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Biomedical subjects

K Okabayashi

Publications and source records attributed to K Okabayashi.

At least 73 records · Page 4Linked to original sources
PubMed1995

Postoperative chylothorax following partial resection of mediastinal lymphangioma: report of a case.

We report herein the rare case of a 20-year-old man in whom a mediastinal lymphangioma was incidentally detected by a chest roentgenogram taken during a routine health examination. Both computed tomography and magnetic resonance imaging confirmed a mass measuring 3 x 7 cm in diameter in the left anterior mediastinum. A thoracoscopic exploration was done, which confirmed a diagnosis of mediastinal lymphangioma, and 3 days later a sternotomy was performed. However, the tumor could not be completely extirpated due to partial invasion. Following the thoracoscopic procedure, a chylous discharge developed which was difficult to treat conservatively and he continued to drain 700-1,000 ml of chyle daily 2 weeks following the tumor extirpation. Therefore, a right thoracotomy with ligation of the thoracic duct was performed which resolved the chylothorax. The patient remains well without any regrowth of the regional tumor 9 months after his operation.

Adult↗
PubMed1995

Experimental carinal autotransplantation and allotransplantation.

Grafting is required when a primary reconstruction of a carinal defect is not feasible. A series of experiments in 21 dogs was conducted to assess the possibility of carinal reconstruction with the use of carinal autografts and allografts, with or without omentopexy. Carinal autograft transplantations were done without omentopexy in group A (n = 6) and with omentopexy in group B (n = 6). In group C (n = 9), carinal allograft transplantations were done with omentopexy and FK 506 was administered after operation. Survival of grafts was seen in 50% of group A, 83% of group B, and 44% of group C dogs. Postoperative bronchoscopy revealed inflammatory changes in the surviving grafts; the changes resolved more rapidly in the dogs with omentopexy than in the dogs without omentopexy. These experiments suggest that omentopexy is an effective method of facilitating survival and healing in carinal grafts and that carinal reconstruction with carinal allografts with FK 506 is feasible.

Anastomosis, Surgical↗
PubMed1995

A new approach for bronchoplastic procedures in the treatment of bronchial carcinoid tumors.

Usually patients with typical carcinoid tumors originating in a segmental bronchus undergo segmentectomy with or without a bronchoplastic procedure. We have performed only sleeve resection of the bronchus for a bronchial carcinoid tumor located in the left basal bronchus thus preserving the lung tissue. This was made possible by transecting and reanastomosing the pulmonary artery.

Aged↗
PubMed1995

Tracheal anastomosis using a metallic stapler. An experimental study.

Experimental use of a metallic stapler in tracheoplastic surgery is described. In contrast to monofilament sutures, the technique permits nontraumatizing tracheal repair and may therefore be advantageous in clinical treatment for lesions of the cervical and the intrathoracic trachea.

Anastomosis, Surgical↗
PubMed1994

Administration of prostaglandin E1 after lung transplantation improves early graft function.

Early graft dysfunction continues to be a major clinical problem after lung transplantation. The objective of this experiment was to determine whether continuous administration of prostaglandin E1 (PGE1) after lung transplantation has a beneficial effect on early graft function. Left lung allotransplantation was performed in 10 size-matched mongrel dogs (weight, 24.4 to 31.4 kg). Lung preservation consisted of a bolus injection of PGE1 (250 micrograms) into the pulmonary artery, followed by a pulmonary artery flush with 50 mL/kg of 4 degrees C modified Euro-Collins solution. The lungs were then stored at 1 degree C for 12 hours. Left lung transplantation was performed using standard technique. The right pulmonary artery and right bronchus were ligated prior to chest closure. Animals were placed in the supine position and ventilated for 6 hours with 100% oxygen at a rate of 20 breaths/min, a tidal volume of 550 mL, and a positive end-expiratory pressure of 5 cm H2O. Animals were randomly allocated to one of two groups. Group I animals (n = 6) received continuous PGE1 infusion from the onset of implantation. The dose was gradually increased and fixed when mean systemic pressure showed a 10% decrease (mean PGE1 dose, 31.7 +/- 6.9 ng.kg-1.min-1). Group II animals (n = 4) received no PGE1. After the 6-hour assessment period, arterial oxygen tension and alveolar-arterial oxygen pressure difference were preserved in group I compared with group II (group I versus group II: arterial oxygen tension, 255.8 +/- 37.6 mm Hg versus 64.7 +/- 7.9 mm Hg [p < 0.05]; alveolar-arterial oxygen pressure difference, 411.1 +/- 70.5 mm Hg versus 597.5 +/- 1.3 mm Hg [p < 0.05]).(ABSTRACT TRUNCATED AT 250 WORDS)

