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Biomedical subjects

K Sako

Publications and source records attributed to K Sako.

At least 127 records · Page 7Linked to original sources
PubMed1981

Bilateral radical neck dissection.

From January 1960 to December 1977, 61 patients had a simultaneous one-stage bilateral neck dissection with or without excision of the primary lesion, while 63 patients had a therapeutic second (two stage) neck dissection performed by our service. In ten patients, one or both of the internal jugular veins and spinal accessory nerve were preserved. Patients in both groups were staged, using the American Joint Commission 1977 clinical classification. All the pathologic specimens had lymph node clearance done. Simultaneous bilateral neck dissection, in the present study, has an operative mortality of 10%, with 11% life-threatening complications and with 62% significant postoperative facial swelling. There is an overall three- and five-year survival rate of 20% and 12.5%. Patients who had bilateral staged neck dissection had complications seen in 54%, with a 3.2% mortality rate. The overall three- and five-year survival in this group of patients was 60% and 38%, respectively.

Aged↗
PubMed1981

Parenteral hyperalimentation in surgical patients with head and neck cancer: a randomized study.

Sixty-nine patients were entered in a randomized study to determine the usefulness and practicality of parenteral hyperalimentation (TPN) in preparing and supporting patients with head and neck cancer undergoing radical resections. The patients were stratified by nutritional status and prognosis and randomization were done within each strata to TPN or control. Minimum full TPN was given at 35 calories/kgm/day for at least 14 days postoperatively. Eight patients received preoperative TPN also. Control patients received customary enteral alimentation by feeding tubes. Under the conditions of this particular study, the administration schedules, and type of solutions used, we were unable to demonstrate any superiority of TPN over conventional enteral nutrition in terms of immune parameters, wound healing, complications, and survival.

Body Weight↗
PubMed1981

[Middle fossa neurinoma with proptosis and oculomotor palsy (author's transl)].

UNLABELLED: Proptosis and oculomotor palsy which occur with intracranial neurinoma are very rare. CASE: A 29-year-old right-handed female was admitted to the Department of Neurosurgery, Hokkaido University School of Medicine on Sept. 6, 1975. Eight months before admission, the patient complained of double vision and one month later, noticed decreasing of right visual acuity. Four months before admission, right-sided ptosis occurred and she noticed right temporal visual field's defect. Two weeks before admission she became aware of proptosis of right side. On admission, the general examination and vital signs were normal. The neurological examination revealed right optic nerve atrophy, right oculomotor palsy and slight decreasing of right corneal reflex. Radiological examination revealed extracerebral mass lesion in the middle fossa. On Sept. 19, 1975, a right frontotemporal craniotomy was performed and a large dura-covered tumor was found. It was found to extend from the middle fossa to the superior orbital fissure and attached to the anterior wall of the middle fossa. The tumor expanded into the interdual space and tightly attached to the dura mater. Histological examination of the tumor revealed typical neurinoma. Reports on cases with middle fossa neurinoma were reviewed and the origin of the tumor was discussed. It was presumed that the origin of the tumor in this case was the dural branch of the trigeminal nerve in the middle fossa.

Adult↗
PubMed1980

Radiation-associated thyroid carcinoma.

Since February, 1977, 735 patients having a history of receiving radiation therapy for benign conditions of the head and neck areas during infancy and childhood were examined in a thyroid screening program, and 159 patients were found to have palpable thyroid nodules. These patients had thyroid function tests and indirect laryngoscopy and were followed closely on suppression therapy consisting of either Cytomel or thyroid extract. Thyroidectomy was advised in those in whom the nodules persisted or increased in size. This study documents the incidence of carcinoma and other benign pathological changes and postoperative complications in this group of patients. So far, 49 patients had either a lobectomy with isthmusectomy or a total thyroidectomy. Eleven patients were found to have carcinoma (six had papillary, four had mixed papillary and follicular, and one had follicular carcinoma). Three patients had a therapeutic modified neck dissection following the documentation of microscopic involvement of paratracheal lymph nodes. A high incidence of chronic nonspecific thyroiditis, postradiation fibrosis, and follicular adenomas were also found in these patients. Three patients had temporary hypocalcemia (two weeks) and none had wound infection, hematoma, or postoperative nerve palsy. Of patients who had surgical resection, 22.4% showed thyroid carcinoma.

