Haigan
Online ISSN : 1348-9992
Print ISSN : 0386-9628
ISSN-L : 0386-9628
Volume 33 , Issue 2
Showing 1-19 articles out of 19 articles from the selected issue
  • Ryuzo Kanno, Takeo Ohori, Yoshihiro Satoh, Koichi Yanai, Akio Ohishi, ...
    1993 Volume 33 Issue 2 Pages 155-162
    Published: April 20, 1993
    Released: August 10, 2011
    JOURNALS FREE ACCESS
    Pneumonectomy was performed in 34 patients (17.3%) of 197 consecutive pulmonary resections for lung cancer in our department from 1981 to 1990. Arrhythmia was the most common postoperative complication (7 cases, 20.6%). Bronchopleural fistulas occured in 6 cases (17.6%). Other complications were palsy of the reccurent nerve, 3 cases (8.8%); respiratory failure, reoperation for postoperative intrathoracic hemorrhage, 2 cases each (5.9%). There were three operative deaths and the operative mortality rate was 9.1%.
    For prophylaxis of postoperative complications, careful operation and postoperative management of respiration and circulation are important. For prophylaxis of bronchopleural fistula, we recommend that the bronchial stump should be covered with available tissues.
    The 5-year survival rate of pneumonectomy was 37.7%(including operative deaths). Causes of death for those who survived long after operation were as follows; local recurrence, 3 cases (19%); distant metastasis, 11 cases (69%) pneumonia, heart failure, 1 case each (6%).
    These results suggest that the primary tumor was relatively well controlled by pneumonectomy. There was no case of death long after pneumonectomy due to cardiopulmonary failure.
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  • Noriaki Iwahashi, Takashi Nakano, Hiroshi Fujioka, Nobuyuki Aihara, Ju ...
    1993 Volume 33 Issue 2 Pages 163-168
    Published: April 20, 1993
    Released: August 10, 2011
    JOURNALS FREE ACCESS
    Thirty-two patients with previously untreated small cell lung cancer were treated with Adriamycin 40mg/m2+Etoposide 100mg/m2×3 days+Cisplatin 80mg/m2, every four weeks for a minimum of two courses. Of 30 patients evaluable for response, six (20.0%) had a CR and 18 (60.0%) had a PR. The overall response rate was 80.0%(24/30). CR and the response rate in LD patients was 37.5%(3/8) and 100%(8/8), while those in ED patients was 13.6%(3/22) and 72.7%(16/22), respectively. Median survival time (MST) for all evaluable patients was 39.3 weeks. The MST for LD and ED patients was 60.7 and 30.6 weeks, respectively. MST for objective responders was significantly longer than that for non-responders (p<0.05). Grade 3-4 hematologic toxicities were leukocytopenia (23/30, 76.7%) and thrombocytopenia (9/30, 30.0%). Grade 2-3 non-hematologic toxicities were appetite loss (25/30, 83.3%), nausea/vomiting 21 (70.0%) and alopecia 20 (66.7%). Grade 2 liver toxicity (elevation of serum GOT/GPT) was noted in one patient (3.3%). Grade 2 renal toxicity (elevation of serum creatinine) was noted in three patients (10.0%). However, these toxicities improved without particular treatment.
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  • Taisuke Ohnoshi, Hiroshi Ueoka, Katsuyuki Kiura, Tsuyoshi Kodani, Masa ...
    1993 Volume 33 Issue 2 Pages 169-175
    Published: April 20, 1993
    Released: August 10, 2011
    JOURNALS FREE ACCESS
    In an attempt to elucidate the prognostic importance of various pretreatment factors and to confirm the effectiveness of chemotherapy in advanced non-small cell lung cancer (NSCLC), 29 pretreatment clinical parameters including chemotherapy regimen were retrospectively analyzed in 164 patients with NSCLC enrolled in the protocol studies of combination chemotherapy between 1982 and 1990. Using univariate analysis of the χ2 test and generalized Wilcoxon test, and multivariate analysis of Cox's proportional hazard model, patients were analyzed to determine factors affecting their prognosis. Univariate analysis demonstrated that stage, liver, bone or bone marrow involvement, number of extrathoracic metastasis, performance status (PS), serum albumin, CRP, NSE, cholinesterase, hemoglobin and chemotherapy regimen were related to the outcome of patients. Multivariate analysis revealed that independently significant factors influencing patient survival were in the order of serum albumin, chemotherapy regimen, stage, PS and LDH, indicating that chemotherapy exerts an impact on patient survival with advanced NSCLC.