Alprostadil↗
PubMed1994

Pentoxifylline reduces lung allograft reperfusion injury.

Early graft dysfunction remains a significant problem in clinical lung transplantation. Pentoxifylline, a methylxanthine derivative, has been shown to have various beneficial effects on neutrophil-induced lung injury. We investigated effects of pentoxifylline on early posttransplantation lung function in a canine allograft model. Ten dogs underwent left lung allotransplantation. Donor lungs were flushed with modified Euro-Collins solution (50 mL/kg) and stored in an inflated state for 18 hours at 1 degrees C. In five experiments (group I), pentoxifylline was added to the flush and storage solutions (200 mg/L) at the time of harvest. The recipient animals received pentoxifylline (20 mg/kg intravenously) before reperfusion followed by pentoxifylline (0.1 mg.kg-1.min-1 intravenously) during the 6-hour posttransplantation assessment period. In group II, donors and recipients received no pentoxifylline. To evaluate only allograft function, the right main pulmonary artery and bronchus were ligated immediately after implantation. For 6 hours thereafter hemodynamics and gas exchange were assessed at 15-minute intervals while the animal was ventilated at an inspired oxygen fraction of 1.0. After 1 hour of assessment there was a significant difference in gas exchange between the groups, which persisted until the end of the study. By the end of the 6-hour assessment, the mean arterial oxygen tension was 236.7 mm Hg for group I versus 101.1 mm Hg for group II (p < 0.01), and the alveolar-arterial oxygen difference was 443.1 mm Hg versus 562.2 mm Hg (p < 0.015). Hemodynamics were not different between groups.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMed1994

[Use of a disposable infusion device for continuous epidural block].

We analyzed 130 patients with intractable pain who were treated with continuous epidural block therapy using a disposable microinjector to evaluate its efficacy and utility. The mean treatment period was 4.3 +/- 0.4 weeks. After the treatment, the mean visual analog scale (VAS) improved to 3.3 +/- 0.2, from the pretreatment value of 6.5 +/- 0.1. Among the intractable pain conditions, postherpetic neuralgia (PHN) and pain in the neck, shoulder and upper limbs were relieved markedly, while cancer pain was difficult to reduce. These data show that continuous epidural block therapy using the disposable microinjector is particularly useful in PHN, in which sympathetic nerve block is the essential treatment. The pain in the neck, shoulder and upper limbs was relieved with continuous somatic nerve block.

Aged↗
PubMed1993

Giant hamartoma of the lung with a high production of carbohydrate antigen 19-9.

A rare case of a giant pulmonary hamartoma with a high production of carbohydrate antigen (CA) 19-9 is presented. A 43-year-old woman with complaints of cough, fever, and chest pain was diagnosed as having a posterior mediastinal tumor with pneumonia. The serum CA 19-9 level was high. A thoracotomy revealed an intrapulmonary solid mass with a histologic diagnosis of cartilaginous hamartoma with no evidence of malignancy. The CA 19-9 concentration in the mucus of the tumor was high, and postoperatively the serum CA 19-9 level returned to normal. The CA 19-9 could be immunohistochemically demonstrated on the surface of the tumor.

