Search PubMed⌕ Search

Biomedical subjects

K Suemasu

Publications and source records attributed to K Suemasu.

At least 19 recordsLinked to original sources
PubMed1992

Hematoporphyrin derivative photodynamic therapy in roentgenographically occult carcinoma of the tracheobronchial tree.

From July 1981 to July 1987, hematoporphyrin derivative photodynamic therapy (HpD-PDT) was administered to 36 patients admitted to the National Cancer Center Hospital with roentgenographically occult lung cancer in whom biopsy showed 39 malignant lesions of the trachea and bronchus, although all the lesions could not be localized by the plain chest radiography and computed tomography scanning. The patients received an injection of HpD (2.5 mg/kg body weight) intravenously 72 hours before laser photoirradiation, and all patients underwent at least one session of PDT through a fiberoptic bronchoscope. Among the 39 malignant lesions of the trachea and bronchus, apparent complete responses were obtained in 11 patients with 12 lesions and less than complete responses in 27 lesions. Those with less than complete responses subsequently were treated with surgical or radiation therapy. Of the 36 patients, 16 patients are alive 37 to 109 months after therapy (mean, 65.1 months) with no apparent recurrence or metastasis, and 20 patients have died. Five of the 20 patients died of recurrent lung cancer, and the other 15 died of secondary causes. Regarding treatment complications, only a small amount of excessive airway secretions were observed, and there was no abscess formation in any patient.

Adult↗
PubMed1992

Closure of fenestra in Clagett procedure: use of rectus abdominis musculocutaneous flap.

Empyema developed in a 62-year-old man after right pneumonectomy for lung cancer. According to the Clagett procedure, an open window thoracostomy was made with two ribs removed. After 5 weeks, primary closure of the fenestra was attempted. Because the fenestra was too large to be primarily closed, a rectus abdominis musculocutaneous flap was successfully transposed to cover the chest wall. There was no evidence of recurrence of empyema during 11 months' observation after closure. In patients with a large fenestra and with little tissue left for closure, the rectus abdominis musculocutaneous flap could be of great help in completing the Clagett procedure.

Abdominal Muscles↗
PubMed1992

Bronchopleural fistulas associated with lung cancer operations. Univariate and multivariate analysis of risk factors, management, and outcome.

During a 28-year period, 52 bronchopleural fistulas developed after pulmonary resection of 49 primary and three recurrent lung cancers at the National Cancer Center Hospital, Tokyo. During the same period there were 2359 pulmonary resections for primary lung cancer; the prevalence of bronchopleural fistula was 2.1%. Multivariate analysis on 15 variables in the most recent 1360 resections revealed significant risk factors for bronchopleural fistula: wider resection such as pneumonectomy, residual carcinomatous tissue at the bronchial stump, preoperative irradiation, and diabetes. Univariate analysis further recognized a risk in preoperative bronchial arterial infusion and the postsurgical stage of lung cancer. Six patients were not treated. Apart from chest tube drainage in seven patients, surgical repair was attempted in 39, direct resuture of the stump in 16, wrapping in 25, thoracoplasty in 31, completion pneumonectomy in 6, and other treatments. Despite various treatments, 37 patients (71.2% mortality) died from fistula-related complications (such as regurgitation of infected pleural fluid through the fistula and airway/intrathoracic bleeding). Even for patients whose fistulas were cured and who were discharged, the average hospital stay was 189 days. Further investigation is necessary to answer whether prevention by flap coverage is of any benefit.

Adult↗
PubMed1992

Carcinoid tumor of the lung: clinicopathological study of 32 cases.

A retrospective study was conducted on 32 patients who had had bronchial carcinoid tumors between 1965 and 1989. The average age of the patients was 48.5 years, with a male to female ratio of 3.6:1. Of the 32 patients, 28 were diagnosed pathologically to have typical bronchial carcinoid tumors and the other four, atypical bronchial carcinoid tumors. Twenty-two of the 28 typical bronchial carcinoid tumors were classified as stage I, but only one of the four atypical bronchial carcinoid tumors was at stage I. Two typical carcinoid tumor patients and two atypical carcinoid tumor patients were found, pathologically, to have lymph node metastasis. The typical carcinoid tumors showed a more significant endobronchial polypoid growth than the atypical carcinoid tumors (P = 0.0138). The five-year-survival rate was 100% in patients with typical carcinoid tumors and 25% in those with atypical carcinoid tumors. The difference between the five-year-survival rate for the typical carcinoid and atypical carcinoid patients was statistically significant (P = 0.001).