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  • Kyoko Hara
    1993 Volume 33 Issue 2 Pages 177-186
    Published: April 20, 1993
    Released: August 10, 2011
    JOURNALS FREE ACCESS
    By immunohistochemical staining with monoclonal antibody Ki-67, growth potential was investigated in 79 resected lung cancers. The percentage of Ki-67 positive cells was defined as growth fraction: GF (%). The GF of squamous cell carcinoma (21.64±8.17%) was significantly higher than that of adenocarcinoma (11.86±9.60%). The GF of small cell carcinoma was high (38.31%). In squamous cell carcinoma, there was no correlation between the GF and other pathological prognostic factors. However, in adenocarcinoma, comparison of the GF with pathological stage, tumor size, lymph node metastasis, pleural invasion, vascular invasion, histological differentiation and survival rate showed a significant correlation between the GF and each of these factors. Thus, it was suggested that the Ki-67 GF is a useful new prognostic factor of adenocarcinomas of the lung.
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  • in Terms of Chemotherapeutic Effect and Prognosis
    Yasufumi Yamaji, Ichiro Yamadori, Akihito Kubo, Yoshifumi Yamagishi, K ...
    1993 Volume 33 Issue 2 Pages 187-193
    Published: April 20, 1993
    Released: August 10, 2011
    JOURNALS FREE ACCESS
    Several recent reports have suggested that the significance of defining “small/large cell carcinoma” or “undifferentiated carcinoma, small cell type (UCS)” as a new histologic subtype of small cell lung cancer (SCLC). This proposal has been based entirely upon a clinical tendency of UCS to be more resistant to chemotherapy than other subtypes of SCLC. Histological examination of UCS showed that relatively small and polygonal cells were in the majority. They also had clear or vesicular nuclei and prominent nucleoli with distinct celluar borders. Small numbers of intermediate or large cells could also be found. Thirty six patients treated with platinum compounds and etoposide were entered in this study in order to evaluate the clinical significance of UCS in the histopathologic subclassification of SCLC. Oat cell type was diagnosed in 13 patients (36%), intermediate subtype was diagnosed in 18 patients (50%) and UCS in 5 patients (14%). Among 5 UCS cases, complete response (CR) was obtained in 1 and partial response (PR) in 4. Survival periods for the UCS cases were 7, 13, 19, 32 and 61+ months, respectively. There were no significant differences in response to chemotherapy and survival period between the UCS patients and other SCLC patients. Our observations were in sharp contrast to findings of previous reports which attempted to define UCS as a distinct clinical entity because of the poor response to chemotherapy as well as the dismal prognosis.
    This discordance might be explained by the difference in the chemotherapeutic regimens employed. Thus, in consideration of advances in chemotherapeutic agents, UCS patients should be treated with similar protocols and philosophy as in the case of other SCLC patients.
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  • Tetsuyuki Morikawa, Yutaka Nishiwaki, Tetsuro Kodama, Mizuyoshi Sakura ...
    1993 Volume 33 Issue 2 Pages 195-205
    Published: April 20, 1993
    Released: August 10, 2011
    JOURNALS FREE ACCESS
    Of 247 patients who were treated in National Matsudo Hospital from November, 1985 to April, 1988, we experienced 17 patients who had acute severe pulmonary toxicity after radiotherapy. All of them had also received chemotherapy before radiotherapy, and 11 died of pulmonary complications.
    Although we could not predict acute severe pulmonary toxicity, these results suggest that we have to be more careful concerning the acute severe pulmonary toxicity of radiotherapy following chemotherapy.
