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T Shirakusa

Publications and source records attributed to T Shirakusa.

At least 37 records · Page 2Linked to original sources
PubMed2004

Video-assisted thoracoscopic surgery (VATS) segmentectomy for small peripheral lung cancer tumors: intermediate results.

BACKGROUND: We investigated the feasibility and suitability of video-assisted thoracoscopic surgery (VATS) segmentectomy for curing selected non-small cell lung cancer (NSCLC) with this less invasive technique. METHODS: We performed VATS segmentectomy for small (< 20 mm) peripherally located tumors and pathologically confirmed lobar lymph node-negative disease by frozen-section examination during surgery. Of the 34 patients who underwent this limited resection, 22 were treated with complete hilar and mediastinal lymph node dissection (intentional group), whereas 12 patients who were deemed to be high risk in their toleration for lobectomy underwent VATS segmentectomy with incomplete hilar and mediastinal lymph node dissection (compromised group). The surgical and clinical parameters were evaluated and compared with those of segmentectomy under standard thoracotomy to evaluate the technical feasibility of VATS segmentectomy. RESULTS: We found that VATS segmentectomy could be performed safely with a nil mortality rate and acceptably low morbidity. The mean period of observation was relatively short at 656.7 +/- 572.1 and 783.4 +/- 535.8 days in the intentional and compromised groups, respectively. At the time of writing, all intentional patients remain alive and free of recurrence. There were two cases of non-cancer-related death in the compromised group. Clinical data indicated that VATS segmentectomy caused the same number or fewer surgical insults compared with segmentectomy under standard thoracotomy. CONCLUSIONS: The present results are intermediate only; the rate of long-term survival and the advantages of the less invasive procedure still need further investigation. Nevertheless, we believe that VATS segmentectomy with complete lymph node dissection is a reasonable treatment option for selected patients with small peripheral NSCLC.

Aged↗
PubMed2004

Biosorbable poly-L-lactide rib-connecting pins may reduce acute pain after thoracotomy.

OBJECTIVE: Conventional thoracotomy is currently used as a standard procedure, and is often required to treat numerous diseases. Additionally, rib resections are occasionally required to maintain an adequate field of view for surgery. The benefits of using rib pins for chest closure following such procedures have not yet been established. This study sought to evaluate the usefulness of rib pins in reducing acute postoperative pain. METHODS: Thirty-three consecutive patients with lung cancer underwent lobectomies using the posterolateral approach. The patients were rib-resected and reconstructed with two techniques: 21 patients with absorbable rib pins (ARP group) and 12 patients by ligation with absorbable sutures (LAS group). Intensity of pain was assessed during the 3 days immediately following surgery. The two groups were assessed using the visual analogue scale (VAS) as a pain scale, amounts consumed of patient-controlled analgesics (PCA), and additional chest x-rays. RESULTS: On the first day following surgery, the mean VAS intensity of the ARP group for patient motion was 2.71 +/- 2.14, compared to 5.33 +/- 2.99 in the LAS group. After three days, the mean score for the ARP group was 1.98 +/- 1.89, compared to 4.60 +/- 1.97 in the LAS group. Scores in the ARP group were significantly lower than in the LAS group one day and three days following thoracotomy. The LAS group (55.0 +/- 15.9 times) made more frequent requests than the ARP group (16.1 +/- 10.3 times). The PCA requirement was also significantly lower in the ARP group. Excessive derangement of the rib (grade 2) was found in one case (4.7 %) in the ARP group compared to five cases (41.6 %) in the LAS group. Rib shifts were seen in numerous cases in the LAS group compared to the ARP group as measured by chest x-rays. CONCLUSIONS: Use of absorbable rib pins reduced postoperative pain and may improve long-term prospects for the post-thoracotomy course.

Acute Disease↗
PubMed2004

Mediastinal solitary fibrous tumor: report of a case with direct invasion to the trachea.

The solitary fibrous tumors in the pleura are a rare entity that is usually adhesive and sometimes invasive. Because of its benign feature, complete surgical resection is generally considered. We describe a very rare case of mediastinal solitary fibrous tumor arised or invaded into the tracheal wall, which was surgically resected with combined cylindrical resection of the trachea.

Adult↗
PubMed2004

Results of surgical treatment for non-small cell lung cancer of 20 mm or less in diameter.

