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Biomedical subjects

R Tsuchiya

Publications and source records attributed to R Tsuchiya.

At least 109 records · Page 6Linked to original sources
PubMed1990

Small cell carcinoma of the pancreas and biliary tract.

Four cases of anaplastic carcinoma of the pancreas or biliary tract were studied clinicopathologically and immunohistochemically. All four cases were intermediate cell type and contained a minimum amount of microscopic foci of differentiated glandular adenocarcinoma. Argyrophilic tumor cells were not seen in any of the four tumors. Immunohistochemically, no tumor was positive for hormonal products, but all tumors were positive for epithelial markers. These findings suggest that the anaplastic carcinoma are not derived from argyrophilic cells, but rather from adenocarcinomas which have the potential for anaplastic metaplasia. The long-term survival of one patient emphasized the importance of chemotherapy in the treatment of small cell carcinoma of the pancreas and biliary tract.

Aged↗
PubMed1990

Heterotopic pancreas: a rare cause of bile duct dilatation--report of a case and review of the literature.

A case of a 77 year old woman with a heterotopic pancreas in the distal common bile duct is reported herein. The patient had no symptoms, but an ultrasound examination showed bile duct dilatation and subsequent endoscopic retrograde cholangiography demonstrated a spherical filling defect in the distal common bile duct. Under suspicion of a benign neoplasm in the common bile duct, resection of the common bile duct and hepaticojejunostomy using a Roux-en Y jejunal limb were successfully performed. Pathological examination revealed heterotopic pancreatic tissue in the distal common bile duct. This is only the ninth reported case of heterotopic pancreas occurring in the common bile duct or ampulla of Vater, and thus, a review of the literature is also given.

Aged↗
PubMed1990

Lymph node metastasis within the pectoralis major muscle in breast cancer--a case report.

We report herein, a case of a 75 year old woman with breast cancer in whom lymph node metastasis within the pectoralis major muscle was found. The breast mass measured 10 X 6 cm, and its overlying skin was red and edematous, suggesting inflammatory carcinoma. An extended radical mastectomy was performed and the lesion was histologically confirmed to be solid-tubular carcinoma with regional lymph node involvement. In the pectoralis major muscle, where lymph nodes do not usually exist, one positive metastatic lymph node and another metastatic lymph node-like nodule were histopathologically confirmed. To our knowledge, no other such case has ever been reported, yet the possibility of lymph nodes existing in the pectoralis major muscle, albeit rare, should nevertheless be considered in the treatment of breast cancer.

Adenocarcinoma↗
PubMed1990

Clear and colorless fluid observed during percutaneous transhepatic gallbladder drainage.

Twelve patients with discharge of clear colorless fluid during percutaneous transhepatic gallbladder drainage (PTGBD) were encountered during a period of 4.5 years. On the average, the fluid appeared on the 12th day after PTGBD and continued to flow until the completion of observation. The volume was usually less than 60ml per day. It flowed in an alternating pattern with normal yellow color bile each day. The fluid was observed in patients in whom satisfactory patency of the biliary system was confirmed by cholangiography and/or cholangio-fiberscopy. Biochemical examinations of the fluid revealed lower biliary lipids but a similar electrolyte composition compared to bile of normal color. It was alkaline. These observations indicate that the clear colorless fluid is different from what is known as "white bile", which is produced when there is an obstruction of the biliary tree. The fluid may be secreted from the gallbladder epithelium or the bile duct epithelium. The significance was not clarified in this study. Further investigation is necessary to elucidate the clinical implications of the clear and colorless fluid secretion.

Bile↗
PubMed1990

Bilateral intrahepatic lithiasis without extrahepatic bile duct stones.