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  • Yuji Mori, Masaki Mori, Kouzou Yamada, Kenjiroh Fukuhisa, Akira Suzuki
    1993 Volume 33 Issue 2 Pages 207-213
    Published: April 20, 1993
    Released: August 10, 2011
    JOURNALS FREE ACCESS
    To investigate agreement on computed tomographic (CT) diagnosis of mediastinal nodal stations, an interpretation experiment was performed. This study consisted of 202 mediastinal nodes shown on CT images. Twenty interpreters designated each node according to the General Rules for Clinical and Pathological Record of Lung Cancer (3rd ed., The Japan Lung Cancer Society). Agreement on CT designations of mediastinal nodal stations was not satisfactory. Unclear anatomic limits of nodal stations, and the presence of mediastinal areas which meet all criteria of several nodal stations seemed to cause the poor agreement on nodal stations. The addition of clear anatomic limits and giving priority to the General Rules appear to be useful for improving agreement on designating mediastinal nodal stations. However, agreement on decision of nodal sides (right or left) was relatively good.
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  • Kouzo Yamada, Ikuo Nomura, Masanori Matsumura, Kazumasa Noda, Yasufumi ...
    1993 Volume 33 Issue 2 Pages 215-222
    Published: April 20, 1993
    Released: August 10, 2011
    JOURNALS FREE ACCESS
    Pleural invasion is one of the most important factors in the clinical diagnosis of lung cancer. Many studies have been conducted to evaluate extrapulmonary invasion by lung cancer. Gross extrapulmonary invasion into the chest wall and the mediastinum can be confidently diagnosed with computed tomography (CT) and magnetic resonance (MR) imaging. However, contiguity of the tumor to adjacent extrapulmonary structures is not equivalent to definite invasion.
    To assess the usefulness of thin-sliced CT in detection of chest wall and mediastinal invasion of lung cancer, we performed a prospective study of 12 patients whose tumors were contiguous to the extrapulmonary structures on conventional CT scans. Comparison of diagnoses based on findings of thin-sliced CT and pathologic examination showed that thin-sliced CT was 83% accurate for pleural invasion. Conventional CT, however, was 58% accurate for pleural invasion.
    This leads to the conclusion that thin-sliced CT is helpful in accurate evaluation of the pleural invasion in lung cancer, especially for patients in whom findings on conventional CT suggest tumor invasion of the chest wall and mediastinum.
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  • Takehiko Saito, Tomoji Yoshida, Takayuki Shirakusa, Keiyoshi Tamae, Yu ...
    1993 Volume 33 Issue 2 Pages 223-231
    Published: April 20, 1993
    Released: August 10, 2011
    JOURNALS FREE ACCESS
    We examined histological factors in 33 resected cases of small (≤2cm) peripheral lung cancer. Lobectomy was performed in all cases in which the tumor was considered potentially completely resectable. All patients underwent a mediastinal lymph node dissection. There were 26 adenocarcinomas, 3 squamous cell carcinomas, 3 adenosquamous carcinomas, and 1 small carcinoma. The examined histological factors were blood vessel invasion, lymph node metastasis, tumor size, histological grade, the degree of collagenization in the fibrotic focus and the degree of lymphoid stromal reaction to the tumor cells. All specimens were stained with H. E. and E. V. G. The presence or absence of blood vessel invasion, the degree of lymph node metastasis, and the degree of collagenization in the fibrotic focus were the major determinants of prognosis (p<0.006). All cases without blood vessel invasion are alive with no evidence of disease.
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  • Yukito Ichinose, Nobuyuki Hara, Tokujiro Yano, Hiroshi Asoh, Hideki Yo ...
    1993 Volume 33 Issue 2 Pages 233-238
    Published: April 20, 1993
    Released: August 10, 2011
    JOURNALS FREE ACCESS
    Intraoperative intrapleural hypotonic cisplatin treatment was performed on 9 patients with carcinomatous pleuritis found at thoracotomy and 10 patients with potentialrisk of recurrence in the pleural space. The treatment procedure was as follows. The entire thorax was exposed to cisplatin (50μg/ml) in distilled water for 10-15 min, which was prewarmed at 37°C. Carcinomatous pleuritis in all 8 patients eligible for assessment of the treatment effect has been controlled for 6 to 29 months. In patients with potential risk of recurrence in the pleural space, the appearance of pleural diseases has not been observed for periods of up to 31 months. As the pleura was destroyed by the treatment, postoperative drainage volume was significantly increased, compared to that of patients without the treatment. However, there were no harmful complications after operation.
