[Surgery in the multidisciplinary treatment of small cell carcinoma of the lung].
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Biomedical subjects
Publications and source records attributed to K Suemasu.
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A preoperative adjuvant chemotherapy for the prevention of recurrence of breast cancer is necessary. We administrated UFT orally at 600 mg/day to 87 patients with primary breast cancer and measured the 5-FU level in the tissue and blood. The mean blood level of 5-FU after administration was 0.073 mcg/ml at one hr, 0.081 mcg/ml at 2 hrs, 0.043 mcg/ml at 3 hrs and remained significantly after 5 hrs (0.031 mcg/ml). The mean 5-FU level in the dominant vessels of the breast was also significantly high. The mean tumor 5-FU level was 0.22 mcg/g (0.025-0.768) and normal breast tissue level was 0.048 mcg/g (0.011-0.394). This showed significantly high tumor 5-FU level compared with that of normal (p less than 0.001). In comparison of 5-FU levels with tumor sizes of T1, T2 and T3 and histological patterns (papillotubular, medullary tubular and scinhous) not significant difference was observed. The mean metastatic lymph node level of 5-FU was 0.193 mcg/g (0.070-0.789) and normal lymph node level was 0.093 mcg/g (0.008-0.210) (p less than 0.05). In conclusion, preoperative administration of UFT was considered to be very effective for the primary breast cancer because of high tumor affinity of 5-FU.
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A new human cell line, Br-NHF-1, was established from the pleural effusion of a patient with advanced mammary carcinoma. The cells survived 52 subcultivations during more than 33 months. The cells possess epithelial features, showing rosettes, acinar formation and domes in or among the compact colonies. The modal chromosome number is 51 with some marker chromosomes. Xenografted tumors retained a similar histology to the original tumor. No estrogen-binding protein was detectable in the culture, but there was a significant amount of basic fetoprotein. Production of casein in the cells was detected by immuno-fluorescence testing.
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A case of mediastinal thoracic duct cyst is described. It is believed to be the first to be diagnosed before thoracotomy. Seven surgically treated cases have been reported but in none was the diagnosis made before operation. This case report concerns a 49-year-old woman who was operated upon because of a thoracic duct cyst that had been diagnosed by lymphangiography before the operation. Symptoms were caused by pressure of the cyst on the esophagus. The operation and immediate postoperative course were uneventful. One year later, the patient was doing well and no further investigation was recommended.
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By means of lymph mapping, the prognosis significance of lymph node metastasis in lung cancer was studied in 270 patients who had undergone radical operations--pulmonary resection combined with complete mediastinal lymph node disection, which is used for patients in whom all cancer could thereby be ablated. Mediastinal lymph node metastasis was found in 64 patients, and 12 patients lived 5 years or more (an absolute 5 year survival rate of 18.8 percent). After radical surgery, there was a significant difference between the prognosis for patients who had metastases to the subcrainal lymph nodes as compared to the prognosis for those who did not. The 5 years survival rates were 9.1 percent and 29.0 percent, respectively. On the other hand, prognosis was not significantly affected by involvement or noninvolvement of the superior mediastinal, paratracheal, tracheobronchial, pretracheal, and the subaortic and para-aortic lymph nodes. No significant difference in survival was detected between patients who were given adjuvant therapy and those who were not. Lymph node mapping gives valuable prognostic information.
Eight cases of squamous cell carcinoma of the anterior mediastinum, most likely derived from the thymus, are presented. Seven were male and one female ranging in age from 39 to 65 years; the average was 55.5 years. There were no cases associated with any paraneoplastic syndromes. They possessed common morphological characteristics. Grossly, the tumors resembled malignant thymoma. Invasion of the lung and metastases to regional lymph nodes were frequent. Often observed microscopically were foci of sharply defined keratinization resembling Hassall's corpuscles, no radial arrangement of tumor cells at the periphery of nests, and broad, fibrotic, or hyalinized stroma. Admixture of a few lymphoid cells and some features transitional to thymoma were also observed in some parts of tumors. However, undoubtedly carcinomatous areas were present in some or large parts of all the tumors, where individual cells possessed a vesicular nucleus and a prominent round nucleolus. These features were distinct from those of bronchogenic squamous cell carcinoma and other thymic tumors, although they appeared to be related to thymoma. Treatment of choice is radical surgery and postoperative radiotherapy, because of relatively high radiosensitivity. Prognosis of patients was relatively good. From analyses of cases it is concluded that squamous cell carcinoma of the thymus should be separated from ordinary thymoma of the epithelial type, and that squamous cell carcinoma involving both the thymus and lungs should be carefully examined for the primary site of growth.
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Twenty patients with lung cancer have undergone bronchoplastic procedures September, 1965, to June, 1976 in our hospital. Bronchoplastic procedures are considered to be indicated for early cases of hilar lung cancer rather than for somewhat advanced cases. Endoscopic examination and roentgenograms of the bronchial arteries are needed to delineate resectional lines of bronchus, the former for deciding the mucosal extent and the latter the intrabronchial extent of the tumor. The bronchoplastic procedures we adopted were free from the risks and dangers generally accompanying the operation, and there were no postoperative deaths. For the prevention of postoperative complications, careful attention to suture technique is needed, and postoperative bronchoscopic suction of intrabronchial secretions is absolutely necessary. These procedures assure good quality of life postoperatively and improvement in the survival rate by preserving pulmonary function, enhancing curability, and increasing the operative indications. These advantages warrant high evaluation of the operation.
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