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Yasunori Sohara

Publications and source records attributed to Yasunori Sohara.

At least 19 recordsLinked to original sources
PubMed2006

Preoperative chemotherapy for cStage III-pN0 patients with non-small cell lung cancer.

OBJECTIVES: Survival benefits with preoperative chemotherapy for non-small cell lung cancer (NSCLC) remain controversial. Preoperative chemotherapy may act on micrometastasis but not lymph node metastasis. To clarify the role of induction chemotherapy for control of micrometastasis, we reviewed and compared 5-year follow-ups of clinical stage III but pathologically-proven node-negative NSCLC patients after complete resection with or without preoperative chemotherapy. METHODS: We reviewed 148 consecutive patients who underwent anatomical lung resection and mediastinal nodal dissection for pathologically-proven node-negative NSCLC at our hospital between 1994 and 1999. Fifty-six patients were preoperatively diagnosed as stage III: 26 received platinum-based chemotherapy prior to surgery (PCT group) and 30 underwent surgery without any prior chemotherapy (PRS group). RESULTS: The 5-year survival rate for clinical stage I/II and pathological node-negative patients was 74.9%; for clinical stage III, but for pathological node-negative patients it was 92.3% in the PCT and 63.3% in the PRS groups. The survival benefit of preoperative chemotherapy was significant for clinical stage II patients without node involvement. CONCLUSION: Preoperative chemotherapy may provide survival benefits for node-negative NSCLC patients.

Aged↗
PubMed2006

Plastron-trapdoor technique for direct-vision sternal re-entry.

Repeat median sternotomy does not allow good access for retrosternal re-entry. Conversely, by using the plastron-trapdoor technique, which we describe in this report, the retrosternal tissues are dissected from the body of the sternum under direct vision, thus allowing relatively safe and wide exposure for retrosternal re-entry.

Aged↗
PubMed2006

Predictors of postoperative complications after radical resection for pulmonary aspergillosis.

OBJECTIVE: Although surgery has proven to be the best treatment for pulmonary aspergillosis, with the highest chance of achieving complete remission, it is difficult to determine the surgical indications for this disease because of the high incidence of postoperative complications. We conducted this study to identify some predictors of postoperative complications, in an attempt to reduce the morbidity rate. METHODS: We retrospectively analyzed the medical records of 31 patients (18 men, 13 women; median age 53 years) who underwent radical resection for pulmonary aspergillosis between 1976 and 2004. The clinical manifestations, surgical procedures, and postoperative complications were reviewed to clarify the predictors of postoperative complications. RESULTS: The morbidity rate associated with major complications such as intrapleural bleeding, bronchopleural fistula, and empyema, resulting in further surgery, was 19%. Univariate analysis revealed the predictors of major complications to be sex, severe preoperative symptoms, and extensive pulmonary resection. Multivariate analyses also indicated that preoperative symptom severity was an independent predictor of major complications. CONCLUSIONS: Pulmonary aspergillosis should be resected before the symptoms become too severe if the patient is a surgical candidate.

Adult↗
PubMed2006

Combined analysis of cyclooxygenase-2 expression with p53 and Ki-67 in nonsmall cell lung cancer.

BACKGROUND: Cyclooxygenase-2 (COX-2) is known to play a role in carcinogenesis and tumor progression. The aim of this study was to evaluate the relationship between COX-2 expression and clinicopathologic features, and to define the importance of COX-2 expression alone and in combination with p53 and Ki-67 expression in the clinical outcome of NSCLC. METHODS: A total of 219 patients with stage I-IIIB nonsmall cell lung cancer (NSCLC) who previously underwent surgery were analyzed in this study. The COX-2 expression was evaluated by means of immunohistochemistry; p53 and Ki-67 immunoreactivity were also studied. RESULTS: The COX-2 expression was observed in 137 patients (63%) and was significantly associated with lymph node metastasis and the histological grade of those with adenocarcinoma (p = 0.02 and 0.04, respectively). Kaplan-Meier analyses revealed that COX-2 expression was correlated with poor survival (p = 0.005), whereas multivariate survival analysis did not reveal COX-2 expression to be an independent prognostic factor. When the patients were stratified according to gender, age, tumor histology, and disease stage, COX-2 expression was significantly associated with unfavorable prognosis in males, younger patients (< or = 65 years), and those with adenocarcinoma and stage I tumors. The prognosis of patients with tumors negative for both COX-2 and p53 expression was significantly favorable, whereas those with tumors positive for COX-2 expression and with a high Ki-67 labeling index had a significantly unfavorable prognosis. CONCLUSIONS: These findings indicate that combined immunohistochemical analysis of COX-2 with p53 and Ki-67 can be useful for identifying the prognosis of NSCLC patients.

Adult↗
PubMed2006

How should the TNM staging system for lung cancer be revised? A simulation based on the Japanese Lung Cancer Registry populations.