Bilateral intrahepatic lithiasis is a rare condition, and for this reason a nationwide survey was conducted. Reports on 675 patients with bilateral intrahepatic lithiasis over a 10-year-period were collected. Among these, 258 patients with bilateral intrahepatic lithiasis having no extrahepatic bile duct stones were analyzed. The peak incidence was seen in the fourth to sixth decades. Males and females were equally effected. The stones removed were mainly calcium bilirubinate stones (75.6%). The main clinical symptoms were abdominal pain, fever and jaundice. Charcot's triad was seen in 29.7%, while 12.4% of the patients had no symptoms. Visualization of each segmental duct of the liver by direct cholangiography was excellent in this survey and ranged from 88 to 97.3% of the patients. The most frequent site of stones was the left hepatic duct (60.1%). The site of bile duct dilatation coincided with the location of stones. The most common sites of stenosis were the central part of the lateral segmental duct (32.5%) and the left hepatic duct (37.6%). Hepatic resection was employed in 49.2% of the patients, and drainage procedures were added in 95.6%. Follow-up studies of 236 patients treated by surgery revealed good results in 67.4%, fair in 13.6%, and poor in 7.6%. In these patients, however, endoscopic lithotomy was often employed intra- and/or post-operatively. Conducting hepatic resection, with adequate biliary drainage procedure and cholangiofiberscopic lithotomy may help to improve the therapeutic results of bilateral intrahepatic lithiasis.

Adult↗
PubMed1990

Operation of choice for resectable carcinoma of the head of the pancreas.

What is the best procedure for resectable carcinoma of the head of the pancreas? In order to respond to the question, a retrospective study was performed based on 510 cases with carcinoma of the head of the pancreas that were experienced from 1975 to 1984 at nine major surgical institutions in Japan. Laparotomized cases (504) were divided into four groups according to operative procedures: pancreatoduodenectomy (PD), total pancreatectomy (TP), regional pancreatectomy (RP), and palliative operation (PO). The postoperative cumulative survival rate (PCSR) was calculated on each group. Although the five year survival rate of PO was 0, those of PD, TP, and RP were 11.2, 4.6, and 4.5%, respectively. There was a significant difference between PD and TP (p less than 0.01) according to generalized Wilcoxon's test. TNM stage grouping was applied to 447 cases that had adequate descriptions on T, N, and M categories. PCSR was calculated on PD, TP, and RP at each stage. It was found in Stage III that survival curve of PD was significantly higher than TP (p less than 0.01), according to generalized Wilcoxon's test. It seems that PD is the best procedure, but it should be accompanied by extensive lymph node and retroperitoneal tissue dissection.

Adult↗
PubMed1990

Uremic changes induced by experimental urinary retention in goats.

The disease process of urinary retention resulting in uremia reported in cattle was studied clinically, clinico-pathologically and pathologically in 4 male goats with artificial urethrobstruction (UO). The blood urea nitrogen (BUN) and serum creatinine values increased at constant rates (mean rates: 29.1 mg/dl/day and 1.6 mg/dl/day, respectively) from the initial stage. These increased levels were thought to be the most useful indicator for the diagnosis of the uremic stage. The serum sodium and chloride values decreased gradually after UO. The glucose and potassium values increased remarkably later than in the intermediate stage. Rupture of the bladder caused severe dehydration. The animals died between 8 to 13 days post-urinary retention. Unusual respiration and heart beat, and severe nervous signs were seen at moribundity. Gross lesions of the urinary organs were characterized by the pressure of retained urine and hemorrhage and edema in the subcutaneous tissues, skeletal muscles and some other organs. To study the effect of urethrotomy, 3 male goats were relieved from UO 3 or 4 days after UO operation. The animals became capable of reurination and recovered from the uremic condition within 4 days.

Animals↗
PubMed1990

Large cell carcinoma of the lung secreting human chorionic gonadotropin which responded to combination chemotherapy: case report.

