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Biomedical subjects

S Akamine

Publications and source records attributed to S Akamine.

At least 55 records · Page 3Linked to original sources
PubMed1994

[Evaluation of hilar and mediastinal lymph node metastases in resected cases of bronchogenic carcinoma].

To establish a reasonable regional lymph node dissection as curative operation for lung cancer, hilar and mediastinal lymph node metastases were analyzed. From 1982 to December, 1990, 404 patients underwent pulmonary resection with complete mediastinal node dissection. There were 194 adenocarcinomas, 175 squamous cell carcinomas, 14 large cell carcinomas, 13 small cell carcinomas and 8 others. The rates of hilar (N1) and mediastinal lymph node (N2) metastasis were 12.4% and 28.9% in adenocarcinoma, 12.6% and 30.3% in squamous cell carcinoma, 14.2% and 28.6% in large cell carcinoma and 15.4% and 30.8% in small cell carcinoma. In cases with adenocarcinoma, there was a close relationship between mediastinal metastasis and grade. No lymph node metastasis was seen in cases with tumor less than one cm in diameter. However, mediastinal node metastasis was found in cases with one cm or more in diameter of primary lesion and rates of metastasis were increased in proportion to tumor size. Because considerable metastases are found in the mediastinal lymph nodes and exact diagnosis of node metastasis before and during operation is difficult, complete mediastinal node dissection is still standard as curative resection for resectable lung cancer except lesion less than one cm in diameter or early hilar type squamous cell carcinoma.

Carcinoma, Bronchogenic↗
PubMed1993

The RNA content of alveolar macrophages in canine lung allografts.

To evaluate the utility of RNA synthesis by alveolar macrophages (AM) in lung allografts as a marker of acute rejection, we performed canine left lung allotransplantation and measured the AM RNA content during immunosuppressive therapy with azathioprine (AZ), cyclosporine A (CsA), or CsA combined with AZ and prednisolone (Pr). We determined the RNA content by determining the RNA index (RI) (peak channel number of AM/peak RNA channel number of peripheral blood lymphocytes) by flow cytometry. The dogs were classified into one of five treatment groups: Group 1 (n = 18), control (no surgery) dogs; Group 2 (n = 11), allotransplanted dogs without pre- or postoperative immunosuppressive therapy; Group 3 (n = 14), received AZ at dose of 5 mg/kg/day orally; Group 4 (n = 17), received CsA at dose of 20 mg/kg/day orally; Group 5 (n = 15), CsA combined with AZ (5 mg/kg/day) and Pr (0.5 mg/kg/day). The RI of normal lungs was 2.14 +/- 0.20 (mean +/- SD) (n = 18). The RI of rejected lungs was significantly higher than the RI of normal lungs in Group 2 (2.51 +/- 0.21, n = 8, P < 0.05) or Group 3 (2.76 +/- 0.36, n = 7, P < 0.05), but did not differ significantly from that in Group 4 (2.19 +/- 0.20, n = 7) or Group 5 (2.05 +/- 0.45, n = 8). The RI of rejected lungs was higher than the RI of nonrejected lungs in Group 2 (vs 2.18 +/- 0.12, n = 3, P < 0.05) or in Group 3 (vs 2.18 +/- 0.22, n = 7, P < 0.01).(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMed1993

Combined transection of the trachea and esophagus following cervical blunt trauma.

The successful management of a patient with combined transection of the cervical trachea and esophagus following blunt trauma is reported. This type of injury was rare in the past, but is gradually increasing at the present time because of the increased use of motorcycles. Immediate primary closure of the transected trachea and esophagus offers the best chance for a good result.

Accidents, Traffic↗
PubMed1993

Transplantation of canine lung allografts preserved in UW solution for 24 hours.

To evaluate the efficacy of University of Wisconsin (UW) solution for lung preservation, we performed canine lung allotransplantation with lungs preserved in UW solution. Donor lungs from eight dogs were flushed with UW solution and lungs from four dogs with Euro-Collins solution, and these were preserved for 24 hr in cold storage at 4-6 degrees C. All recipient dogs were given cyclosporine at a dose of 20 mg/kg/day until death. None of the four dogs that received a lung allograft flushed with Euro-Collins solution survived contralateral pulmonary artery and bronchial occlusion. All eight dogs that received a lung allograft flushed with UW solution were alive between 8 and 21 days postoperatively. Six of them survived until pulmonary function tests were performed. The engrafted lungs functioned well until death between days 10 and 21 posttransplantation. The PaO2 was 428 +/- 26 prior to transplantation, 317 +/- 140 at 60 min after transplantation, and 382 +/- 76 mmHg at 10 to 21 days after transplantation. In the other two dogs, the grafted lungs functioned poorly, and macroscopically revealed diffuse organizing pneumonia. We conclude that UW solution is useful for up to 24 hr of cold preservation prior to lung allografting. However, we recommend that lungs preserved with UW solution be transplanted within 24 hr, because, despite adequate function, microscopic damage occurs in the grafted lung.