OBJECTIVE: The 1997 version of the TNM staging system for lung cancer has several prognostic problems. Among these, the overlapping survival of stages IB and IIA is the most serious. We performed this retrospective study to test a revised TNM staging system for lung cancer. METHODS: We revised the T1 descriptor definition and stage grouping for testing as follows. According to the greatest tumor diameter, T1 tumors were divided into T1a tumors (< or =2.0 cm) and T1b tumors (2.1-3.0 cm). With these descriptors, new IA, IB, and IIA stages were defined as T1a N0 M0, T1b N0 M0, and T2 N0 M0 + T1 N1 M0, respectively. For 6644 patients with histologically non-small cell lung cancers resected in 1994 and reported in the Japanese Lung Cancer Registry Study, the survivals and prognostic difference between neighboring stages were studied. RESULTS: The 5-year survival of the entire population was 52.6%. In the clinical setting, the 5-year survivals of the new IA, new IB, new IIA, IIB, IIIA, IIIB, and IV stages were 77.5%, 69.3%, 49.8%, 40.6%, 35.8%, 28.0%, and 20.8%, respectively. In the pathologic setting, they were 83.7%, 76.0%, 60.0%, 42.2%, 29.8%, 19.3%, and 20.0%, respectively. For both clinical and pathologic settings, differences between all neighboring stages were statistically significant, except for that between IIIB and IV. CONCLUSION: Subcategorization of T1 and minor changes in stage grouping results in a system with significant differences in prognosis between neighboring stages. The unification of stages IB and IIA, especially, improves the discriminatory power of the staging system.

Adult↗
PubMed2006

Thoracoscopic findings of a small posterior mediastinal parathyroid adenoma.

We report herein the rare case of a posterior mediastinal parathyroid adenoma 8 mm in diameter, that was identified by both 99m-technetium-methoxyisobutylisonitrile scintigraphy (Tc-MIBI) and high-resolution chest computed tomography (HRCT). Thoracoscopy clearly showed a mediastinal parathyroid adenoma which was successfully removed.

Adenoma↗
PubMed2005

Intrathoracic sporadic desmoid tumor with the beta-catenin gene mutation in exon 3 and activated cyclin D1.

We report a case of intrathoracic desmoid tumor without familial adenomatous polyposis and demonstrate beta-catenin mutation of exon 3. A 15-year-old male presented with a desmoid tumor after having sustained an assault. In an examination for a mutation of the beta-catenin gene, an activating mutation from ACC (Thr) to GCC (Ala) at codon 41 was found. Immunohistochemical staining showed that accumulated beta-catenin protein was predominantly localized in the nuclei of desmoid cells, and cyclin D1 protein was also overexpressed. These findings might suggest that an activating mutation of the beta-catenin gene affected regulation of the cyclin D1 gene, resulting in the generation of intrathoracic sporadic desmoid tumor, which arose at the site of posttraumatic injury.

Adolescent↗
PubMed2005

Prognosis of 6644 resected non-small cell lung cancers in Japan: a Japanese lung cancer registry study.

For the scheduled future revision of the TNM staging system for lung cancer, it is important that the present 1997 version be evaluated in a large population. In 2001, the Japanese Joint Committee of Lung Cancer Registry sent a questionnaire to 320 Japanese institutions regarding the prognosis and clinicopathological profiles of patients who underwent the resection for primary lung neoplasms in 1994. We compiled the data for 7408 patients from 303 institutions (94.7%). Among these, 6644 patients with non-small cell histology were studied in terms of prognosis. The 5-year survival rate of the entire group was 52.6%. The 5-year survival rates by clinical (c-) stage were as follows: 72.1% for IA (n = 2423), 49.9% for IB (n = 1542), 48.7% for IIA (n = 150), 40.6% for IIB (n = 746), 35.8% for IIIA (n = 1270), 28.0% for IIIB (n = 366) and 20.8% for IV (n = 147). The difference in prognosis between neighboring stages was significant except for between IB and IIA and between IIIB and IV. The 5-year survival rates by pathological (p-) stage were as follows: 79.5% for IA (n = 2009), 60.1% for IB (n = 1418), 59.9% for IIA (n = 232), 42.2% for IIB (n = 757), 29.8% for IIIA (n = 1250), 19.3% for IIIB (n = 719) and 20.0% for IV (n = 259). The difference in prognosis between neighboring stages was significant except for between IB and IIA and between IIIB and IV. The survival curves of stages IB and IIA were almost superimposed in both c- and p-settings. These findings indicated that the present stages IB and IIA should be merged into the same stage category. Otherwise, the present TNM staging system seemed to well characterize the stage-specific prognosis in non-small cell lung cancer. The future revision should focus on the subdivision of stages I and II.

