mortality and postoperative neurologic dysfunction and a satisfactory long-term results could be obtain in patients with atherosclerotic arch aneurysms.

Aged↗
PubMed2002

[Successful lingular segmentectomy using bronchoplasty in a patient with early hilar second primary lung carcinoma].

A 71-year-old man was admitted to our hospital with a small protrusive lesion at the lingular orifice of the left upper bronchus. He had undergone a right lower lobectomy and mediastinal dissection for lung carcinoma (large cell carcinoma, pT1N0M0) 14 months earlier. Early hilar squamous cell carcinoma was diagnosed by chest radiograph, CT and transbronchial biopsy. We performed a lingular segmentectomy with wedge resection of the left upper bronchus and N 1 lymph node dissection. The tumor was histopathologically diagnosed as early hilar second primary lung carcinoma. The patient's postoperative course was uncomplicated. At present, he is alive with good respiratory condition and without any evidence of recurrence. Segmentectomy is appropriate for a patient with contralateral second primary lung carcinoma as well as a patient with early hilar lung carcinoma. Bronchoplasty seems to increase the likelihood that such a patient will be a candidate for segmentectomy.

Aged↗
PubMed2002

[Cardiovascular surgery in patients with Marfan syndrome].

The natural history of patients with Marfan syndrome is depressing, however, cardiovascular surgery can improve the prognosis. We reviewed the results of this surgical procedure for 10 years. Fourteen Marfan patients underwent cardiovascular surgery for a total of 21 times. Hospital mortality was 4.8% (1 case died on the 105th day after entire thoraco-abdominal aortic replacement because of pyothorax and sepsis), and the 5- and 10-year Kaplan-Meier survival was 92.9% and 77.4% respectively. Reoperation free rate was 51.4% and 38.6% respectively. Cardiovascular surgery in Marfan syndrome can be performed with good result. Aggressive surgical management and close follow-up of patients who undergo surgery is important.

Acute Disease↗
PubMed2001

Simultaneous cardiac operations with pulmonary resection for lung carcinoma.

OBJECTIVES: A procedure remains to be established for managing patients with both cardiac and pulmonary diseases requiring surgical interventions. We review our experience with 6 patients having cardiac disease and lung cancer surgically treated simultaneously to determine whether simultaneous surgery is safe and effective. METHODS: Subjects were 6 men with a mean age of 64 +/- 10 years undergoing cardiac surgery combined with pulmonary lobectomy from January 1986 through June 2000. Cardiac procedures consisted of coronary artery bypass in 3, coronary artery bypass plus left ventricular aneurysm repair, aortic valve replacement, and minimally invasive direct coronary artery bypass surgery in 1 patient each. All underwent lobectomy. RESULTS: No early deaths occurred. Bleeding complications occurred in 2 patients and lymph node dissection was incomplete in 3. Two died of carcinoma-related events, 1 at 28 and the other at 84 months after surgery. One died suddenly from a cardiac-related event 42 months after surgery. Only 1 patient is currently alive and disease-free at 104 months after surgery. CONCLUSION: Simultaneous surgery can be conducted with acceptable mortality. The occurrence of bleeding complications and incomplete lymph node dissection, however, indicates combined procedures only in patients requiring simultaneous surgery due to their disease or unable to tolerate a second operation.

Aged↗
PubMed2001

Twenty-seven-year follow-up of arrhythmogenic right ventricular dysplasia.

This case report describes clinical features, especially of surface ECG changes, observed for 27 years in a patient with arrhythmogenic right ventricular dysplasia (ARVD). The course of this patient was characterized by progressive deterioration of right ventricular function and progression of delayed potentials (so-called epsilon waves) following QRS complexes. However, the relation between ventricular arrhythmias and ECG changes or the degree of right ventricular abnormality was difficult to discern.

Adult↗
PubMed2001

[The estimation of the effectiveness of GRF glue in the respiratory].