Adult↗
PubMed1993

Angiosarcoma of the chest wall with a gastric metastasis.

A rare case of chest-wall angiosarcoma with high tendency of local recurrence and with a solitary gastric metastasis is reported. The patient was an 84-year-old man who had a left lateral thoracic mass with a colic pain. The histological diagnosis of a biopsied specimen suggested an angiosarcoma. The first resection was performed, the resected specimen consisted of the 8th, 9th and 10th ribs including the tumor. However the tumor recurred around the primary site and the second resection was undertaken eight months after the first resection. Only three months after the second resection a second chest-wall recurrence together with a solitary gastric metastasis was found. Progressive emaciation, anemia and thrombocytopenia became evident, and the patient died the 40th day after the gastrectomy. Primarily a wide resection of the chest wall beyond the pathologically negative region around the tumor is thought to be necessary.

Aged↗
PubMed1993

Dystrophic calcinosis of the penis.

A 22-year-old man had had a dome-shaped tumor on his penis for one year. Neither his particular past history nor family history was available. The excised specimen contained numerous von Kossa-positive deposits. Four types of histologic pattern were identified: 1) a cystic structure filled with amorphous material lined by a few layers of epithelial cells, 2) a cyst containing calcified deposits in the keratinous material, 3) a large calcified nodule lined by attenuated epithelial cyst walls, 4) numerous calcium collections without an epithelial wall. The cystic structure showed the histologic features of syringoma or sweat duct milia. The luminal cells of the cyst showed positive immunoreactivity for both keratin and carcinoembryonic antigen. These findings suggested that the keratinous contents of syringoma had gradually calcified, the cyst wall had been attenuated, and, finally, numerous calcium collections without an epithelial wall were formed. Our case further supported the hypothesis that penile calcinosis as well as scrotal calcinosis might derive from syringoma.

Adult↗
PubMed1993

Aspergilloma within cavitating pulmonary carcinoma. Case report.

Aspergillosis was diagnosed in a 69-year-old man presenting with blood-stained sputum, and was treated with an antifungal agent. As radiographic lesions persisted after 3 months, left upper lobectomy was performed. The surgical specimen revealed pulmonary carcinoma associated with an intracavitary aspergillar infection.

Aged↗
PubMed1993

[Onset of RSD and causalgia].

This study examined the time of onset of RSD and causalgia after injury. Many forms of treatment were tried to relieve the complex and debilitating symptoms in 36 subjects. Burning pain occurred in less than a month in 77.8% of patients.

Causalgia↗
PubMed1992

[Mutations of ras and p53 genes in human non-small cell lung cancer cell lines and their clinical significance].

We examined 77 non-small cell lung cancer (NSCLC) cell lines for mutations of 3 ras genes and p53 gene, and ras mutations were detected by designed RFLP assay generated by mismatched primers during the PCR step and p53 gene mutations were detected using SSCP analysis. The incidence of ras mutations were 27/77 (35%) while that of p53 gene mutations were 57/77 (74%). The incidence of ras mutations in cell lines with p53 mutations were not different from that without p53 mutations, suggesting that they occurred independently. Neither ras nor p53 mutations correlated with histologic subtype, disease extent, in vitro culture time nor prior therapy status. The patients whose cell lines had any ras mutations survived for shorter period of time not only among the patients who were treated with curative intent but among those treated with palliative treatment. The Cox proportional hazards model predicted the higher risk for patients with ras mutations but not those with p53 mutations. We conclude that ras and p53 mutations are frequent, apparently independent genetic alterations which play different roles in NSCLC and that this information should be utilized in surgical oncology in the near future.

Carcinoma, Non-Small-Cell Lung↗
PubMed1992

[Resection of tracheal carcinoma using partial cardiopulmonary bypass--report of a case].