A 68-year-old man was admitted to the National Cancer Center Hospital on November 10, 1988 to undergo chemotherapy for recurrent lung cancer, which had been resected on June 22, 1988. The tumor was diagnosed histologically as large cell carcinoma with trophoblastic differentiation, and human chorionic gonadotropin (HCG) was immunohistochemically found in tumor cells. Chemotherapy was initiated on November 14, 1988. The patient received three courses of methotrexate, actinomycin D and cyclophosphamide (MAC); and two courses of cisplatin and etoposide (PVP). Following this therapy, partial response was achieved, however, the tumor soon progressed and the serum HCG level increased to 7,571 mIU/ml. The patient was consequently given four courses of cisplatin, adriamycin, cyclophosphamide and etoposide (PACE) up to September 13, 1989, and received 52 Gy irradiation to the chest from July 20 to August 24. The tumor regressed markedly and the serum HCG decreased to within normal limits. The changes in serum HCG levels in serial samples correlated well with the clinical tumor burden. The patient is now in partial remission having survived for more than 15 months after the initiation of chemotherapy.

Aged↗
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

[Hepatic artery reconstruction grafting with the right gastroepiploic artery for surgical treatment of upper bile duct cancer].

The right gastroepiploic artery (GEA) was used as hepatic artery graft in 2 patients with advanced upper bile duct cancer. The pedicle, including the right GEA and surrounding tissues, was mobilized along greater curvature of the stomach. The GEA pedicle was raised up beyond the gastric pylorus and was anastomosed to the distal right hepatic artery by interrupted suture technique using 7-0 monofilament-nylon stitches. The patients recovered well without evidences of anastomotic dehiscence of hepatico-jejunostomy and prolonged liver dysfunction beyond three postoperative days. Angiograms at one week after operation showed good patency of the GEA graft. The method of hepatic artery grafting with the right GEA is very simple and useful for surgical treatment of upper bile duct cancer.

Aged↗
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↗
PubMed1990

[Resection of chondrosarcoma of anterior chest wall with pleural dissemination].

A 52-year-old woman admitted with difficulty of breathing and had an anterior chest wall tumor. Primary lesion of the chest wall tumor invading the inferior one third of sternum, right third to sixth ribs, a part of the right middle lobe, the pericardium and a part of the diaphragma and small nodules on the parietal pleura were resected, and a diagnosis of chondrosarcoma of the right fifth or sixth rib and pleural dissemination of the tumor was established. The defect of pericardium was repaired with artificial dura mater and the defect of bony chest wall was repaired with a double layer of Marlex mesh. Although the resection was palliative because of pleural dissemination, she is now working as a housewife without difficulty of breathing.

Chondrosarcoma↗
PubMed1990

[Completion pneumonectomy--a review of 29 cases].

From 1962 through 1988, a total of 29 consecutive patients had completion pneumonectomy (CP). Indications for initial pulmonary resection were primary lung cancer in 27 patients, metastatic lung tumor in 1, and mediastinal tumor with pulmonary invasion in 1. Indications for CP were lung cancer (including local recurrence, pulmonary metastasis from the first lung cancer, and second primary lung cancer) in 21 patients, complications after initial operations in 7, and pulmonary arterial injury during second operation in 1. Severe adhesion of the residual lung and the hilar structures made operative procedures extremely difficult. Injury of pulmonary arteries occurred in 6 patients. Especially, in cases the left upper lobe had been resected previously, deviation of the lower lobe and hilar adhesion lead to operative difficulty. Post-CP bronchial fistula occurred more frequently in what the bronchi had been dissected at more peripheral level than main bronchus, because of some severe hilar adhesions. Operative mortality was 13.8% (9.5% for second lung cancer, 28.5% for post-operative complication). Five-year survival for patients with lung cancer was 32.9% according to the Kaplan-Meier method. We conclude that the indications for CP are clinically resectable lung cancer and bronchial stenosis with residual pulmonary organic changes following bronhoplastic procedure. Postoperative bronchofistulae should be managed by other operative procedure.

Adenocarcinoma↗