Biomedical subjects

R Tsuchiya

Publications and source records attributed to R Tsuchiya.

At least 19 recordsLinked to original sources

PubMed1992

Intrapulmonary sublesions detected before surgery in patients with lung cancer.

BACKGROUND: The treatment of patients with multiple intrapulmonary lesions remains controversial. METHODS: Fifty-three patients with lung cancer, in whom preoperative evaluation disclosed intrapulmonary nodules distinct from the main tumor, were analyzed retrospectively to establish the optimal treatment in such cases. RESULTS: These sublesions proved to be intrapulmonary metastases (PM) in 16 cases (30%), multiple primary lung cancers in 7 cases (13%), and various nonmalignant lesions in the others. The survival of the 53 patients, and of patients with clinical Stage I/II disease in particular, compared favorably with that of all patients with resected lung cancer. Those with multiple sublesions had a poorer prognosis, irrespective of their nature. Although patients with PM as sublesions often had clinically advanced cancer, metastatic foci, per se, did not influence the survival data as calculated by a multivariate analysis. CONCLUSIONS: The authors conclude that the existence of a solitary intrapulmonary sublesion should not preclude surgical treatment, unless surgery is contraindicated because of other clinical and radiologic findings.

Humans↗

PubMed1992

Intussusception of an appendiceal mucocele: report of a case.

A 66 year old Japanese female was admitted to our department for the examination and treatment of a mass in the cecum. She had experienced no symptoms or signs other than a positive test result for fecal occult blood. The mass in the cecum was confirmed by barium enema, colonofiberscopy and CT scanning. The presumptive diagnosis was a submucosal tumor of the cecum, however, a laparotomy subsequently revealed intussusception of an appendiceal mass. An ileocaecal resection with an ileocolic anastomosis was therefore performed and the mass was histologically diagnosed as a mucocele of the appendix. This patient is only the 24th case of intussusception of a mucocele of the appendix to be reported in Japan. A review of the available literature on this condition follows the case report.

Aged↗

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

Malignant pleural mesothelioma producing human chorionic gonadotropin. Report of two cases.

Two cases of malignant pleural tumor producing human chorionic gonadotropin, one confirmed at surgery and autopsy and the other by biopsy, are reported. Both of the patients had bilateral gynecomastia with high levels of serum human chorionic gonadotropin. The first patient underwent panpleuropneumonectomy because of diffuse malignant pleural tumor, but died five months later due to recurrent disease. The histological diagnosis was diffuse, malignant, monophasic mesothelioma of the epithelial type. Immunostaining for alpha-, beta-human chorionic gonadotropin and human placental lactogen was positive in syncytiotrophoblast-like cells. The second patient had diffuse pleural tumor with massive effusion. A pleural biopsy specimen showed diffuse proliferation of epithelioid large cells. Immunostaining for alpha, beta-human chorionic gonadotropin and human placental lactogen was positive in mono- and multinucleated bizarre giant cells mimicking trophoblasts. A diagnosis of malignant mesothelioma with trophoblastic differentiation seemed most likely in both cases in view of the clinical and pathological findings. In both cases, results of mucin histochemistry and various immunohistochemical stains for antigens or with antibodies were consistent with diagnosis of mesothelioma except in a few cells in the choriocarcinomatous portion. This may be the first report describing human chorionic gonadotropin-producing malignant mesotheliomas of the pleura.

Adult↗

PubMed1992

Isolation of secretory IgA from feline bile and bile IgA levels in growing cats.

Secretory IgA was isolated from feline bile, using ammonium sulphate precipitation, gel-filtration chromatography and affinity chromatography. It formed a precipitating line between anti-cat whole serum or anti-cat bile serum by immunoelectrophoresis and double diffusion. It consisted of three subunits that molecular weight were 80 kd, 62 kd and 27 kd by SDS-PAGE analysis. The 80 kd protein was equivalent to secretory component of human and other animals. Immunoglobulin levels were observed on bile collected continuously by gallbladder cannulation in growing cats. Although immunoglobulins were not detected in bile of feline fetus, after birth its levels increased gradually. Biliary IgA levels reached the adult levels earlier than that of their serum.