Aged↗
PubMed2005

Primary pulmonary synovial sarcoma confirmed by molecular detection of SYT-SSX1 fusion gene transcripts: a case report and review of the literature.

This is a case report of a rare patient with primary pulmonary synovial sarcoma. The patient was a 58-year-old woman who presented with a well-defined giant mass in the right lower field on a chest radiograph. A malignant pulmonary tumor was suspected and consequently a right middle and lower lobectomy was performed. Grossly, the tumor measured 10 x 8 x 7 cm, was whitish-yellow in color and friable with hemorrhage. Histologically, the tumor showed a dense proliferation of spindle cells. In some areas, a herringbone-like pattern with coagulation necrosis of large size was noted. Immunohistochemically, the tumor cells were focally positive for cytokeratin and epithelial membrane antigen (EMA). As these features suggested a monophasic synovial sarcoma, we looked for the presence of SYT-SSX fusion gene transcripts using RNA samples from the paraffin-embedded tissue. A reverse transcription-polymerase chain reaction (RT-PCR) amplified a single 118 bp fragment characteristic of the SYT-SSX1 fusion gene transcripts. As no tumor was found at other sites, it was diagnosed as primary pulmonary synovial sarcoma. Molecular testing proved to be very helpful or necessary when monophasic spindle cell synovial sarcoma was recognized in uncommon/unexpected sites. In our review of primary pulmonary synovial sarcomas confirmed by molecular detection of SYT-SSX fusion gene transcripts, the SYT-SSX2 fusion protein expression correlates with poorer prognosis. This is in contrast to the association between the SYT-SSX1 fusion protein expression and poorer prognosis in soft tissue synovial sarcomas.

Female↗
PubMed2005

Overexpression of the aldo-keto reductase family protein AKR1B10 is highly correlated with smokers' non-small cell lung carcinomas.

PURPOSE: Squamous cell carcinoma (SCC) and adenocarcinoma of the lung are currently subject to similar treatment regimens despite distinct differences in histology and epidemiology. The aim of this study is to identify a molecular target with diagnostic and therapeutic values for SCC. EXPERIMENTAL DESIGN: Genes specifically up-regulated in SCC were explored through microarray analysis of 5 SCCs, 5 adenocarcinomas, 10 small cell lung carcinomas, 27 normal tissues, and 40 cancer cell lines. Clinical usefulness of these genes was subsequently examined mainly by immunohistochemical analysis. RESULTS: Seven genes, including aldo-keto reductase family 1, member B10 (AKR1B10), were identified as SCC-specific genes. AKR1B10 was further examined by immunohistochemical analysis of 101 non-small cell lung carcinomas (NSCLC) and its overexpression was observed in 27 of 32 (84.4%) SCCs and 19 of 65 (29.2%) adenocarcinomas. Multiple regression analysis showed that smoking was an independent variable responsible for AKR1B10 overexpression in NSCLCs (P < 0.01) and adenocarcinomas (P < 0.01). AKR1B10 staining was occasionally observed even in squamous metaplasia, a precancerous lesion of SCC. CONCLUSION: AKR1B10 was overexpressed in most cases with SCC, which is closely associated with smoking, and many adenocarcinoma cases of smokers. These results suggest that AKR1B10 is a potential diagnostic marker specific to smokers' NSCLCs and might be involved in tobacco-related carcinogenesis.

Aldehyde Reductase↗
PubMed2005

Thoraco-pleuropneumonectomy for rupture of a huge chronic hematoma of the thorax.

A 67-year-old woman with a huge chronic expanding hematoma of the thorax due to previous tuberculous pleuritis was referred to our hospital with frequent hemoptysis. The hematoma had ruptured into the lung parenchyma. The patient had undergone apical thoracoplasty 40 years earlier. To provide complete resection of the huge cavity in the costodiaphragamatic recess, thoraco-pleuropneumonectomy was performed, and the patient was able to resume daily activities a few months after the operation.

Aged↗
PubMed2005

Pulmonary cryptococcosis mimicking pulmonary metastases in a patient treated with Tegafur-uracil after lung cancer surgery.

A 71-year-old man who had undergone surgery for stage II adenocarcinoma of the lung followed by adjuvant tegafur-uracil (UFT; 300 mg/day) therapy was admitted. Multiple nodules were found in both lungs on chest radiographs obtained 1.5 years after the surgery. Imaging characteristics of the nodules resembled those of pulmonary metastases. Histologic assessment of a biopsy specimen obtained during thoracoscopic resection revealed pulmonary cryptococcosis. The patient was administered 200 mg/day fluconazole for 6 months. Physicians need to be aware of the possibility of pulmonary cryptococcosis mimicking pulmonary metastases in patients treated with UFT after surgery for lung cancer.

Adenocarcinoma↗
PubMed2005

Tracheocele: surgical and thoracoscopic findings.