Adult↗
PubMed1991

Randomized trial of cyclophosphamide, doxorubicin, and vincristine versus cisplatin and etoposide versus alternation of these regimens in small-cell lung cancer.

Between April 1985 and May 1988, we conducted a randomized study comparing two standard chemotherapy regimens with the same regimens given on an alternating basis in patients with small-cell lung cancer. The patients were randomly assigned to receive cyclophosphamide at a dose of 800 mg/m2 intravenously (IV) on day 1, doxorubicin at 50 mg/m2 IV on day 1, and vincristine at 1.4 mg/m2 IV on day 1 (CAV); cisplatin at 80 mg/m2 IV on day 1 and etoposide at 100 mg/m2 IV on days 1, 3, and 5 (PE); or CAV alternating with PE (CAV/PE). Each regimen was repeated every 3-4 weeks. Three hundred patients were entered in the study, and 288 of them were eligible for analysis (97 for CAV, 97 for PE, and 94 for CAV/PE). The response rates for PE (78%) and CAV/PE (76%) were significantly higher than the rate for CAV (55%), while the complete response rates were similar (14%, 16%, and 15%, respectively). Nine (23%) of 39 patients who failed to respond to the initial CAV regimen responded to PE when they were crossed over. In contrast, only one (8%) of 13 patients responded to CAV after failing to respond to the PE regimen, suggesting that these two regimens were partially non-cross-resistant. The response duration on CAV/PE was significantly longer than that with CAV (P = .004). The survival time with CAV/PE (11.8 months) was superior to that with CAV (9.9 months) (P = .027) or that with PE (9.9 months) (P = .056). In patients with limited disease, the survival in the alternating arm was significantly superior to the survival in the CAV arm (P = .014) or the survival in the PE arm (P = .023). The toxic effects were acceptable in all three chemotherapy regimens. These results favor the alternating chemotherapy over either standard chemotherapy, such as CAV and PE, although the differences are not dramatic.

Adult↗
PubMed1991

Radiotherapy in inoperable stage I lung cancer.

In 38 cases of Stage I lung cancer, for which surgery was not indicated because of poor cardiopulmonary function or other reason, radical irradiation yielded excellent results. The five year survival rate was 42.1%, the 10-year survival rate 28.4% and the 15-year survival rate 17.1%. Postradiation complications which can be life-threatening, were acceptably low in incidence, and there was no radiation-related death. The results support the concept of radical irradiation being acceptable as a treatment modality for Stage I lung cancer if the patients concerned cannot have surgery because of poor cardiopulmonary function or some other reason.

Female↗
PubMed1991

Cavernous lymphangioma of the breast: case report with electron microscopic and immunohistochemical investigations.

A rare case of cavernous lymphangioma of the breast in a 16-year-old Japanese girl was investigated by light and electron microscopies, and immunohistochemistry. The patient, who had a soft breast tumor measuring 16 x 14 cm, had undergone a tumorectomy two years after she noticed the tumor. Histologically, the tumor was composed of numerous narrow spaces containing amorphous fluid lined with a monolayer of endothelial cells. Abundant collagen fibers and numerous fibroblasts were found beneath the endothelium. Histological findings confirmed a diagnosis of lymphangioma of the breast. Immunohistochemically, the endothelium showed negative immunoreaction for factor VIII-related antigen, but the discontinuous basal lamina was positive for laminin. Ultrastructurally, numerous microfilaments and pinocytotic vesicles were found in the cytoplasm of the endothelial cells, and intermediate junctions were recognized between adjacent cells. In addition, a discontinuous basal lamina was seen beneath the endothelium. Electron microscopic and immunohistochemical investigations are thus useful in confirming a diagnosis of cavernous lymphangioma of the breast.

Adolescent↗
PubMed1991

Esophageal and pulmonary metastases from ovarian carcinoma: a case report of long-term survival following metastatic resections.

A case of ovarian carcinoma which has been followed up for more than 28 years after the initial ovarian resection is reported. A 50-year-old woman came forward with a metastatic esophageal tumor 16 years after a salpingo-oophorectomy for ovarian carcinoma. After irradiation with a dose of 3090 cGy, an esophagectomy and a partial resection of the directly invaded pericardium was successfully performed. Ten years later, progressive dyspnea due to a total collapse of the right lung developed. The right main stem bronchus was almost occluded by an endobronchial tumor, contiguous with the recurrent mass at the previous resectional margin. A right pneumonectomy and a combined resection of the pericardium and left atrium were performed. The patient has been followed up for further two years, and no signs of recurrence are evident. In spite of distant thoracic involvement and its local regrowth, the patient has survived for 28 years following her initial resection with surgical interventions.