We had reported on the basis of experimental findings that the efficacy of protecting the suture line in tracheoplasty by using a self-fascia lata and GRF glue. This time we investigated the effectiveness of GRF glue in the respiratory surgery on the basis of clinical findings. All ten cases in which GRF glue was used resulted in an excellent outcome, namely, GRF glue prevented from air leakage, bleeding and leakage of chyle. Moreover, it was not recognized that any grave side effects occurred in any cases after using GRF glue. We could conclude that GRF glue was a useful material for the respiratory surgery, especially for the case that had a dead space after lobectomy. However its price is not inexpensive, therefore, there seems need to restrict the use of GRF glue--for example--to cases of Giant bulla resection, residual of a large dead space as a postoperative possibility and chemotherapy performed before an operation, and so on.

Aged↗
PubMed2001

[A case of Castleman lymphoma in the right pulmonary hilum and mediastinum].

A 36-year-old man who complained of low grade fever and cough was detected an abnormal shadow in the right pulmonary hilum and mediastinum on a chest X-ray film. On admission, laboratory data showed high CRP and hyper gamma globlinemia. In thoracotomy, original tumor and mediastinal lymph node were resected. Histopathologically, main tumor and two of all the resected lymph node were diagnosed as Castleman lymphoma (plasma cell type). We consider that not only the main tumor and also the peripheral lymph node should be resected in this disease, because the lesions were often showed multicentric if this tumor were plasma cell type.

Adult↗
PubMed2001

[A resected case of multiple lung cancers].

A 78-year-old man was admitted to our hospital because of abnormal shadows on chest film. A 20 x 25 mm tumor shadow was found in the right lower lung field (S10) and a 5 x 10 mm tumor shadow in the right upper lung field (S2). Bronchoscopic curettage revealed squamous cell carcinoma from the specimen on the S10 and did not revealed malignant cells from the specimen on the S2. He was performed operation, squamous cell carcinoma in the S10 was removed by right lower lobectomy and nodule in the S2 was also removed by partial resection. Histological examination confirmed well-differentiated squamous cell carcinoma from the S10 and well-differentiated adenocarcinoma from the S2. He is healthy three year after operation.

Adenocarcinoma↗
PubMed2001

[The feasibility of a limited operation for primary lung cancer].

We reviewed 33 patients who underwent a limited operation for primary lung cancer between 1980 and 1998. These cases were divided into three groups; a poor risk group consisting of 18 patients who had a high risk such as pulmonary or cardiac dysfunction and who underwent partial resection of a lung, a reduction group consisting of 9 patients who had advanced lung cancer or uncontrolled cancer of an organ other than the lung and who underwent partial resection, and an active limited operation group consisting of 6 patients who underwent segmentectomy with lymphoadenectomy for the treatment of early lung cancer. The 1 and 3-year survival rates in the poor risk group, reduction group and active limited operation group were 73.9, 60.0, 100%, and 63.4, 0.0, 100%, respectively. The results of limited operations performed for poor risk cases were satisfactory in terms of both functional state and prognosis. Limited operations performed to reduce tumor in advanced lung cancer cases did not improve the prognosis. Although an active limited operation for a case of early lung cancer remains controversial with respect to indication, it is thought that this operation is not inferior to a standard radical operation (lobotomy with mediastinal lymphoadenectomy) in selective cases in which the maximum tumor diameter is 2 cm or less. The indication for a limited operation must be further examined from aspects of tumor size, tumor histology and the other factors of the tumor.

Adenocarcinoma↗
PubMed2001

[Endoventricular circular patch plasty (dor operation) for postinfarction left ventricular aneurysm and ischemic cardiomyopathy].