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  • Makoto Nonaka, Mitsutaka Kadokura, Toshihiro Takaba, Kazuhiko Soejima, ...
    1993 Volume 33 Issue 2 Pages 239-245
    Published: April 20, 1993
    Released: August 10, 2011
    JOURNALS FREE ACCESS
    A 52-year-old man was admitted with chest pain. Chest X-ray showed a pleural tumor in the left intrathoracic space. It was diagnosed as sarcomatous mesothelioma by biopsy. During admission, this tumor enlarged rapidly, and pleural effusion increased. Combination chemotherapy consisting of cisplatin and vindesine was performed. After chemical pleurodesis and systemic chemotherapy, pleural effusion disappeared and the growth of tumor was halted. The patient underwent panpleuropneumonectomy with combined resection of adjacent structures such as the diaphragm and the chest wall. After the operation, radiotherapy (63Gy) was performed. Twelve months after the operation, there is no evidence of tumor recurrence. Combination therapy was effective in this case.
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  • Koji Sugimoto, Shuji Adachi, Masahiko Kusumoto, Eiichiro Itouji, Michi ...
    1993 Volume 33 Issue 2 Pages 247-253
    Published: April 20, 1993
    Released: August 10, 2011
    JOURNALS FREE ACCESS
    A case of mucoepidermoid carcinoma of the lung which showed a poor course was reported, and the literature was reviewed. The patient was a 66-year-old male. A mass shadow on the right lower lung field was seen on the chest X-ray.
    Because of widespread lymph nodes metastases in the right hilum and mediastinum, radiation therapy was performed, but he died 4 months later.
    In general, mucoepidermoid carcinoma is known to be a low grade malignancy, however our case was thought to be high grade malignancy.
    In Japan, 13 cases of mucoepidermoid carcinoma with aggressive clinical behavior have been reported. In those cases, the chest radiogram and bronchoscopic findings showed various and histological findings did not always agree with clinical behaviour.
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  • Hiromasa Kohno, Mitsutoshi Shiba, Shinichiro Mitsunaga, Takehiko Fujis ...
    1993 Volume 33 Issue 2 Pages 255-260
    Published: April 20, 1993
    Released: August 10, 2011
    JOURNALS FREE ACCESS
    A 55-year-old male with idiopathic interstitial pneumonia had been treated with a corticosteroid for 19 months. In the course of treatment, malignant cells (squamous cell carcinoma) were confirmed by sputum cytology. His chest roentgenogram showed ring-like reticular shadows in the right lower lung field without any apparent tumorous shadow. Right middle and lower lobectomy combined with partial resection of right S2 was performed. The macroscopic findings on surgical specimens revealed only diffuse stiffness within the parenchyma of the honey comb lung in the subpleural area of the lower lobe, and it was difficult to determine the primary site of the tumor. Histologically, honeycomb formation and fibrous wall thickening were noted in the lower lobe, throughout which atypical squamous metaplasia and squamous cell carcinoma were scattered. In part, transition from squamous metaplasia to carcinoma was observed. Squamous cell carcinoma of the lung rarely proliferates in such a fashion and it was suggested that lung cancer accompanying idiopathic interstitial pneumonia might develop multifocally.
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  • Koichi Tomoda, Kazuya Fukuoka, Kaoru Hamada, Keiichi Saitoh, Yoshizumi ...