Aging↗

PubMed1992

[Recurrent hepatocellular carcinoma after hepatic resection].

A total of 125 patients with hepatocellular carcinoma (HCC) treated by hepatic resection in our department from 1970 to 1989 were reviewed to determine recurrent factors, recurrent modes of HCC and to assess the treatment for recurrent HCC. Seventy-five of 125 patients had recurrent tumors after the first hepatic resection. The 1-, 2-, and 3-year cumulative recurrent rates after hepatic resection were 25%, 52% and 67% respectively. The size of the tumor, intrahepatic metastasis, portal vein involvement, clinical stage and DNA ploidy pattern were judged as useful predictive factors for recurrence of HCC after hepatic resection. In the patients with intrahepatic metastases, the bilateral lobes of the remnant liver were the most frequent recurrent sites. The treatment for recurrent HCC was divided into 3 groups such as re-resection, transcatheter arterial embolization (TAE) and palliative treatment. The survival curves of patients receiving re-resection and TAE were significant better than those of patients receiving palliative treatment. Patients treated by re-resection for recurrent HCC had the longest survival. The 1-, 3- and 5-year cumulative survival rates after re-resection were 84%, 60% and 48% respectively. It is concluded that the early detection of recurrent HCC is important and re-resection or TAE is effective treatment for recurrent HCC.

Adult↗

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

Tuberculous liver abscess with bronchobiliary and gastrobiliary fistulae--a case report.

A rare case of a primary tuberculous liver abscess with bronchobiliary and gastrobiliary fistula formation is presented herein, emphasizing the difficulty in establishing its diagnosis. The clinical course was complicated and a wide range of antibiotics administered repeatedly, based on the initial diagnosis of a liver abscess, until the final diagnosis of a tuberculous liver abscess was established by histopathological reinvestigation of the resected liver specimen. Thereafter, antituberculous chemotherapy proved extremely effective for the alleviation of symptoms, reduction of the abscess and closure of the fistulae.

Adult↗

PubMed1991

Common bile duct exploration--primary closure of the duct with retrograde transhepatic biliary drainage.

A new method of retrograde transhepatic biliary drainage (RTBD) using an RTBD tube with primary closure of the common duct was investigated with special reference to the usefulness and feasibility of this procedure. At operation, an atraumatic vinyl chloride tube was inserted from a choledochotomy incision and in most cases advanced via the left hepatic duct to the liver surface, which was then penetrated. After the choledochotomy incision had been primarily sutured, the RTBD tube was fixed to the abdominal wall. This drainage method was applied to 71 patients as an alternative to the conventional T-tube drainage and its effect on bile drainage was prominent. The insertion of an RTBD tube did not influence liver function tests and an RTBD tube cholangiography revealed no severe deformity at the primary closure site of the bile duct. The most common complication was movement of the optimal site for stenting of the bile duct, however, no serious complications were encountered. On average, the RTBD tube was removed on the 16th postoperative day, the mean postoperative stay in hospital being 22 days. These findings suggest the need for a prospective randomized clinical trial to prove the usefulness and feasibility of primary bile duct closure using our drainage method.

Bile↗

PubMed1991

Lithium carbonate in the preoperative preparation of Graves' disease.

Lithium carbonate was given in the preoperative preparation of 12 patients with Graves' disease, the reasons for its use being side effects of thionamide in 9 patients, insufficient control by thionamide in 1 and psychic symptoms in 2. Lithium carbonate was often used in combination with other drugs, namely; thionamide in 4 patients, beta-adrenergic blockades in 5, reserpine in 5 and glucocorticoid in 1. This preoperative control significantly decreased the mean serum T2 and T4 levels from 656 +/- 55 ng/dl to 180 +/- 16 ng/dl and from 25.9 +/- 2.1 micrograms/dl to 9.7 +/- 1.5 micrograms/dl, respectively. The only adverse effect of lithium carbonate was pollakisuria observed in one patient. All patients underwent subtotal thyroidectomy uneventfully. It is concluded that the administration of lithium carbonate alone or in combination with other drugs is an effective method of preoperatively controlling hyperthyroidism when conventional antithyroid drugs show adverse effects.