The determination of purse-string suture line is one of the most important point in endoventricular circular patch plasty (Dor operation) for postinfarction left ventricular aneurysm (LVAN), especially for ischemic cardiomyopathy (ICM). We suggest following three points to decide appropriate suture line. First, the purse-string suture on the basal side should be placed on the 1-2 cm level under diagonal branch. Secondly, lateral wall should not be over excluded to maintain left ventricular function. And the third, akinetic or dyskinetic lesion of apex and septal wall should be excluded as much as possible. Nine cases of five LVAN and four ICM were underwent Dor operation in our institute from Dec. 1999 to Jan. 2000. All patients were weaned from cardiopulmonary bypass easily except one patient, who was operated under IABP support, because of his preoperative severe heart failure. All patients recovered well without any serious complications and postoperative left ventricular graphies were satisfactory. Left ventricular ejection fraction and stroke volume index were increased from 34 +/- 17 to 55 +/- 16% and from 38 +/- 7 to 47 +/- 6 ml/m2, end-diastric and systric volume index decreased from 141 +/- 37 to 88 +/- 19 ml/m2 and from 96 +/- 41 to 41 +/- 23 ml/m2 respectively. The Dor procedure adopted our idea led to satisfactory result in hemodynamic and also in morphologic study.

Aged↗
PubMed2001

Bronchial stump reinforcement in right pneumonectomy with fascia lata and gelatin resorcin formalin (GRF) glue: case report.

We reinforced the bronchial stump with fascia lata and Gelatin Resorcin Formalin (GRF) glue in a right pneumonectomy. This method was found to be simple and useful. We describe our case and the method herein. A 62-year-old woman had a malignant polypoid lesion which completely occluded the introitus of the right main bronchus and deviated to the introitus of the left main bronchus. Right pneumonectomy was done but materials (pleura, pericardium, intercostal muscle, etc.) obtained from the thoracic cavity were insufficient for bronchial stump reinforcement due to severe adhesion caused by prior tuberculosis. Therefore, we reinforced the bronchial stump using the fascia lata and GRF glue. Fascia lata is a superior material for reinforcement in terms of strength and ease of molding, as well as harvesting. GRF glue is a superior adhesive with rapid and strong fixation. We consider this method of reinforcing the bronchial stump with fascia lata and GRF glue to be feasible, in particular, for pneumonectomy or lobectomy without adequate material in the thoracic cavity because of severe adhesion or lesions.

Drug Combinations↗
PubMed2001

[Detection of visceral ischemia with doplex scanning method of mesenteric arteries: in patients with acute type B aortic dissection].

Between March, 1997 and January, 1999, 11 patients with acute type B aortic dissection underwent doplex scanning evaluation of mesenteric arteries for the early detection of visceral ischemia. Peak systolic velocity (PSV) of the celiac artery (CeA) and superior mesenteric artery (SMA) was measured on their admission. Mean PSV of CeA in the non-ischemic group (8 patients) and in the ischemic group (3 patients) was 1.66 +/- 0.34 m/sec and 3.60 +/- 0.49 m/sec (p = 0.0481), respectively. Mean PSV of the SMA in the non-ischemic group and in the ischemic group was 1.93 +/- 0.52 m/sec and 3.33 +/- 0.37 m/sec (p = 0.00768), respectively. All patients with PSV of the mesenteric arteries above 3.00 m/sec presented visceral ischemia that required emergency operation. If PSV of the mesenteric arteries exceeds 3.00 m/sec, urgent surgical repair should be considered.

Aged↗
PubMed2001

[A case of mucosa associated lymphoid tissue (MALT) lymphoma].

We examined a 49-year-old man, who was referred to our hospital for resection of abnormal findings on the X-ray. Before hospital admission, he was performed TBLB and aspiration biopsy in other hospital, but the results was not decided diagnosis. Because the possibility of the lung cancer was not completely nagated, we performed the tumor resection (partial pulmonary resection) in use of thoracoscopy. The tumor was diagnosed as a MALT (mucosa associated lymphoid tissue) lymphoma at histologically and immunohistologically (CD 79), and resectable lymph node did not detected malignant cell. He has had no evidence of recurrence for 5 months after the operation.