Combined Modality Therapy↗
PubMed1991

[Operation for preservation of lung function in lung cancer cases--study on bronchoplasty].

In the period between 1962 and 1989, there were 2,279 resected cases of primary lung cancer, out of which 134 cases (21 cases in stage I; 29 cases in stage II; 66 cases in stage IIIA; 9 cases in stage IIIB; 9 cases in stage IV) underwent bronchoplasty excluding carinal resection. Survival rate was 38.2% in these cases including one operative death. Five year survival rate was significantly better than 22.5% in 453 cases which underwent pneumonectomy. To preserve pulmonary function, enhance curability and extend scope of operative indication, bronchoplasty is a safe and valuable procedure for selected cases of squamous carcinoma and low-grade malignancy.

Bronchi↗
PubMed1991

[Bronchopleural fistulas developing after pulmonary resections for lung cancer predisposing factors, management, and prognosis].

During the past 28 years, 55 bronchopleural fistulas (BPFs) have developed after pulmonary resections for 52 primary and 3 recurrent lung cancers at the National Cancer Center Hospital, Tokyo. During the same period, there were 2446 pulmonary resections for primary lung cancer, the incidence of BPF being 2.1%. As an operative mode of initial resections, pneumonectomy (26 cases) was most common, followed by lobectomy (20 cases), bronchoplasty (8 cases), and stump resection for recurrence (1 case). The following predisposing risk factors for BPF development were identified: resection for locally advanced lung cancer (80.8%); residual carcinomatous tissue at the resected end of bronchus or anastomosis line (29.1%); hypoalbuminemia, diabetes, or steroid administration (20%); pre- and postoperative adjuvant therapy (49.1%). Seven cases received no treatment for BPF because of sudden deaths by massive airway bleeding (5 cases), worsening pneumonia (1 case), and spontaneous recovery (1 case). Remaining 48 cases underwent treatment; tube thoracostomy only in 7 cases and surgical interventions in 41 cases, one case of which was lost during rethoracotomy due to vascular rupture. Initial surgical interventions were composed of combinations of the following procedures; direct re-suture of fistula (16 cases); amputation of the stump and re-closure (3 cases); completion pneumonectomy (6 cases); reinforcement and wrapping of fistula (27 cases); thoracoplasty (29 case). Among these 40 surgical repairs, fistula was successfully closed in 11 cases. In 5 cases, the fistula closure could be achieved after subsequent surgical procedures. Direct re-suture was successful only in 4 cases. In spite of various kinds of treatment, overall prognosis was quite poor; 37 cases died of BPF-related complications (67.3% mortality).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1990

Endoscopic ultrasound examination for mediastinal lymph node metastases of lung cancer.

Among patients with primary lung cancer who were admitted to the National Cancer Center Hospital from July 1987 to April 1988 for surgical treatments, 132 underwent preoperative transesophageal endoscopic ultrasound examination (EUS) on mediastinal lymph nodes. Of the 132 patients, 101 were pathologically evaluated and studied in this article. A GF-UM2 radial scanner with 7.5-MHz (Olympus Co Ltd) was used for image examination. The lymph nodes were diagnosed as positive for metastasis when they had thickened images, clear contours, and low echoing images of fusion or lobulation. The results obtained from 509 sites were as follows: sensitivity, 53.6 percent; specificity, 97.5 percent; positive predictive accuracy, 77.1 percent; negative predictive accuracy, 93.1 percent; and overall accuracy, 91.6 percent. The sensitivity rate was 80.6 percent excluding the result of the right superior mediastinal lymph nodes that were difficult to examine for anatomic reasons. Although EUS was considered to be an excellent method in diagnosing lymph node metastases, it had a blind angle in the field. More accurate diagnoses of mediastinal lymph node metastases could be achieved by using EUS and computed tomography (CT) together.

Adult↗
PubMed1990

[Clinico-pathological study of primary malignant chest wall tumors].

