Haigan
Online ISSN : 1348-9992
Print ISSN : 0386-9628
ISSN-L : 0386-9628
Volume 35, Issue 2
Displaying 1-17 of 17 articles from this issue
  • Makoto Tanaka, Hideaki Miyamoto, Yukinori Sakao, Ryuichi Harada, Tetsu ...
    1995 Volume 35 Issue 2 Pages 115-119
    Published: April 20, 1995
    Released on J-STAGE: August 10, 2011
    JOURNAL FREE ACCESS
    Primary lung cancer cases with postoperative lymph node recurrence have poor prognoses, because there is at present no effective therapy. We examined 8 re-operated cases of lymph node recurrence, among 309 surgically treated cases of primary lung cancer in our hospital from 1986 to 1993. On the occasion of the primary operation, we performed R2a dissections in 5 cases, R2b in 1 through a posterolateral thoracotomy, and R3 γ in 2 through a median sternotomy.The average time between first operation and re-operation was 16 months, and the average time of survival after re-operation was 16 months (2 are alive at present). Based on these results, we conclude that we should perform systemic and extended radical lymph node dissections on the occasion of the primary operation (e.g.bilateral mediastinal lymph node dissection through a median sternotomy for left lung cancer cases, and extended ipsilateral mediastinal lymph node dissection through a posterolateral thoracotomy for right lung cancer cases).
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  • Hiroyuki Nakamura, Kousuke Kashiwabara, Hisanaga Yagyu, Toshio Kiguchi ...
    1995 Volume 35 Issue 2 Pages 121-125
    Published: April 20, 1995
    Released on J-STAGE: August 10, 2011
    JOURNAL FREE ACCESS
    We examined the effectiveness of sustained continuous subcutaneous infusion (CSI) of granulocyte colony-stimulating factor (G-CSF) in neutropenia of lung cancer cases undergoing chemotherapy in comparison with daily subcutaneous infusion (SC). We treated 9 cases, all of whom were PS 0-1, under 75 years old, had never been treated previously and who had non-operable non-small cell lung cancer, by multiple combination chemotherapy consisting of 80mg/m2 dl CDDP, 3mg/m2 dl VDS, and 8mg/m2 dl MMC.G-CSF was given from days 4-17. The first course was 2μg/h (48μg/d) by CSI and the second course was 75μg/d by SC. Although the CSI dosage was 60% of the SC dosage, no significant difference was found during the period from the first day of chemotherapy in terms of the lowest neutrophil count and the period of the neutrophil count remaining below 1000/mm. We have not found any case report concerning this method but conclude that this makes safe chemotherapy possible for out-patients. We believe that this method will benefit patients making possible a better quality of life.
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  • Naofumi Takehara, Yoshinobu Ohsaki, Satoru Fujiuchi, Shuji Yamaguchi, ...
    1995 Volume 35 Issue 2 Pages 127-132
    Published: April 20, 1995
    Released on J-STAGE: August 10, 2011
    JOURNAL FREE ACCESS
    Eight patients with early stage lung cancer underwent photodynamic therapy (PDT) using a flexible bronchofiberscope from 1982 to 1993. All patients had one or two early epidermoid carcinomas in the central airway which were not detectable by chest radiography. Six patients, including two multiple primary cases had TisN0M0 lung cancers. Two patients had T1N0M0 lung cancers. Seven cancers in six patients were less than 10mm in length, while three cancers in two patients were greater than 10mm in length. Results of PDT were evaluated using biopsy specimens, sputum cytology and bronchofiberscopic observation at 2 and 4 weeks after the PDT. Five patients achieved complete response (CR). Three patients achieved partial response (PR). In the 8 cancers in the 6 patients with carcinomas in situ, 6 cancers in the 4 patients achieved CR. In the 7 cancers in the 6 patients which were less than 10mm in length, 5 cancers in 4 patients achieved CR.One CR case that had local recurrence and 2 PR patients received additional irradiation in the lung after the PDT and then achieved complete response. Median survival period was 50 + months (range 39-120 months). Three patients survived more than five years. Three patients died from secondary cancer, another 2 patients died from diseases unrelated to the malignancy. No patient died from primary lung cancer. These results suggest that PDT is effective in the treatment of inoperable patients with early bronchial carcinoma.Careful evaluation of the disease, with extensive biopsy specimens and additional irradiation of PR patients or recurrent patients seem to contribute to control of the disease.