Humans↗
PubMed2001

[Relationship between Noguchi's classification for small adenocarcinomas of the lung and tumor markers in serum].

We evaluated the relationship between Noguchi's classification for small adenocarcinomas of the lung and tumor markers in serum (CEA, Cyfra, SLX, CA 19-9, CA 125). Fifty surgically resected small peripheral adenocarcinomas measuring 2 cm or less in greatest diameter were examined. The tumors were divided into three groups on the basis of Noguchi's classification: group AB of tumors belonging to Noguchi's classification A or B, group C of tumors belonging to Noguchi's classification C, and group DEF of tumors belonging to Noguchi's classification D, E, or F. The level of serum CEA was higher in group DEF (5.9 +/- 7.6 ng/ml) than in group AB (2.3 +/- 2.4 ng/ml) and group C (2.0 +/- 1.3 ng/ml). There were no differences in the levels of the other serum tumor markers among the three groups. The incidences of anormality in serum CEA and Cyfra were higher in group DEF (6/18 and 6/18, respectively) than in group AB (1/7 and 0/7) and group C (1/25 and 1/25). Although a high level of serum CEA or Cyfra is a strong indication that the tumor is Noguchi's classification D, E, or F of pulmonary adenocarcinoma, it is difficult to classify small adenocarcinomas by Noguchi's classification using a serum tumor marker level.

Adenocarcinoma↗
PubMed2001

[A case of carcinosarcoma of the lung].

A 63-year-old man was admitted to our hospital because of cough and slight fever up. A tumor shadow in right S6 and obstructive pneumonia was detected by X-ray and CT. Bronchoscopic study showed that right B6 bronchous was occluded by the tumor and in which malignant cell (squamous cell carcinoma suspect) were detected. Therefore right middle and lower lobectomy was performed. Histological examination of the resected specimen showed that the tumor was composed of poorly differentiated squamous cell carcinoma and abnormal spindle cell component. Both components of the tumor were mixed each other in part. Immunohistologically, malignant cell of sarcomatous elements were positively stained by vimentin and actine, but was not found such as osteosarcoma or rabdomyosarcoma. He was diagnosed as so-called carcinosarcoma of the lung.

Carcinosarcoma↗
PubMed2000

[A therapeutic metastasectomy of pulmonary metastases by VATS].

The use of VATS to perform diagnostic metastasectomy is uniformly accepted, but the role of therapeutic VATS metastasectomy remains controversial. We retrospectively compared the value of therapeutic metastasectomy by VATS with that by open thoracotomy in the management of pulmonary metastatic tumors. The forty-six patients who underwent a complete metastasectomy of pulmonary metastatic tumors were divided into groups: one group in which metastasectomy was performed by VATS (VATS group; 23 cases, 25 operations) and another group in which metastasectomy was performed by open thoracotomy (Thoracotomy group 23 cases, 26 operations). Here, complete metastasectomy means compete resection of all tumors, which were detected by preoperative high resolution computed tomography in both groups and also by intraoperative manipulation in the thoracotomy group, without positive lesions of the surgical margin. The groups were matched with respect to preoperative clinical characteristics (age, sex, primary lesion, disease-free interval) and histological findings (maximum tumor size, number of metastatic tumors, minimum distance between surgical margin and tumor edge). The cumulative survival one-year and three-year rates were 83.5 and 83.5% in the VATS group, and 89.5 and 77.5% in the thoracotomy group, respectively. The cumulative one-year and three-year non-recurrence rates were 72.3 and 68.0% in the VATS group and 83.9 and 63.8% in the thoracotomy group, respectively. There were no significant differences between the two groups. We conclude that pulmonary metastasectomy by VATS can be used safely not only as a diagnostic but also therapeutic tool if complete resection is done following diagnosis by preoperative high resolution computed tomography.

Aged↗