A 43-year-old male was admitted to our hospital with chief complaints of stridor and dyspnea. Bronchoscopy revealed a tumor obstructing almost the whole lumen of the trachea. As it was impossible to insert an endotracheal tube into the distal site of the stenosis in the mediastinum, we used partial cardiopulmonary bypass to maintain gas exchange. The axillary artery and the femoral artery and vein were cannulated for the bypass using local anesthesia. During 105 minutes of bypass, the PaO2 value was good but the PaCO2 value increased up to 70 mmHg. After the trachea was opened, the anesthetic gas was administered across the operative field through the endotracheal tube and the cardiopulmonary bypass was discontinued. Tracheolaryngectomy and permanent tracheostomy with relocation to the right and caudal side of the brachiocephalic artery was performed successfully. The post operative course was very smooth. The patient has been well for 6 months since the surgery. Partial cardiopulmonary bypass proved to be useful for maintaining gas exchange during reconstructive surgery of the trachea. We treated a case of tracheal carcinoma by resection while using partial cardiopulmonary bypass. We believe this is the ninth such case reported Japanese literature.

Adult↗
PubMed1992

[Lymph node dissection around the splenic artery for gastric cancer--a comparative study of pancreatectomy and pancreas-preserving operation].

From 1977 to 1988, four hundred and sixty-five patients received total or proximal gastrectomy for advanced gastric cancer without leaving a tumor mass at National Cancer Center Hospital. Of these, 182 patients received distal pancreatectomy (PS) and 123 received pancreas-preserving operation with removal of the splenic artery (PP). The 5-year survival rate for the PS group (32.0%) was significantly lower than 61.0% for the PP group. Concerning grades of cancer stage, the 5-year survival rates for the PP group were better than those for the PS group in stages 1, 2 and 3. Seventy-four of the 465 patients were found to have histologically proven metastatic nodes around the splenic artery. Their 5-year survival rates were 9.2% for the PS group (n = 46) and 32.7% for the PP group (n = 13) respectively. Considering the difference in the background factors, these data suggest the effectiveness of the pancreas-preserving operation for advanced gastric cancer even with microscopic lymph node metastasis around the splenic artery. The pancreas-preserving operation with removal of the splenic artery might be indicated for the patient without definite macroscopically metastatic lymph node around the splenic artery.

Gastrectomy↗
PubMed1991

Non-ominous micrometastases of gastric cancer.

So-called R2 or wider meticulous node dissection was performed in 1368 patients with resected gastric cancer invading beyond the submucosa but without distant metastases. Survival rates were similar in subsets of patients with or without microscopic node metastases and macroscopically normal lymph nodes. The extent of node metastases has previously been shown to be one of the two most important prognostic factors in gastric cancer without distant metastases, and its lack of impact in these patient groups was not explained by the imbalance of other prognostic factors. The findings indicate that micrometastases of gastric cancer are curable by a wide node dissection made in the absence of palpable abnormality. They also offer the possibility that an extensive node dissection may yield good stage-specific survival rates, in part because of upstaging of patients. The findings should influence the recording of node metastases for evaluation of stage-specific treatment results and for research purposes.

Female↗
PubMed1991

Surgical treatment of carcinoma of the gastric stump.

To evaluate retrospectively the surgical treatment of patients with gastric stump cancer following gastrectomy for benign disease, we reviewed 52 patients operated on at the National Cancer Centre, Tokyo, between 1962 and 1988. Resection was carried out in 47 patients (90 per cent) and with curative intent in 36 (69 per cent). Stage distribution was: stage 1, 15 patients; stage 2, 5; stage 3, 9; stage 4, 23. In 36 cases curatively resected, 32 had completion total gastrectomy and four had subtotal resection. An R1 resection was performed in 11 patients and an R2 in 25. We had two hospital deaths and a 5-year survival rate excluding hospital deaths of 39 per cent. The 5-year survival rates of resected cases, curative cases and those having metastatic nodes were 43 per cent, 57 per cent and 29 per cent respectively. Radical resection is a reasonable treatment for gastric stump cancer as it is for primary cancer of the stomach.

Duodenal Ulcer↗