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Biomedical subjects

W Chiba

Publications and source records attributed to W Chiba.

31 records · Page 2Linked to original sources
PubMed1993

[Diagnosis of mediastinal neoplasms using mediastinoscopy and CT-guided needle biopsy supported by gene analysis].

Of 140 cases of mediastinal neoplasms in our hospital, histological diagnosis was confirmed in 129 cases. We examined the methods of preoperative biopsy with those 129 cases. Biopsy had been performed in 25 cases. Mediastinoscopy was performed in seven cases, needle biopsy in eight cases, lymph node biopsy in eight cases, esophageal biopsy using a gastrofiberscope in one case, transbronchial biopsy using a bronchoscope in one case. The true positive rates of those methods were 100% for both mediastinoscopy and lymph node biopsy, and 75% for needle biopsy. Preoperative misdiagnosis occurred in two cases of needle biopsy. The postoperative histological diagnosis was malignant lymphoma in both cases. We performed gene analysis of the immunoglobulin heavy chain gene, light chain kappa and lambda genes, and the T-cell receptor beta gene by use of biopsied specimens, and we found rearrangement bands of these genes in the cases of malignant lymphoma. Therefore, we summarize that gene analysis is a reliable method if malignant lymphoma is suspected. If a needle biopsy is performed under CT guidance, the needle is sure to puncture the tumor. We concluded, therefore, that if a tumor is located in the anterior mediastinum, CT-guided needle biopsy should be performed first of all. Mediastinoscopy is a useful method if the tumor is located in the mid-mediastinum.

Biopsy, Needle↗
PubMed1993

[An autopsy case of primary pulmonary malignant lymphoma associated with right pulmonary infiltrative shadow and macroglobulinemia].

We experienced a patient with two peaks of elevated monoclonal IgM and IgA in the serum, and lambda type Bence-Jones protein in the urine. Chest X-ray films showed right pulmonary infiltrative shadow and effusion. The results of the autopsy of this patient revealed infiltration of malignant lymphoma cells in both lungs, but in no other organs. The results of immunohistochemical staining for L26. UCHL-1, IgM, IgA and lambda chain in this case led to the diagnosis of diffuse small cell type. B-cell lambda, IgM type malignant lymphoma. Gene analysis using bone marrow did not reveal any rearrangement bands for the heavy chain, light chain kappa and lambda, or TcR beta genes. Therefore, we concluded that malignant lymphoma cells had infiltrated only the bilateral lungs, causing a rare case of primary pulmonary malignant lymphoma with two monoclonal peaks of increased serum IgM and IgA.

Aged↗
PubMed1992

[Diagnosis, incidence, clinicopathology and surgical treatment of acquired tracheobronchomalacia].

We report our recent findings on the diagnosis, incidence, appearance of the trachea at autopsy, and surgical treatment of acquired trachobronchomalacia. In the diagnosis of this disease, continuous dynamic CT scanning (1 slice/0.6 second) from inspiration to deep expiration was better than X-ray cine recording. It is difficult to observe the most collapsed airway on coughing using bronchofiberscopic recording, because its duration time was estimated to be 1/10 second by X-ray cine recording, whereas the findings at one instant were easily recorded by video-bronchoscopy on coughing. The degree of severity of this disease was classified into three groups. 1st degree 0-50% narrowing of airway caliber, 2nd degree 50-75%; and 3rd degree 75-100%. Severity of 2nd or 3rd degree was present in 542 (12.7%) of 4283 patients suffering from chest disease who underwent bronchoscopy. Seventy-two percent of patients were aged 50 to 80 years. Third degree tracheomalacia was found in 131 patients with an incidence of 3.1%, which increased from 2.2% at 50 years to 6.2% at 80 years. The autopsy findings of the trachea consisted of fragmentation of the tracheal cartilage and extension of the membranous portion. The pathogenesis may be varied with different types of collapse of the airway, including the saber sheath type and the crescent type. Surgical treatment consists of prevention of the airway collapse by wrapping the airway with Marlex mesh and bonding Lyodura (lyophilized dura mata) with fibrin glue, which is more reliable than the span plasty proposed by Nissen.

Adolescent↗
PubMed1992

[Chest wall reconstruction using polyester mesh].

Using polyester, we prepared a new material for chest wall reconstruction. The polyester mesh has the same rigidity and elasticity as Marlex tracheal mesh. From January 1987 through July 1991, we performed chest wall reconstruction using the polyester mesh in 8 patients with lung cancer, 9 with empyema after open drainage, 2 with metastatic chest wall tumors, 1 with a primary osteogenic giant cell tumor originating from the rib and 1 with radiation dermatitis and costal chondritis. Three or more ribs were resected in 17 patients. The defects of the chest wall were reconstructed with the polyester mesh covered with a GORE-TEX soft tissue patch to achieve air tightness. Fifteen cases have passed at least one year with no sign of infection. In conclusion, the polyester mesh prevents flail chest and seems to be a satisfactory material for chest wall reconstruction.