Adenosine↗
PubMed1993

[Effect of FK-506 on bronchial healing of canine lung allografts].

The effects of the immunosuppressive agents on the healing of the bronchial anastomosis following canine lung allo-transplantation were evaluated. Auto- or, allo-transplantation was performed in 44 dogs. The dogs were classified into following three groups: Group A (18 dogs) underwent autograft, Group B (13 dogs) underwent allograft following immunosuppressive therapy with cyclosporin A (20 mg/kg/day) orally and Group C (13 dogs) underwent allograft with FK-506 (0.1 mg/kg/day) injection intramuscularly and omentopexy on the bronchial anastomosis. The dogs were sacrificed at 1, 2, 3 or 4 weeks after surgery. The grafted lung and anastomosed bronchi were removed, and microscopic examination was performed. We estimated bronchial healing according to the inflammatory response score (IRS), which was defined as comprehensive assessment by histologic findings in each of the inflammatory response: inflammatory cell type, a degree of the proliferation of collagen fibers, edema, bleeding, degeneration and ulcer. There was no significant difference between the incidences of rejection and the inflammatory cell types. The degree of the proliferation of collagen fibers in Group C was moderate at 2 weeks and remarkable at 3 or 4 weeks. IRS at one week after operation was 9.1 +/- 1.5 in Group A, 8 in Group B and 8 in Group C. IRS at two weeks after surgery was 4.8 +/- 1.3 in Group A, 5.1 +/- 1.2 in Group B, 4.3 +/- 1.0 in Group C. IRS at three or four weeks after transplantation was 3.0 in Group A, 3.2 +/- 1.9 in Group B and 2.0 +/- 1.2 in Group C. There was no significant difference between each group and each week.(ABSTRACT TRUNCATED AT 250 WORDS)

Anastomosis, Surgical↗
PubMed1993

[Study of combined hepatocellular and cholangiocarcinoma].

Four patients with combined hepatocellular and cholangiocarcinoma were studied. One case received hepatic arterial infusion therapy (HAIT), 2 hepatectomy and the case with extrahepatic cholangiocarcinoma underwent enucleation. According to Allen's classification, two were combined type and the others mixed type. Tumor ploidy patterns on flow cytometric DNA analysis were aneuploid in 2 cases with curative resection, of which one is still alive 6 years and 3 months after surgery. It suggested that the patient's survival was affected by the pathological factors more than the ploidy patterns of the tumor. A case treated by HAIT improved considerably in terms of symptoms and evidenced reduction in the size of the deposits. Selection of anticancer agents sensitive to both hepatocellular and cholangiocarcinoma is required.

Adenoma, Bile Duct↗
PubMed1993

[Comparison of typical and atypical bronchoplasty for bronchogenic carcinoma].

One-hundred and twenty-eight patients who underwent bronchoplasty for bronchogenic carcinoma from 1969 to 1990 were retrospectively analyzed. Ninety-six patients had upper sleeve lobectomy or upper lobectomy with wedge bronchoplasty (typical procedure) and 32 underwent bronchoplasty with lobectomy other than upper lobes (atypical bronchoplasty). The two groups were statistically similar in preoperative characteristics including sex, age, cell types and stages. In typical group, right upper sleeve lobectomy was performed in 48 patients, left upper sleeve lobectomy in 27, right upper lobectomy with wedge bronchoplasty in 11, left upper lobectomy with wedge bronchoplasty in 7 and sleeve bronchoplasty alone in 2. In atypical group, right middle and lower lobectomy with sleeve bronchoplasty in 10 patients, left lower sleeve lobectomy in 5, right lower lobectomy with wedge bronchoplasty in 4 and others in 13. Postoperative mortality was 5.2% in the typical group and 9.4% in the atypical group. Postoperative respiratory complications occurred in 16 patients (50%) in the patients with the atypical group and in 33 (34.7%) in those with typical group. Three years and 5 years survival rates in the typical group were 46 and 40% and those in the atypical group, 27 and 18%. However, there was no statistical difference in survival between the two groups. In conclusion, atypical bronchoplasty is useful for preserving the lung parenchyma, but, careful perioperative management and surgical technique of bronchoplasty are mandatory.

