[A case of carinal resection for adenoid cystic carcinoma of the right main bronchus followed by primary reconstruction].
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Biomedical subjects
Publications and source records attributed to K Sawada.
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Seventy-eight patients with resected carcinoma of the lung classified as T1 and which arose in the periphery of the lung during the past 10 years were reviewed in order to evaluate both diagnostic methods in assessment of lung cancer and surgical survival. According to the size of the surgically excised lung tumor measured in greatest diameter, the patients were divided into Groups A, B, C and D. From the diagnostic point of view, procedures performed to establish a conclusive diagnosis during surgery, so-called exploratory thoracotomy, were most prevalent in Groups A, B, and C and least in Group D in decreasing degree. On the contrary, the frequency with which diagnosis could be achieved preoperatively increases with size of tumor. Metastases to the regional lymph nodes were found in Group D at a greater rate than in the other 3 groups. However there was no statistical correlation between histologic types and metastases to regional lymph nodes. The 5-year survival rate was 66.7% in Group A, 72.7% in Group B, 21.2% in Group C and 35.4% in Group D. And there was a statistically significant difference between Groups A and B and Groups C and D.
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In a study of 65 of patients with bronchogenic carcinoma who had thoracotomy over a 5-year period, cytodiagnosis by 3-day consecutive sputum cytology was reported positive for malignant cells in 55.4%. Data analysis revealed that the overall cytodiagnosis correlated with clinical stage, tumor size, site of origin, topography and histologic types. From the histologic standpoint, the site of origin was significantly related to the positive cytology in patients with squamous cell carcinoma among factors influencing the results of sputum cytology. On the other hand, there was a correlation of tumor size and the positive cytology in patients with adenocarcinoma. In addition, poor prognosis related to the positive cytology in adenocarcinoma cases in terms of the relationship between the results through sputum examination and survival. The authors emphasized that sputum cytology has proven to be a valuable factor for determining prognosis, especially in patients with adenocarcinoma.
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5 patients with histologically and/or cytologically confirmed lung cancer were treated with Cis-platinum (CDDP) infused into the bronchial artery (BAI). 2 patients with squamous cell carcinoma disclosed hypervascular type and 3 patients with adenocarcinoma demonstrated avascular or hypovascular type on bronchial arterial angiography. All patients showed more than 20% shrinkage of the tumor shadow on chest X-ray taken 2 weeks after BAI and were evaluated to be radiologically effective by Takeuchi's criteria. One patient with squamous cell carcinoma who underwent lobectomy after BAI with 100 mg of CDDP showed grade III histological effects by Shimosato's criteria. The other patient had superior vena cava syndrome and showed regression of a tumor which occluded the orifice of the right upper and showed lobe after BAI with 100 mg of CDDP. By of contrast, only 1 out of the 3 patients with adenocarcinoma who under went resection showed a grade IIa histological effect after BAI with 50 mg of CDDP. Side effects included mild gastrointestinal toxicity in 1 out of the 5 patients. In conclusion, BAI with CDDP was shown to be sufficiently useful as a chemotherapeutic modality for lung cancer, especially for patients with squamous cell carcinoma, because higher local doses can be delivered without systemic toxicity.
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TRH tests (500 micrograms, i.v. bolus) were performed in 15 patients with various hypothalamic or pituitary disorders and in 6 control subjects. TSH (highly sensitive RIA) and T3 were measured before and 30, 60, 90 and 120 min. after TRH. In 8 out of 15 patients, low circulating thyroid hormone levels were observed, but their basal TSH levels were all in the normal range or even higher (0.8 - 5.5 microU/ml). Further, their integrated TSH responses (38 +/- 21 microU/ml) did not differ significantly from those of control group (35 +/- 16 microU/ml). Except for 2 cases with hypothalamic hypothyroidism, T3 increments after TRH were found consistently lower than 5 ng/dl in these hypothyroid patients. One of them revealed significant elevations of T3, T4 and thyroid 99mTc-pertechnetate uptake after 5 I.U. x 2 i.m. bovine TSH. In 19 cases studied (2 cases with hypothalamic hypothyroidism were omitted), basal T3 levels were found to show quite a good correlation (r = 0.738) with T3 increments after TRH. Therefore, TSH values by radioimmunoassay in hypothalamo-pituitary disorders were considered not relevant to be the levels of a real thyroid stimulator, or they seemed to contain biologically inactive moieties. In conclusion, measurement of the TSH level and even the TRH-TSH test were found unreliable in diagnosing central hypothyroidism, and the TRH-T3 test appeared to give quite useful diagnostic information.