Adult↗
PubMed1992

[Surgical treatment of lung cancer with mediastinoscopic positive lymph nodes].

There are no definite criteria for the indication of surgery in lung cancer with mediastinal lymph node involvement. During the past 20 years, 100 patients (76 patients with adenocarcinoma and 24 patients with squamous cell carcinoma) have undergone thoracotomy for lung cancer with mediastinoscopic positive lymph nodes at our hospital. Of these, relatively curative resection was performed on 13 patients. The 5-year survival rate in these 13 patients was 28%, which was significantly higher than the 0% in 42 patients with relatively non-curative resection and the 0% in 26 patients with absolutely non-curative resection. The 5-year survival rate was 9% in both T1 (n = 14) patients and T2 (n = 37) patients. No T3 (n = 21) and T4 (n = 9) patients survived 3 years. The 5 year survival rate in patients with squamous cell carcinoma was 12% and that in patients with adenocarcinoma was 0%, but there was no significant difference. The survival rates of T1 and T2 patients were significantly higher than that of T3 patients (p less than 0.02 and p less than 0.005) respectively. Contralateral mediastinal lymph node metastasis (N3) was observed significantly more frequently in patients with adenocarcinoma (38%) than in those with squamous cell carcinoma (13%), but there was no significant difference in the survival rate. In N2 patients, the survival rate was compared between those with mediastinal nodal involvement of an early stage (N2-1) and those with lymph node metastasis of more advanced stage (N2-2) according to the lobe bearing the primary cancer.(ABSTRACT TRUNCATED AT 250 WORDS)

Adenocarcinoma↗
PubMed1991

[Surgical indications for thoracotomy in cases of small advanced lung cancer by use of DNA content analysis and mediastinoscopy].

Twenty-seven patients with small advanced lung cancer were treated at Kyoto Katsura Hospital. Of 27 patients, 19 patients underwent thoracotomy. The mean survival time of the 19 resected patients was 49 months, while that of the 8 unresected patients was 36 months. There was no statistically significant difference between these mean survival times. Of the 19 resected patients, 6 patients underwent a relative curative operation (RCO), 4 patients underwent a relative noncurative operation, and 9 patients underwent an absolute noncurative operation. The respective mean survival times were 79 months, 30, and 33. We compared the mean survival time of RCO cases with that of the unresected cases, and there was a significant difference in favor of the RCO cases. So we recommend thoracotomy for patients with small advanced lung cancer if RCO is possible, and that requires of a histological classification of less than N2. We performed mediastinoscopy for 18 of the 27 patients to check for mediastinal lymph node metastasis, and 16 of those patients were confirmed to have metastasis pathologically. Mediastinoscopy is useful and reliable for confirming lymph node metastasis, because it gives us a pathological diagnosis. We also performed DNA content analysis on the 19 resected cases. There were 7 DNA diploidy cases, 11 DNA aneuploidy cases, and 1 case couldn't be determined. There was no significant difference between the mean survival times of DNA diploidy cases and the DNA aneuploidy cases.

Aneuploidy↗
PubMed1991

[Gene analysis of pulmonary lymphoproliferative disorders].

The authors performed gene analysis of pulmonary lymphoproliferative disorders. Cell suspensions were obtained from tissues of malignant lymphoma or pseudolymphoma in Cases 1 to 3. High-molecular-weight DNA was extracted from these specimens, digested with restriction endonucleases, size-fractionated by agarose-gel electrophoresis and transferred by the Southern procedure to nitrocellulose. Hybridization to nick-translated 32P DNA probes of the immunoglobulin JH, C kappa, C lambda, regions, and T cell receptor beta 1 region. In case 1 and 2, which were diagnosed as B cell lymphoma, cells from tumor had rearranged heavy chain genes, clearly establishing the clonal nature. In Case 3, which was diagnosed as pseudolymphoma, the tumor contained clonal immunoglobulin gene rearrangements as detected with both the JH heavy chain and C kappa light chain gene probes. It was concluded that gene analysis is an effective procedure for establishing a diagnosis of lymphoma in neoplastic disorders of uncertain cell type and for detecting clonal T cell or B cell populations with atypical lymphofollicular hyperplasia.

Adult↗
PubMed1983

Chronic pulmonary infection caused by Mycobacterium terrae complex: a resected case.

A case of localized cavitary disease in lung with multiple isolations of Mycobacterium terrae complex from the patient's sputum is presented. The patient's past history and clinical tests supported his immunologic competency. Prolonged cavitary disease with persistent positive sputum led him to submit to right lower lobe resection after 5 months of chemotherapy. Innumerable isolates of the same mycobacteria from the resected cavity with a compatible histopathologic finding supported Mycobacterium terrae complex as the definitive etiologic agent in this case.

Chronic Disease↗