Adult↗
PubMed1992

[Management of airway obstruction using the neodymium-yttrium-aluminium-garnet laser].

The neodymium-yttrium-aluminium-garnet laser (Nd-YAG laser) has proved to be useful therapeutic tool for the management of endobronchial lesions. Between February 1983 and January 1991, 16 patients received endobronchial laser therapy at the Nagasaki University Hospital, 7 patients for tracheal stenosis, and 9 for endobronchial obstruction. In 4 patients with tracheal stenosis, the therapy was performed in an emergency. The type of lesions were lung cancer in 7 patients, thyroid cancer in 3, tracheal tumor (squamous cell carcinoma, and chondrosarcoma) in 2, esophageal cancer in 1, bronchial submucosal tumor in 1, and tracheobronchial tuberculosis in 2. Good symptomatic relief was obtained in 13 patients. One patient died from massive bleeding in the left main stem bronchus. Reobstruction had occurred in 2 patients with cicatricial lesion in right main stem bronchus. In patients with an unresectable malignant lesion, concurrent radiotherapy was needed to prevent the reobstruction.

Aged↗
PubMed1990

[The prognostic significance of nuclear DNA content in non-small-cell lung carcinoma].

The nuclear DNA content of paraffin-embedded specimens of primary non-small-cell lung carcinomas was analysed using flow cytometry in 210 patients (80 squamous cell carcinomas, 99 adenocarcinomas, 19 large cell carcinomas and 15 others). The relationship between nuclear DNA content and prognostic factors was studied using multivariate analysis with Cox's proportional hazard model. 1) The frequency of DNA aneuploidy was 77.3% among 210 patients, and it significantly (p less than 0.05) increased with advanced stage and the presence of lymph node metastasis. 2) The patients with DNA aneuploid tumors had a significantly (p less than 0.001) less favorable prognosis than those with DNA diploid tumors among 179 patients with non-small-cell lung carcinomas. Similar results were demonstrated in 79 patients with stage I carcinomas and in 85 patients who underwent absolute curative resection. 3) Multivariate analysis using Cox's proportional hazard model showed that DNA ploidy was an independent prognostic factor for survival. Especially in the patients with absolute curative resection, DNA ploidy was the most important prognostic factor. In conclusion, flow cytometric nuclear DNA content analysis provided useful biological information, and DNA ploidy was an important and major independent prognostic factor in non-small-cell lung carcinoma.

Adult↗
PubMed1990

[Two cases of pulmonary leiomyosarcoma].

Pulmonary sarcoma is a rare tumor of the lung. There are 81 cases in the literature for review, including our two cases. Our first case who was a thirty-seven year old male who was admitted to our hospital with complaints of left back pain. His chest X-ray showed an 11 X 14 cm tumor shadow in the lower left lung area. A left upper lobectomy was performed, and the histological diagnosis was leiomyosarcoma of the pulmonary vein. He died due to mediastinal recurrence 29 months later. Our other case was a fifty-six year old female. Her chest X-ray showed an abnormal shadow that was a tumor shadow in the right central lung area of 4 cm in diameter. As the diagnosis of the transcutaneous lung biopsy was benign tumor, partial resection of lung was performed. The histological diagnosis was leiomyosarcoma of the bronchus, and she is alive and well at 29 months after the operation. As the rate of diagnosis in leiomyosarcoma detected by transcutaneous lung biopsy is low, the most acceptable method of diagnosis is a total examination, including cytology of sputum, bronchoscopic findings, and roentgenoscopy. Probe thoracotomy would also be necessary if malignancy could not ruled out. The treatment of lobectomy should include lymph node resection.

Adult↗
PubMed1990

[Relationship between the nuclear DNA content and the prognosis in squamous cell carcinoma of the lung].