BACKGROUND: Surgical efficacy is still unsatisfactory for small lung cancer; accordingly, minimal resection has recently been the focus of increased study. The objective of the current study was to evaluate the factors associated with small lung cancer, and to determine whether such factors are reliable predictors of long-term survival. METHODS: We retrospectively investigated 130 patients with histologically confirmed non-small cell carcinoma, whose treatments were primarily surgical, with no chemotherapy or radiotherapy prior to surgery. All tumors were located peripherally and were less than 20 mm in diameter. Follow-up was performed for five-year and eight-year survivors and multivariate analysis with Cox's proportional hazards regression model was performed. RESULTS: Of all 130 patients, the 5-year survival rate among patients with tumors less than 15 mm was 82.5 %, vs. 57.4 % of patients with tumors with a diameter of 16 - 20 mm. The 5-year survival rate of patients who were node negative was 73.9 % while it was 28.5 % for node-positive patients. Status of nodal invasion was also significantly associated with survival in small-size tumors ( p < 0.0001). Furthermore, the 5-year survival rate among patients with pleural involvement was 55 % vs. 83.8 % for patients without pleural involvement. Using multivariate Cox analysis, lymph node involvement ( p = 0.0004), size ( p = 0.0475), and pleural invasion ( p = 0.0482) were found to be independent prognostic factors in cases of tumors 20 mm or less in diameter. CONCLUSIONS: The results of this study at least demonstrate that the optimal therapy for patients with nodal involvement or patients with tumors of 16 - 20 mm must be carefully determined even in cases of small lung cancer.

Aged↗
PubMed2004

[Extrapleural pneumonectomy for malignant pleural mesothelioma and primary lung cancer].

The extrapleural pneumonectomy for 6 patients with malignant pleural mesothelioma and 2 patients with primary lung cancer have been performed in our unit in those 10 years. Range of the age was 48-57 year-old. All of them were male and have been in occupational asbestos exposure. The mean survival time after extrapleural pneumonectomy was 620 days. In those, we experienced a case of malignant mesothelioma with excellent reduction by induction therapy of cisplatin+docetaxel hydrate, who underwent the extrapleural pneumonectomy continuously. We mentioned more over about the role of extrapleural pneumonectomy for primary lung cancer with pleural dissemination, and intrapleural perfusion hyperthermo-therapy for malignant mesothelioma.

Adult↗
PubMed2004

[Pleuropneumonectomy for pulmonary tuberculosis and chronic tuberculous empyema].

Surgical intervention is often necessary to treat either the active pulmonary tuberculosis or its sequelae such as destroyed lung, tuberculous empyema, and bronchial stenosis. Pleuropneumonectomy, which has been reported to be associated with high mortality and morbidity, is performed when the pleural space is completely obliterated due to previous inflammation or when preoperative empyema is complicated. In this article we report 3 patients receiving pleuropneumonectomy for pulmonary tuberculosis or chronic tuberculous empyema in recent 3 years. The mean operation time is 5 hours and 56 minutes, and the mean volume of intraoperative bleeding amounted to 1,417 ml. Autologous blood transfusion was prepared for all 3 patients and transfused them during the operation. No mortality, but postoperative complications were seen in 2 patients (67%) with a history of diabetes mellitus. They were sternum infection and bronchopleural fistula, which were successfully treated conservatively. Diabetes mellitus is thought to be a major risk factor for not only tuberculous disease itself, but also postoperative morbidity. As for surgical techniques, wide skin incision with multiple thoracotomy is necessary to keep a good operative field, and special care must be taken for great vessels and nerves at extrapleural dissection. We conclude that pleuropneumonectomy is relatively risky but effective surgical procedure for adequately selected patients with destroyed lung and tuberculous empyema.

Aged↗
PubMed2003

Clinicopathological analysis of 143 primary malignant lymphomas in the small and large intestines based on the new WHO classification.