Clinicopathological studies of primary malignant chest wall tumor on 16 cases operated between 1962 and 1988 were made. Of 9 osteogenic sarcomas, 8 cases were chondrosarcoma and 1 case was Ewing's sarcoma. Of 7 soft part sarcomas, 2 cases were fibrosarcoma, liposarcoma and neurogenic sarcoma respectively, and one case was hemangiosarcoma. Most of the cases had symptoms, such as chest mass and/or chest pain comprehend symptoms for more than one year. The intrathoracic growth of tumor is common, especially in osteogenic sarcoma. The maximum size of tumor was 8.2 cm in a mean diameter. Preoperative histological diagnosis is difficult to make even though various radiologic diagnosis or pathological technique as biopsy or cytology were assessed. And true rate of preoperative diagnosis is limited only 43.8%. Wide resection combined with the tissue distant more than 3 cm length from tumor is recommended and 6 cases underwent combined resection of diaphragm, pericardium or lung. 3 cases underwent chest wall reconstruction using the Marlex mesh and 10 cases were able to direct closure, in 13 cases with ribs resection. The 5 year survival rate of endurable cases was 62.2%, and that of soft tissue sarcoma (68.6%) is better than that of osteogenic sarcoma (41.7%). The recurrent or metastatic rate in high, 7 cases (43.8%), but reoperation was added for 5 cases of local recurrence or for a case of lung metastasis. 5 year survival rate of cases with recurrence or metastases is relatively good, 46.8%, especially excellent in 4 cases with recurred lesions after more than 2 years of tumor free interval.

Adult↗
PubMed1990

Prognostic significances of estrogen and progesterone receptors in primary operable breast cancer.

Both estrogen and progesterone receptors have been determined in 613 primary breast cancer patients treated by radical mastectomy. At the cut-off value of 5 fentomoles (fmol) cytosol protein/mg for both receptors, patients with estrogen or progesterone receptor-positive breast cancer showed significantly favorable disease-free, overall and post-recurrence survival curves to those of receptor-negative breast cancer patients. In the patient subgroups: premenopausal, stage III, more than four positive lymph node metastases, postoperative adjuvant tamoxifen therapy, a significantly favorable prognosis was recognized in either estrogen or progesterone receptor-positive patients. Both receptors are thought to be useful prognostic indicators for patients with advanced tumors or for those receiving postoperative adjuvant tamoxifen therapy. When the cut-off value was changed, the maximum significant difference in prognosis between receptor-positive and receptor-negative patients was observed at 5 fmol cytosol protein/mg for the estrogen receptor or 10 fmol/mg cytosol protein for the progesterone receptor. A more detailed examination should be made on the cut-off values of both receptors.

Adult↗
PubMed1990

Prognosis for resected lung cancer patients with tumors greater than ten centimeters in diameter.

During the period 1962-1986, 43 lung cancer patients, 2.3% of the 1,832 patients who underwent pulmonary resections at the National Cancer Center Hospital, Tokyo, had tumors greater than 10 cm in diameter. These 43 cancers were classified postsurgically according to the 1987 guidelines for TNM classification of malignant tumors established by Union Internationale Contre le Cancer (UICC), and included 35 cases (81.0%) in stages IIIA, IIIB and IV. The histological tumor types were adenocarcinoma in 18 cases (41.9%), squamous cell carcinoma in 13 (30.2%), large cell carcinoma in 11 (25.6%) and adenosquamous cell carcinoma in one (2.3%). Twenty-two patients underwent pneumonectomy and 21, lobectomy. In terms of the radical extent of surgery, 16 patients underwent a curative operation (37.2%) and 27 received non-curative surgery (62.8%). Excluding one patient who died of an unknown postoperative cause, the overall cumulative five-year survival rate was 19.7%. There was, however, no significant difference in five-year survival rates between the patients who underwent a curative operation (21.5%) and those who received non-curative surgery (18.8%). There was no significant difference in five-year survival rates between patients with adenocarcinoma (21.2%), those with squamous cell carcinoma (15.4%) and those with large cell carcinoma (27.3%). There was little difference in five-year survival rates between patients with postoperative stage I or stage II tumors (25.0%), patients with stage IIIA tumors (9.5%), patients with stage IIIB tumors (30.0%) and patients with stage IV tumors (20.0%), while the five-year survival rates for patients with postoperative N0 disease were 33.3%, N1 disease 28.9% and N2 disease 0%. Among the 42 patients the survival study, there were eight long-term survivors (greater than 5 yr), all of whom had been in N0 or N1 stage and four of whom had undergone curative surgery. Two were classified as being in stage T4 with malignant pleural effusions, and the other two as being in stage M1 with intrapulmonary metastasis. Patients with N2 disease have an unfavorable prognosis and may be considered suitable for studies on adjuvant therapy, although the relative influence of other prognostic factors must be considered. Classifying the tumors according to whether or not they had reached 10 cm in diameter was of no importance.

Adult↗