Analysis of the nuclear DNA content from paraffin-embedded specimens using flow cytometry was performed on 86 patients in squamous cell carcinoma of the lung. There were no relationships between the site of tumor origin and the nuclear DNA content or the survival of the patients. The frequency of DNA aneuploidy was 74.4% among tumors, and it significantly (p less than 0.05) increased with advanced stage. The patients with DNA aneuploidy were significantly (p less than 0.01) less favorable prognosed than those with DNA diploidy. Similar results were demonstrated in patients of absolute or relative curative resections. These results indicate that DNA aneuploidy is of higher grade malignant intensity than DNA diploidy in squamous cell carcinoma of the lung. In patients with absolute or relative curative resection, DNA aneuploid tumors occurred much more often in distant metastasis. In conclusion, there were no relationships between the site of tumor origin and the biological features or the prognosis of patients in squamous carcinoma of the lung. DNA ploidy pattern is related to relapse and prognosis of the tumors. If the DNA ploidy pattern of patients on whom absolute curative resection was performed is DNA aneuploidy, adjuvant therapy should be strongly performed and carefully followed up as long as possible.

Aged↗
PubMed1990

[Tracheal T-tube treatment following tracheoplasty--post-intubation tracheal obstruction and stenosis].

A 26-year-old man with post-intubation tracheal obstruction and stenosis was treated at our department. The lesions were granulomas, showing almost complete obstruction of the tracheal lumen at the stomal level, circumferential cuff stenosis at the cuff level and pressure necrosis on the trachea directly behind the brachiocephalic artery. Circumferential resection of the trachea including 13 tracheal cartilages with end to end tracheal anastomosis was performed. The site of the anastomosis was covered with pedicled omentum retrosternally. Seven days following the tracheal resection, a granulomatous lesion resulting in dyspnea was found at the distal trachea of the anastomosis. Subsequently, a tracheal T-tube was inserted, he had a remarkable improvement of the patient's overall condition. Pedicled omental wrapping of tracheal anastomotic site was found quite useful, particularly in the case of possible anastomotic insufficiency. Treatment of post-intubation stenosis with tracheal T-tube proved effective when the tracheal resection was not possible.

Adult↗
PubMed1989

[Clinical application of the omentum in chest surgery].

The benefit of the omentum in chest surgery was experimentally evaluated on the basis of findings in relation to recanalization of the bronchial artery in bronchoplasty with and without omental wrapping. The arterial blood supply at the anastomotic sites was observed in the early stage following bronchoplasty using the omental wrapping. Clinical application of the omentum in chest surgery was performed by wrapping anastomotic site at tracheobronchoplasty in 3 cases, bronchial stump coverage after lobectomy or pneumonectomy in 2 cases, repair of bronchial fistula following pneumonectomy in 1 case and repair of bronchopleurocutaneous fistula in pulmonary tuberculosis in 1 case. Six of these clinical cases could have favorable postoperative results. Based on these experimental and clinical results, we consider that the omentum is very useful tissue for wound healing in chest surgery.

Adult↗
PubMed1989

[Surgical experience with tracheoplasty].

We have had experience with 31 tracheoplastic procedures. Underlying diseases consisted of primary tumor, cancer invasion from carcinoma of the thyroid gland and the esophagus, traumatic rupture and post-tracheostomy and tuberculous stenoses. During operation, respiratory support has been satisfactorily established by using the intubation method via the operative field and/or high frequency ventilation instrument. Furthermore, development of absorbable suture material like Dexon and Vicryl benefited by minimizing granulation stenosis at anastomosis due to less foreign body reaction. The prognosis for carcinomatous involvement from surrounding organs was much worse according to advanced cancer stages. However, surgical outcome of this procedure was satisfactory in terms of relieving respiratory distress.

Humans↗
PubMedDate not supplied

Bronchoplastic procedures for lung cancer: clinical study in 136 patients.

Between 1969 and 1991 a total of 136 patients (119 men, 17 women) underwent bronchoplastic procedures for lung cancer. A bronchoplastic procedure with angioplasty was performed in 37 patients. Ages ranged from 30 to 79 years (mean 62 years). The histologic type of cancer was squamous cell carcinoma in 97 patients (70.0%). The 30-day mortality was 5.1% (7 patients), and morbidity was 30.1% (41 patients). The most common complications were bronchopleural fistula in nine (6.6%), stricture or stenosis in eight (5.9%) and atelectasis in eight patients. Local recurrence occurred in nine (6.6%) patients. The overall 5-year survival for patients undergoing bronchoplastic procedures was 37.1%: 60.1% for patients with stage I disease (n = 41), 31.7% for stage II (n = 17), and 29.7% for stage IIIA (n = 66). We conclude that bronchoplastic procedures are effective therapy for selected patients with lung cancer.

Adult↗