AIM: To study the clinicopathological and immunohistochemical features of 143 cases of primary small and large intestinal non-Hodgkin's lymphoma (NHL) in Japanese patients who presented between 1981 and 2000. METHODS AND RESULTS: The new World Health Organization (WHO) classification was used to classify NHL. The patients included 109 males and 34 females, with an average age of 54.1 years. Tumour sites were as follows: ileocaecal (n = 51, 35.7%), ileum (n = 29, 20.3%), rectum (n = 13, 9.1%), and duodenum (n = 11, 7.7%). Macroscopically, 124 cases (86.7%) were classified as tumorous type, 12 (8.4%) as diffuse infiltration type (erosion, superficial ulceration), five (3.5%) as polyposis type, and only two cases (1.4%) as ulceration type. Immunohistochemically, 122 lesions (85.3%) were of B-cell phenotype and 21 lesions (14.7%) were of T-cell phenotype. According to the WHO classification, of the B-cell lymphomas, 84 cases (68.9%) were large cell, 16 (13.1%) were Burkitt, 10 (8.2%) were marginal zone B-cell lymphomas of mucosa-associated lymphoid tissue (MALT), and seven (5.7%) were mantle cell tumours. Among the T-cell lymphomas, 15 (71.4%) were of unspecified type, two (9.5%) were natural killer type, two were anaplastic large-cell lymphomas, one was lymphoblastic, and one was an adult T-cell leukaemia lymphoma. The survival rate for T-cell lymphomas was poorer than for B-cell lymphomas. Among the B-cell lymphomas, mantle cell lymphoma tended to have a poorer prognosis, whereas MALT lymphomas had a better prognosis than other B-cell tumour types. CONCLUSIONS: Our retrospective study of patients with primary malignant lymphomas in the small and large intestines has illustrated the clinical features and outcomes of patients with this disease.

Adolescent↗
PubMed2003

Video-assisted thoracic needle aspiration cytology for malignancy of the peripheral lung.

BACKGROUND: The technique of video-assisted thoracic fine-needle aspiration cytology (VAT-FNA) to the lung has been described in very few publications, and its diagnostic role has not been evaluated so far. Thus current studies focus on whether the diagnostic role could be applied usefully to VAT-FNA of peripheral lung lesions. METHODS: Between January 1995 and January 2000, a total of one hundred and twenty-eight cases of VAT-FNA on lung tumors were reviewed retrospectively. The superficial lung was visualized a part of directly or indirectly by scope and a 22-gauge needle inserted for FNA. Material was expressed onto glass slides, and smears were stained by our modified quick-stain method. The cytological diagnoses based on VAT-FNA were reviewed and compared with the final histopathological diagnoses. RESULTS: The cytological diagnosis was true positive in 100 cases (93.5% sensitivity), whereas the true negative result in 20 cases was 95.2% specificity. The false-positive rate was 4.8%, and false-negative results were 6.5%. The accordance in all malignant cases between cytology and histology was 73.8%. VAT-FNA caused no difficulties in any of the cases. CONCLUSION: The application of VAT-FNA to the peripheral lung lesion is not only useful, cost-beneficial, safe and minimally invasive but also accurate. Especially, this method may play an important role in cases of suspected malignancy in peripheral cases.

Adult↗
PubMed2003

Evaluation of lung volume reduction surgery (LVRS) based on long-term survival rate analysis.

OBJECTIVE: Lung volume reduction surgery (LVRS) is an effective therapy for some patients with end-stage emphysema. In most cases, functional improvement is maximized during the first 6 months after surgery and decreases steadily afterwards. This study was aimed at gaining further understanding of the optimal candidates for LVRS and survival rates. METHODS: 62 patients with LVRS were selected according to the inclusion criteria. Changes in lung function were evaluated by FEV1, VC, RV, TLC, DLCO, PaO2, and PaCO2, and survival rates were analyzed at 12, 24, 36, and 48 months. Patients with LVRS were divided into two groups--those surviving after 48 months and those not surviving after 48 months--and analyzed according to group. RESULTS: The overall survival rate at 2 years and 4 years was 81.0 % and 67 %, respectively, with LVRS. VC, FEV1, TLC, DLCO, PaO2, and PaCO2 were potential factors leading to mortality according to univariate analysis. Multivariate analysis demonstrated that DLCO was the only independent factor that could predict the post-LVRS prognosis; the other factors failed as independent factors. Preoperatively, the FEV1 percentage predicted gave a good index for post-LVRS survival. CONCLUSIONS: Patients with higher preoperative FEV1 values had higher survival rates. These favorable long-term survival rates might justify LVRS for treating selected patients with severe emphysema. Additionally, DLCO turned out to be the only predictive factor for high mortality risk 4 years after LVRS. DLCO may thus be a very important marker in surgical planning.

Aged↗
PubMed2003

[Surgical treatment for esophageal cancer in elderly patients over 75 years of age].