Adolescent↗
PubMed1980

Carcinoma of the thyroid gland.

Thyroid cancer is not a common cancer and consists of a variety of tumors with different biological characteristics. Diagnosis and therapeutic approaches differ considerably, depending on which subgroup the tumor belongs to. Differentiated carcinomas, which constitute the bulk of thyroid carcinoma, often retain the features of the thyroid gland, which can be taken advantage of in their management. The prognosis of these patients is usually excellent. Undifferentiated carcinoma, in contrast, is an aggressive tumor and usually is fatal within a year from the diagnosis. Therefore, an aggressive therapeutic approach is required. Transformation of differentiated carcinoma to undifferentiated carcinoma does occur, although infrequently. The importance of proper management of patients with differentiated carcinoma is obvious. Medullary carcinoma, which originates from the parafollicular cells, has various interesting biological characteristics and is a medium-grade malignancy.

Adenocarcinoma↗
PubMed1980

Implantable oxygen microelectrode suitable for medium-term investigations of post-surgical tissue hypoxia and changes in tumor tissue oxygenation produced by radiotherapy.

Teflon-covered platinum oxygen probes were used to monitor tissue oxygen levels in post-surgical cancer patients and those treated with radiotherapy. Progressive wound healing was usually accompanied by a decrease in tissue pO2. Radiotherapy produced a slight increase in pO2 while hyperthermia effected a significant increase in the oxygen level during 100% oxygen breathing.

Animals↗
PubMed1978

Myxedema coma and inappropriate antidiuretic hormone secretion after deep neck irradiation: clinical implications and report of a case.

A case report is presented in which myxedema coma and inappropriate antidiuretic hormone secretion developed as a result of radiation therapy and surgery to the neck area in a patient with recurrent metastatic squamous cell carcinoma of the floor of the mouth. Laboratory findings of low thyroxine level and the findings of persistent hyponatremia and hypoosmolality of serum in spite of persistent sodium loss in the urine were helpful in diagnosing the problem. Treatment included thyroid hormone replacement and fluid restriction resulting in complete reversal of her condition. We believe that patients with head and neck cancer who have undergone a course of radiation to the neck, and particularly when thyroid function might have been altered by previous subtotal thyroidectomy as part of a curative resection, should be carefully followed with periodic thyroid function assays and serum electrolytes with particular attention to serum sodium values.

Carcinoma, Squamous Cell↗
PubMed1978

The diagnosis of thyroid carcinoma during the postoperative period after less than total thyroidectomy.

In clinical practice, small or localized thyroid cancer is often missed at the time of surgery and is diagnosed only later after the pathologist has been able to study multiple sections. Our data suggest that patients with early or localized thyroid cancer can be controlled with less than total thyroidectomy. If the nodule is completely excised without fracture (preferably lobectomy) or not cut into, if there is no evidence of metastatic disease either by palpation or frozen section, and if gross examination of the surgical specimen and frozen sections is negative for carcinoma, it is our policy to place these individuals on a regimen of observation only. Additional surgery is performed only if clinical evidence of recurrent cancer develops. Long-term follow-up of forty-four patients supports this treatment policy. Of these, seven had clinical recurrences: three benign; four (9 per cent) malignant. (The 2 patients with metastatic periglandular lymph nodes in the surgical specimen would not meet our present criteria.) We have in our files several additional patients who seem to support the same conclusions but will be reported on only after longer follow-up.

Adenocarcinoma↗
PubMed1978

Significance of site and nodal metastases in squamous cell carcinoma of the epiglottis.