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A new inotropic agent, TA-064, (-)-alpha-(3,4-dimethoxyphenethylaminomethyl)-4-hydroxybenzylalcohol, was shown to have strong effects in experimental animals. Its effectiveness and associated adverse effects were tested in humans invasively (n = 6) and noninvasively (n = 17). Increasing doses of intravenous infusion (1, 2, and 4 micrograms/kg/min) increased plasma levels to 15, 35, and 82 ng/ml, respectively, resulting in marked increases in the peak rate of left ventricular pressure rise (dP/dt) (1,450 +/- 63 to 3,042 +/- 349 mm Hg/s) (mean +/- standard error of the mean [SEM], p less than 0.01) and the ratio of dP/dt to left ventricular pressure at a developed pressure of 40 mm Hg (25 +/- 3 to 39 +/- 2 s-1) (p less than 0.01), with a reduction in left ventricular end-diastolic pressure (12 +/- 2 to 4 +/- 1 mm Hg) (p less than 0.01). Minimal or no changes were seen in heart rate and left ventricular systolic pressure. After a single oral dose (10 mg), the plasma level reached its peak at 90 minutes (16 +/- 9 ng/ml, n = 17). A positive inotropic effect was confirmed echocardiographically in both healthy volunteers (n = 8) and patients with congestive heart failure (CHF) (n = 9) who were maximally treated with conventional regimens: increase in mean velocity of circumferential fiber shortening (healthy volunteers: 1.29 +/- 0.05 to 1.60 +/- 0.11 circ/s [p less than 0.05]; patients with CHF: 0.69 +/- 0.08 to 0.93 +/- 0.09 circ/s [p less than 0.01]), ejection fraction (healthy volunteers: 68 +/- 2 to 75 +/- 2% [p less than 0.05], patients with CHF: 37 +/- 4 to 45 +/- 5% [p less than 0.01]) without change in heart rate. The cardiac index was increased only in the CHF group (2.71 +/- 0.22 to 3.21 +/- 0.24 liters/min/m2) (p less than 0.05). No significant untoward effects were observed. Thus TA-064 is a potent inotropic agent and can be used either parenterally or orally. Salutary effects can be expected in patients with congestive heart failure who are treated with digitalis and diuretic agents.
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To ascertain whether the long cardiac pauses on the Holter ECGs of patients with the sick sinus syndrome were related to the spontaneously occurring overdrive suppression, the heart rates for the 12 seconds preceding the cardiac pauses longer than 5 seconds were compared with that averaged for 24 hours. Even in six out of seven patients with bradycardia-tachycardia syndrome the former rate was not significantly greater than the latter, indicating that episodes of such long cardiac pauses may not result from spontaneously occurring overdrive suppression. This observation was also consistent with the result that no statistically significant correlation was obtained between the maximum pauses measured from Holter ECGs of sick sinus syndrome and those obtained by the overdrive suppression test. In conclusion, many episodes of long life-threatening cardiac pauses observed in sick sinus syndrome may be attributed to accidental depression of the sinus nodal and subsidiary pacemaker activity rather than to spontaneously occurring overdrive suppression; therefore, Holter monitoring may be useful as an additional tool for diagnosis of sick sinus syndrome.
An area where the sinus node was located in 36 dogs was defined as the "SN-area." Five to 7 days after cauterization of the SN-area, a subsidiary pacemaker remained in the SN-area in seven (group S) and shifted to outside the SN-area in 14 dogs (group E). The SN-area in group S had escaped complete destruction, but that in group E was destroyed completely. Heart rate in group S and group E was 154.0 +/- 27.1 and 107.6 +/- 16.8 beats/min (p less than 0.001), respectively. Maximum duration of asystole after overdrive (maxDAO) in group S and group E was 656.7 +/- 260.2 and 2470.2 +/- 2271.6 msec (p less than 0.01), respectively. Propranolol (0.2 mg/kg intravenously) decreased heart rate in group S and group E to 88.3 +/- 7.9 and 71.7 +/- 8.7% (p less than 0.001), and prolonged maxDAO to 140.1 +/- 28.1 and 492.7 +/- 591.4% (p less than 0.025), respectively. It is concluded that the rate and stability of subsidiary pacemakers after cauterization of the sinus node have a close relationship with their location in the right atrium, which is dependent on the extent of lesions in the SN-area. Sympathetic tone played a significant role in maintaining these functions in group E.
The relationship between adult speech and body movements of full-term healthy newborns was analyzed with a microcomputer (TM990/101M). The mother, pediatrician, and nurse were asked to talk with the subject, the infant, freely and also to read structured patterns such as "hi hi." There was a significant relationship between the infant's body movements and human voices (P less than 0.01). As a control, the infant was subjected to white noise, tapping sounds and to non-patterned sounds, where little relationship between body movements and non-human sounds was found. In 17 of 64 examined periods the infants reacted to the spoken voice with movement within 1.3 +/- 0.5 sec after the words. In 20/64, the mother spoke to the infant with a 1.4 +/- 0.4 sec latency after his movements. In 15/64, both the infant's movements and adult speech occurred at almost the same time with a 0.05 +/- 0.2 sec lag. This analytical method using a computer suggests not only the ability of a neonate to move his body synchronously with his mother's speech, but also that a mother also talks to her infant by reacting to his movements. This may be the basic process of language acquisition, and this method may have applications in the early diagnosis of some neurological diseases.