UNLABELLED: We performed 127 esophageal resections for the esophageal cancer patient from December 1995 to September 2001. It was separated to under 70 years old patients group (group I), 71-74 years old patients group (group II), and over 75 years old patients group (group III). RESULTS: Postoperative complication was occurred in 53 cases (41.7%) within all of 127 esophageal resected cases. It was 33.7% in group I, 53.6% in group II, 62.5% in group III. Four years survival rate of each group is 38.3% in group I, 44.6% in group II, 31.3% in group III. It is significantly better in group II rather than in group III. Operative death rate is 12.5% (2 cases) in group III, 7.1% (2 cases) in group II, 3.6% (3 cases) in group I, and it is gradually higher and higher by patient's age. CONCLUSIONS: (1) In the esophageal cancer patient over 75 years old, postoperative complication rate is higher than under 74 years old patients, and prognosis is significantly poor rather than in 70-74 years old patients group. (2) In the esophageal cancer patient over 75 years old, we considered it is good indication of esophagectomy for stage I and stage II patient without preoperative complication, however, there are no operative indication for stage III and stage IV patient.

Age Factors↗
PubMed2002

[Surgical therapy for patients with thymoma or thymic carcinoma; based on WHO classification].

The treatment strategy for patients with thymoma or thymic carcinoma still has not been confirmed, and the molecular biologic characteristics of these tumors have not been defined also. We have emphasized the clinical significance of this classification so far by the research cooperation with professor Müller-Hermelink, the institute of pathology, Würzburg University. This time, We introduced clinico-pathological findings based on the new WHO classification in 59 Case of thymic epithelial tumor and reffered the treatment strategy for patients with thymic cancer.

Adult↗
PubMed2001

Highly sensitive immunohistological study for detection of estrogen receptor in human breast cancer.

BACKGROUND: Immunohistological methods for the detection of estrogen receptor in human breast cancer using formalin-fixed, paraffin-embedded tissue not only have the advantages of being cheaper and requiring less tissue but also have several theoretical advantages. For example, such methods enable direct histological visualization of the assessed tissue and thereby reduce sampling error. Traditional immunohistological methods (traditional LSAB), however, show false-negative reactions more often than the enzyme-binding immunoassay method (EIA). METHODS: After determining 25 estrogen receptor-positive cases and 50 estrogen receptor-negative cases by EIA, we analyzed these same cases using a traditional LSAB method and a new highly sensitive immunohistological method for assaying formalin-fixed, paraffin-embedded tissue. RESULTS: Using this new method, we detected 10 instances of positive estrogen receptors among the 50 EIA receptor-negative cases. The 25 EIA-positive cases were positive for estrogen receptor antigen except 1case using the new method. CONCLUSIONS: This new method not only has the advantage of use in paraffin-embedded tissue but also is more sensitive than the EIA. We recommend this new method as a choice to decrease false-negatives.

Adult↗
PubMed2001

Obliterative airway disease and graft stenting in pig-to-dog tracheal xenotransplantation.

OBJECTIVE: Obliterative airway disease occurring in concordant tracheal xenografts in rodent models is histologically similar to obliterative bronchiolitis in human lung allografts. We studied whether obliterative airway disease would occur in a large animal-discordant model. METHODS: Pig and dog tracheas were cryopreserved for 7 to 14 days, and 18 recipient dogs given splenectomy 7 days before transplantation, then seven tracheal rings were removed and a corresponding five-ring donor tracheal segment was transplanted to the excised site. Grafts were wrapped with pedicled omentum and inmmunosuppression was conducted with tacrolimus or deoxyspergualin. Graft status was observed by bronchoscopy. Dogs were classified into three groups. Group 1 consisted of dog-to-dog allotransplantation animals (control group, n = 5), Group 2 of pig-to-dog xenotransplantation animals (n = 8), and Group 3 of pig-dog xenotransplantation animals who also underwent graft stenting immediately after transplantation (n = 5). RESULTS: Grafts healed well in 4 of 5 Group 1 dogs. Tracheal stricture began on day 5 post transplantation and the lumen was obstructed by fibrosis by days 8 to 14 in all Group 2 dogs. All Group 3 dogs remained in good respiratory status until death. CONCLUSION: Obliterative airway disease developed quickly in pig-to-dog discordant tracheal xenografts. Graft stenting is a feasible treatment for managing of tracheal obstruction.

Airway Obstruction↗
PubMed2001

An immunohistochemical examination of basaloid squamous cell carcinoma of the esophagus: report of a case.

We recently encountered a patient with basaloid carcinoma of the esophagus with extensive node involvement. The patient died of hematogenous metastasis 6 months after surgery. The tumor expressed cytokeratin but did not express either Type IV collagen or laminin. Both tumor cells and metastatic lesions in the regional lymph nodes expressed p53, Bcl-2, and Ki-67 proteins, but did not express cyclin D1 proteins.

Biomarkers, Tumor↗
PubMed2001

Soluble thrombospondin-1 suppresses T cell proliferation and enhances IL-10 secretion by antigen presenting cells stimulated with phytohemagglutinin.