One hundred twelve patients treated by surgery alone for squamous cell carcinoma of the epiglottis were retrospectively reviewed. The results showed: (1) 27 per cent of patients with N0 disease had microscopic nodal metastases; (2) 35 to 47 per cent of patients with N0 and N1 disease and histologically positive nodes (micrometastases) in the initial neck dissection developed contralateral nodal metastases; (3) 36.9 per cent of the patients who had nodal micrometastases (histologically positive) survived five years, as contrasted with 94.5 per cent of those who did not have node involvement; (4) 53.2 per cent of the patients who had nodal metastases in one neck and 16 per cent of those who had metastases in both necks survived five years; (5) when the primary tumor in the epiglottis was located in the midline or there was bilateral supraglottic involvement, 18 to 50 per cent of patients developed contralateral ("second") neck nodal metastases; (6) performing early elective contralateral ("second") neck dissection shortly after recovery from the initial surgery may improve survival of patients in whom either the "first" neck dissection showed microscopic nodal metastases and/or the primary tumor was located either in midline or there was bilateral supraglottic involvement.

Adult↗
PubMed1978

Chemotherapy for advanced and recurrent squamous cell carcinoma of the head and neck with high and low dose cis-diamminedichloroplatinum.

Cis-diamminedichloroplatinum (cis-DDP) in both a high dose regimen of 120 mg/M2 every three weeks with pretherapy hydration and mannitol diuresis and a low dose regimen of 20 mg/M2 daily for five days and cycled every three weeks have effective antitumor activity in approximately one third of patients. Its toxicity in both regimens appears to limit the number of cycles of administration and the duration of response. Further trials with dose schedules intermediate between the present high and low dose schedules are needed to provide a suitable and effective one day regimen every three to four weeks that can be given on an outpatient basis and on a long-term basis.

Cisplatin↗
PubMed1977

Influence of initial neck node biopsy on the incidence of recurrence in the neck and survival in patients who subsequently undergo curative resectional surgery.

During a period of 23 years, 57 patients who had an initial neck node biopsy elsewhere, with the diagnosis of metastatic squamous cell carcinoma established, underwent curative resection by our department after the site of head and neck primary was found. Ten patients free of disease died of other causes, leaving 47 patients who were eligible for at least 3 years of follow-up. Ninteen patients are alive after 3 or more years. The incidence of recurrence in the neck was 57% (27/47). The 3-year survival in this group of Stage III was 40% (19/47) and 5-year survival was 34% (16/47). Compared with historical data, it appears from the present study that a previous biopsy of a neck node did not adversely affect the incidence either of neck recurrence or survival when appropriate surgery is performed.

Biopsy↗
PubMed1977

Management of "localized" oral cancer.

We have outlined the clinical manifestations of "localized" malignant lesions of the intraoral cavity, their clinical behavior after intraoral excision, and their control rate employing intraoral excision as primary therapy. We must keep in mind that these small "localized" cancers are potential "killers" and the five year mortality from disease in our series was 25 per cent. This mortality may decrease with (1) more careful selection when patients are included in the "localized" lesion group and (2) earlier use of composite procedures in questionable cases.

Aged↗
PubMed1977

Correlation between prognosis and degree of lymph node involvement in carcinoma of the oral cavity.

Accurate histologic determination of lymph node metastasis is most important in predicting prognosis in patients who undergo radical neck dissection. In this study of 340 determinate patients, the five year survival was 75 per cent when lymph nodes were histologically negative, 49 per cent when one lymph node was positive, 30 per cent when two lymph nodes were positive, and 13 per cent when three or more nodes were positive. Other factors useful in predicting prognosis are, to some extent, the level of lymph node metastasis in the neck, and the presence or absence of capsule penetration and soft tissue involvement. Those patients with metastasis to three or more lymph nodes had a five year survival of 13 per cent and belong to a high risk group. In this high risk group among those who died, the incidence of recurrence in the neck was 72 per cent, and the incidence of distant metastasis was 70 per cent. When autopsy was performed, more still were found to have distant metastasis, 75 to 80 per cent. Most of these high risk patients already have systemic dissemination of cancer at the time of their initial therapy; therefore, the addition of a systemic form of adjuvant therapy, such as chemotherapy and/or immunotherapy, is justified.

Adult↗