Adolescent↗

PubMed1991

Segmental primary sclerosing cholangitis mimicking bile duct cancer--report of a case and review of the Japanese literature.

A rare case of the segmental type of primary sclerosing cholangitis (PSC) is reported herein. A 27 year old Japanese man with obstructive jaundice was referred to our hospital with a provisional diagnosis of bile duct cancer at the hepatic hilum. A PTCD tube had been inserted from the right anterior segmental duct and direct cholangiograms showed complete obstruction of the bile duct at the confluence of the right and left hepatic ducts. Resection of the extrahepatic bile duct and partial hepatectomy were thus performed, however, the postoperative histological examination revealed no malignant features. Instead, the lesion was shown to be compatible with PSC microscopically. A diagnosis of PSC was finally established on the basis of clinical features, cholangiographic appearance and the pathological report.

Adult↗

PubMed1991

Hashimoto's thyroiditis presenting with severe pressure symptoms--a case report.

A extremely rare case of Hashimoto's thyroiditis presenting with pressure symptoms is described herein. A 50 year old Japanese woman was referred to our department with swelling of the anterior neck, facial edema and recent heavy snoring. Oto-rhinolaryngological examinations revealed no movement of the bilateral vocal cords, severe laryngeal edema and diffuse edema of the tongue and pharynx. These findings had apparently been induced by compression of the bilateral recurrent nerves and internal jugular veins by an enlarged thyroid gland. The results of thyroid function and autoimmune tests were compatible with a diagnosis of Hashimoto's disease and thus, total thyroidectomy with a tracheostomy was performed uneventfully. The resected specimen weighed 168 grams and was confirmed histologically to be Hashimoto's disease. Following her operation, all the above symptoms disappeared and 4 months later, the patient is well and asymptomatic.

Cranial Nerve Diseases↗

PubMed1991

Caroli's disease associated with hepatolithiasis: a case report and review of the Japanese literature.

A 27-year-old woman was admitted to Nagasaki University Hospital complaining of abdominal pain and fever. Percutaneous transhepatic cholangiography showed multiple cystic dilatations of the intrahepatic bile ducts without stone formation. The illness was diagnosed as a pure type of Caroli's disease. No surgical intervention was made. Subsequently, the patient suffered repeated attacks of cholangitis, and six years later, computed tomography demonstrated cystic lesions of both lobes of the liver and stones within the cystic lesions of the right lobe. We collected 62 cases of Caroli's disease reported in the Japanese literature, including our own case. Among them, cholangitis was found in 43.5%, hepatolithiasis in 30.6%, esophageal varices in 17.7% and cholangiocarcinoma in 8.1%. It is difficult to successfully treat Caroli's disease involving both lobes of the liver. Long-term repeated cholangitis could lead to fibrosis of the liver, hepatolithiasis, portal hypertension and cholangiocarcinoma. Considering the above-mentioned aspects of the disease, careful follow-up studies are required in each case.

Adult↗

PubMed1991

UICC and Japanese stage classifications for carcinoma of the pancreas.