Thrombospondin-1 (TSP-1) is different from other components of the extracellular matrix (ECM) regarding its production and distribution. TSP-1 is considered to be released in large quantity in inflammatory sites and exogenously added TSP-1 does not bind to preformed ECM but instead binds to cells. To define the physiological role of TSP-1 in the immune system, we studied the influence of TSP-1 on the in vitro culture of T cells and antigen-presenting cells (APCs) in the presence of phytohemagglutinin. By adding soluble TSP-1 to the culture, T cell proliferation was suppressed and anti-inflammatory cytokine IL-10 secretion by APCs was enhanced. The enhanced expression of IL-10 was also demonstrated at the mRNA level by RT-PCR using multiprimer kit for cytokines. The suppression of T cell proliferation and the enhancement of IL-10 secretion with soluble TSP-1 was inhibited byadding RGDS peptide or heparin. This result indicates that the effect of soluble TSP-1 may be caused by binding to its ligand(s) on T cells and/or APCs, resulting in transducing regulatory signals to the cells or disturbing appropriate interaction between T cells and APCs. We therefore propose that TSP-1 is an immunosuppressive modulator which may play a role in inflammatory sites.

Antigen-Presenting Cells↗
PubMed2001

Glutathione S-transferase mu1 null genotype is associated with K-ras gene mutation in lung adenocarcinoma among smokers.

Glutathione S-transferase mu1 (GSTM1) plays a role in the detoxification of benzo[a]pyrene (BP) diol epoxide in tobacco smoke. Individuals who genetically lack the GSTM1 gene are likely to have an increased risk of smoking-related lung cancers, however, the target oncogenes for mutation are unknown. To investigate the relation between GSTM1 genotype and K-ras gene mutation we examined 193 adenocarcinomas and 119 squamous cell carcinomas of lung. The GSTM1 genotype was determined by PCR and K-ras gene mutations at codons 12 and 13 were detected by dot-blot hybridization analysis using sequence-specific oligonucleotide probes. K-ras gene mutations were found in 29 of 312 (9.3%) tumors. All of them arose in patients who were habitual smokers. Mutations of the K-ras gene were detected in 6 of 100 (6%) and 15 of 93 (16.1%) adenocarcinoma cases with the GSTM1(+) and GSTM1(-) genotypes, respectively, and the difference was statistically significant. These findings suggest that the cause of K-ras gene mutation in smokers with lung adenocarcinoma may be in part an accumulation of BP diol epoxide which is not well detoxified in individuals with the GSTM1 null genotype.

Adenocarcinoma↗
PubMed2001

The localization of thrombospondin-1 (TSP-1), cysteine-serine-valine-threonine-cysteine-glycine (CSVTCG) TSP receptor, and matrix metalloproteinase-9 (MMP-9) in colorectal cancer.

Thrombospondin-1 (TSP-1) is a 450 kDa matrix bound glycoprotein involved in tumor invasion, metastasis, and angiogenesis. One of the receptors involved in TSP-1 mediated tumor cell adhesion and metastasis is the cysteine-serine-valine-threonine-cysteine-glycine (CSVTCG) receptor. One mechanism of TSP-1 in promoting tumor cell metastasis involves the up-regulation of matrix metalloproteinase-9 (MMP-9) expression, specifically through the CSVTCG TSP-1 receptor. TSP-1 and its CSVTCG receptor has been implicated in tumor progression in a variety of cancers including breast adenocarcinomas, head and neck squamous cell carcinomas, and pancreatic carcinomas. In this study, we examined 99 cases of colorectal cancer by immunohistochemical analysis to investigate 1) the localization of TSP-1 and CSVTCG TSP-1 receptor, 2) the relationship with MMP-9, and 3) the correlation of expression with clinical staging. Strong expression of TSP-1 was observed in the submucosa or the serosa adjacent to the tumor. Positive staining for CSVTCG TSP-1 receptor was observed in tumor cells and microvessels. MMP-9 was also expressed in tumor cells. In addition, staining intensity of CSVTCG TSP-1 receptor was higher in poorly differentiated adenocarcinoma than well or moderately differentiated adenocarcinoma. Tumors in which inflammatory cells stained strongly for CSVTCG TSP-1 receptor correlated with decreased incidence of distant metastasis and angiogenesis. These data were consistent with our previous studies for breast, pancreatic, and head and neck carcinoma. They suggest an important role for TSP-1 and CSVTCG TSP-1 receptor in tumor progression in colorectal cancer.

Adenocarcinoma↗