    1993 Volume 33 Issue 2 Pages 261-267
    Published: April 20, 1993
    Released: August 10, 2011
    JOURNALS FREE ACCESS
    A 66-year-old man was admitted with small cell carcinoma of the lung (T2, N2, MO, stage III A), accompanied by SVC syndrome. With chemo- and radiotherapy, the SVC syndrome temporarily improved, but recurred. Because the SVC syndrome was thought to be refractory to these therapeutic modalities, a Gianturco expandable metallic stent (EMS) was inserted into the stenotic SVC. Immediately, many symptoms related to SVC syndrome, edema of the face and upper extremities and dyspnea, improved. A month after placement of the EMS he died of pneumonia but without any side effects induced by the EMS. Autopsy demonstrated that there were no thromboses over the EMS, which was covered with white sheets composed of proliferating intima.
    Placement of an EMS is thought to be effective in alleviating the symptoms of SVC syndrome.
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  • Makoto Isobe, Yoshihiro Yamauti, Setsuo Edakuni, Kohzi Shinozaki, Sige ...
    1993 Volume 33 Issue 2 Pages 269-273
    Published: April 20, 1993
    Released: August 10, 2011
    JOURNALS FREE ACCESS
    A 45-year-old man was admitted to our department with an enlargement of the right hilar lymph node recognized roentgenologically. However, no primary lesion was revealed by subsequent examinations using CT scan and MRI. Right thoracotomy was carried out, and an encapsulated tumor was found between the right middle and lower lobe. The histological diagnosis of the resected specimen was a metastatic lymph node of small cell carcinoma. Pre-and postoperative examinations did not detect the primary lesion at any site. This case was a very rare case of T0N1M0 lung cancer. The postoperative course of the patient has been good with no evidence of recurrence 6 months after the operation.
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  • Manabu Kasashima, Shigeki Sugiyama, Masanobu Kitagawa, Kazuhiro Matsui ...
    1993 Volume 33 Issue 2 Pages 275-279
    Published: April 20, 1993
    Released: August 10, 2011
    JOURNALS FREE ACCESS
    During a health check up, an abnormal shadow was detected in the right upper lung field of a 64-year-old male who had worked at an iron foundry for 15 years. Although a chest wall tumor was suggested by chest X-ray and CT finding, it was shown to be a tumor of the visceral pleura by ultrasonography. The tumor protruded from the posterolateral pleural surface of S3a in the right upper lobe, which was resected together with a small amount of the lung parenchyma. Histologically, the tumor was entirely hyalinized, and incorporated mesothelial cells at the basis. It was assumed to be a benign fibrous mesothelioma judging from the site of origin and morphologic pattern. There has been no case report of complete hyalinization of the fibrous type of mesothelioma. In the diagnosis of a tumor arising from the visceral pleura, ultrasonography is useful, enabling real time visualization of the relationship between the tumor and the pleura.
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  • Emiko Odaka, Mitsutoshi Shiba, Hisami Yamakawa, Shinichiro Mitsunaga, ...
    1993 Volume 33 Issue 2 Pages 281-287
    Published: April 20, 1993
    Released: August 10, 2011
    JOURNALS FREE ACCESS
    A rare case of postoperative recurrence of pulmonary sclerosing hemangioma (PSH) is reported. A 41 year-old female was admitted because of a coin lesion in the left upper lung field on chest X-ray. A PSH was diagnosed by percutaneous fine needle biopsy (PNB). The hemangioma was resected, and no malignant pathological findings were recognized. After 2 years, a coin lesion reappeared at the same site and appeared to have grown. Since the same diagnosis was made by PNB, reoperation was performed. Histopathological findings of the initial and recurrent lesion both showed papillary hyperplasia and partial sclerosis. No malignant findings such as cell atypism or mitosis were seen. In the recurrent lesion, the sclerotic findings were less than in the initial tumor and many clear cells were observed. The immunohistochemical examination by monoclonal antibodies to keratin and surfactant apoprotein indicated differentiation into type II alveolar cells. These results were also supported by electron microscopic findings. This case was considered to provide helpful information for the clarification of the etiology of PSH.
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  • 1993 Volume 33 Issue 2 Pages 288-300
    Published: April 20, 1993
    Released: August 10, 2011
    JOURNALS FREE ACCESS
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  • 1993 Volume 33 Issue 2 Pages 300-304
    Published: April 20, 1993
    Released: August 10, 2011
    JOURNALS FREE ACCESS
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