The stage classification (SC) for carcinoma of the pancreas recommended by UICC (UICC-SC) was compared with that of Japan Pancreas Society (JPN-SC) using 229 patients encountered consecutively at the Second Department of Surgery, Nagasaki University School of Medicine over the past 20 yr. By UICC-SC, 51% of the patients belonged to stage IV and 38% to Stage III. By JPN-SC, 82% of the patients belonged to stage IV. Curative resection rates in JPN stage II and III were significantly higher than those in UICC-SC by the chi-squared test. In 60 patients undergoing resectional surgery, postoperative cumulative survival (PCS) curves and rates by each staging criterion (tumor size [T], lymph node metastasis [N], distant metastasis [M], serosal invasion [S], retroperitoneal invasion [Rp], and invasion to the portal venous systems [V]) were calculated by the Kaplan-Meier method. Among these prognostic factors, significant differences in the PCS curves were demonstrated only between Rp(-) and Rp(+), and between V(-) and V(+) according to the generalized Wilcoxon's text. In UICC-SC, the underestimation of these factors leads to a tendency to classify the patients in a less advanced stage than in JPN-SC. JPN-SC is more complex than UICC-SC. Continuing efforts are necessary to establish a more practical, simple, and universal staging system for the disease.

Adolescent↗

PubMed1991

The study of the mass screening of persons without symptoms and of the screening of outpatients with gastrointestinal complaints or icterus for pancreatic cancer in Japan, using CA19-9 and elastase-1 or ultrasonography.

To investigate the possibility of detecting carcinomas of the pancreas at an early stage by mass screening of persons without symptoms or by screening the outpatients with gastrointestinal complaints or jaundice, we performed a multicentral study of the mass screening of 10,162 persons at five local areas and of the outpatient screening of 4506 at 17 hospitals for pancreatic cancer in Japan for two years from 1984 to 1985, using serum CA19-9 and elastase-1 determinations or ultrasonography. Mass screening of 10,162 persons over 40 years old found only four (0.04%) cases of pancreatic cancer, including one case that was curatively treated. According to the screening of 4506 outpatients with gastrointestinal complaints or icterus, 85 (1.9%) patients were found to have pancreatic cancer. Of these 85 patients, 28 could undergo curative treatment. In addition to them, 73 (1.6%) patients with other digestive organ cancer were found. Our results suggest that the mass screening of persons without symptoms is not worthwhile in the early detection of pancreatic cancer, but outpatient screening is useful for detecting curative cancers of the pancreas.

Adult↗

PubMed1991

Clinicopathologic and immunohistochemical characteristics of goblet cell type adenocarcinoma of the lung.

Twenty-two resected goblet cell type adenocarcinomas of the lung were examined clinicopathologically and immunohistochemically. The stage and survival curve of goblet cell type adenocarcinomas were compared with those of 44 cases of pure or mixed Clara cell and bronchial surface epithelial cell (Clara and BSE) type adenocarcinomas. Each case of goblet cell type was matched with two cases of Clara and BSE type as to sex, age and date of surgery. In goblet cell type adenocarcinomas, lymph node metastasis was less frequently and intrapulmonary metastasis was more frequently detected than in other types of adenocarcinomas (p less than 0.001 and p less than 0.05, respectively). Goblet cell type adenocarcinomas showed better prognoses than Clara and BSE type adenocarcinomas. However, the estimated survival curves of those two groups become similar after adjustment of the TNM condition using Cox's proportional-hazard general linear model. This result indicated that the longer survival of goblet cell type adenocarcinoma was due to the characteristic distribution of TNM conditions, that is, unique local growth and low incidence of lymph node metastasis. When goblet cell type adenocarcinoma was macroscopically classified into two types, i.e. solitary peripheral nodule type (nodular type) and multifocal nodular type or consolidation of all or part of a lobe (diffuse type), the nodular type had better prognosis than the diffuse type (p less than 0.05). Immunohistochemically, 83%, 11%, and 0% of goblet cell type adenocarcinomas were positive for NCC-CO-450, carcinoembryonic antigen (CEA), and surfactant apoprotein, respectively. Most Clara and BSE type adenocarcinomas were negative for NCC-CO-450, but positive for CEA and surfactant apoprotein.(ABSTRACT TRUNCATED AT 250 WORDS)

Adenocarcinoma↗

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↗