We report a rare case of tracheocele found incidentally on a chest computed tomographic scan of a 78-year-old woman undergoing left hemithyroidectomy. The tracheocele was removed, and our operative and thoracoscopic findings are reported herein. The causes and possible clinical implications of tracheocele are discussed.

Aged↗
PubMed2005

Alternative surgical approaches for apical neurinomas: a thoracoscopic approach.

BACKGROUND: Neural tumors at the thoracic apex present technical problems for surgeons because of their inaccessibility and postoperative neural complications. Although several approaches offering better accessibility have been proposed, none have become standard. METHODS: Between 1976 and 2004, 23 patients, histologically 20 neurilemmomas and three ganglioneuromas, underwent surgical intervention for apical neurinoma. Surgical approaches were in three groups: (1) open thoracotomy, 8 patients; (2) transcervical, 10 patients; and (3) video-assisted thoracoscopy utilizing intracapsular enucleation to preserve important nerves and vessels, 5 patients. Perioperative variables and postoperative neurological complications were reviewed and compared among the groups. RESULTS: Operation time and t blood loss in the vessels group were significantly less than in the other groups. Multivariate analysis with the perioperative variables showed the transcervical approach to be an independent predictor for postoperative neurologic complications (p = 0.0029). All patients remain free from recurrence, even in the follow-up period for patients in the vessels group ranging from 6 to 60 months (average, 35 months). CONCLUSIONS: Video-assisted thoracoscopic intracapsular enucleation, when an apical neurinoma is benign and well-capsulated, is the optimal treatment to preserve nerve function. Careful follow-up to monitor for recurrence is necessary.

Adult↗
PubMed2005

Phosphodiesterase type 4 inhibitor rolipram inhibits activation of monocytes during extracorporeal circulation.

OBJECTIVE: Cardiopulmonary bypass is associated with systemic inflammatory response syndrome and risk of multiorgan injury mediated by activated leukocytes. Phosphodiesterase type 4 is the predominant phosphodiesterase isozyme in leukocytes and plays a key role in the regulation of leukocyte activation. The aim of this study was to examine the effect of rolipram, a selective phosphodiesterase type 4 inhibitor, on functional changes of monocytes during simulated extracorporeal circulation. METHODS AND RESULTS: Simulated extracorporeal circulation was established by recirculating heparinized human blood for 120 minutes on a membrane oxygenator with or without 10 micromol/L of rolipram. L-selectin and CD11b expression of monocytes were measured with flow cytometry. C4d fragment, Bb fragment, C5b-9, and interleukin-6 were measured with enzyme immunoassay. Rolipram reduced the increase in CD11b expression and the decrease in L-selectin expression of monocytes in response to simulated extracorporeal circulation. Rolipram inhibited the increase in C4d fragment and interleukin-6, but it did not affect the increase in Bb fragment or C5b-9. CONCLUSION: Rolipram inhibited changes in adhesion molecule expression and interleukin-6 release by activated monocytes in simulated extracorporeal circulation. This study suggests that phosphodiesterase type 4 inhibition could be feasible therapeutic strategy to prevent exaggerated inflammatory response and organ injury in patients undergoing cardiopulmonary bypass.

3',5'-Cyclic-AMP Phosphodiesterases↗
PubMed2005

A case of thoracic hemorrhage due to ectopic parathyroid hyperplasia with chronic renal failure.

We report a case of secondary hyperparathyroidism in a 53-year-old man who had thoracic hemorrhage originating from an ectopic thymic parathyroid gland tumor. He was on long-term hemodialysis treatment and had persistent secondary hyperparathyroidism caused by 3 swollen parathyroid glands around the thyroid gland and a mediastinal ectopic parathyroid gland tumor. Parathyroidectomy and removal of the mediastinal tumor were planned. Preoperative chest x-ray and a computed tomographic scan obtained just before surgery showed left pleural effusion. Furthermore, diagnostic thoracentesis yielded hemorrhagic exudative fluid. Thoracoscopy confirmed the presence of a mediastinal tumor lesion that was bleeding into the thoracic cavity. The tumor was resected using thoracoscopic surgery, and ectopic thymic parathyroid gland hyperplasia associated with hemorrhage was pathologically diagnosed. A postoperative diagnostic chest computed tomographic scan and technetium 99m 2-methoxyisobutyl isonitrile scintigraphy showed successful removal of the ectopic parathyroid gland tumor. Subsequently, the secondary hyperparathyroidism could be clinically controlled by medical treatment, and total parathyroidectomy has been postponed indefinitely. We consider that hemorrhage from the ectopic parathyroid gland tumor resulted in thoracic bleeding. To our knowledge, this is the first case report of secondary hyperparathyroidism with thoracic hemorrhage originating from an ectopic mediastinal parathyroid gland.

Adenoma↗