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  • Yukinori Sakao, Ryuichi Harada, Tetsurou Hamada, Hideaki Miyamoto, Enj ...
    1995 Volume 35 Issue 2 Pages 133-139
    Published: April 20, 1995
    Released on J-STAGE: August 10, 2011
    JOURNAL FREE ACCESS
    Since 1986, 73 patients underwent bilateral mediastinal lymph node dissection for left lung cancer in Mitsui Memorial Hospital. We examined the location, frequency, and spread of metastases to the mediastinal lymph nodes in 25 cases with histologically proven N2 or N3 and MO disease. Contralateral metastases were more frequent than ipsilateral in the highest mediastinal lymph nodes. The 5-year survival rate of the patients who underwent R3 dissection was 65%. In this calculation, deaths occurring within 30 days after surgery (2 cases) and the patients with N3α(4 cases) disease were included and those with N3γ were excluded.There was no significant difference in postoperative survival between the patients with one level metastases and multilevel metastases.Furthermore, we subtyped the patients into two groups according to the spread of mediastinal lymph nodes metastases. The patients with limited nodal involvements such as #2*, #4, #5, #6, #7, #8 and #9 were placed in the posterolateral lesion group (10 cases) and patients with extended nodal involvements such as #1, #3 or contralateral mediastinal lymph nodes were placed in the median lesion group (7 cases). There was no significant difference in postoperative survival between these two groups. Survival in patients with clinical stage I (8 cases) or II (1 case) disease who underwent R3 was favorable despite the presence of N2 or N3α nodes (100% at 5 years). However survival in clinical N2 (8 cases) or N3 (1 case) was not so good (65% at 2 years). We suggest that R3 resection through a median sternotomy should be a standard operation for patients with N2 or N3α cancer of the left lung.
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  • Clinicopathological Correlation
    Yukitoshi Satoh, Sakae Okumura, Shigehiro Tsuchiya, Ken Nakagawa, Beni ...
    1995 Volume 35 Issue 2 Pages 141-148
    Published: April 20, 1995
    Released on J-STAGE: August 10, 2011
    JOURNAL FREE ACCESS
    Solid carcinoma with mucus formation, a subtype of pulmonary adenocarcinoma by the WHO classification, was classified as a large cell carcinoma according to the Japanese Lung Cancer Society Classification. In order to study which classification best represents the clinicopathologic characteristics of the tumor, we analyzed and compared these characteristics with those of other subtypes of adenocarcinomas and large cell carcinomas.The examined materials were 459 cases of surgically resected lung cancers (solid carcinomas with mucus formation: 20 cases; well differentiated adenocarcinomas: 179 cases;moderately differentiated adenocarcinomas: 142 cases; poorly differentiated adenocarcinomas: 61 cases;large cell carcinomas: 57 cases) from 1980 to 1992 in the Cancer Institute Hospital.
    The male to female ratio for solid carcinomas with mucus formation was about 4 to 1, which was lower than for large cell carcinomas (13:1) but similar to that of poorly differentiated adenocarcinomas (3:1). The prognosis of solid carcinomas, showing a similar figure to that of moderately differentiated adenocarcinomas in 5-year survival curves, was not as poor as with large cell carcinomas.Although many of carcinoma cases showed bulky progression, 50% of them showed no lymph node metastasis. These findings were also similar to those of moderately and poorly differentiated adenocarcinomas. Therefore, the clinicopathologic findings suggest that a solid carcinoma with mucus formation might better be classified as an adenocarcinoma rather than a large cell carcinoma.
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  • Kiyoshi Mori
    1995 Volume 35 Issue 2 Pages 149-156
    Published: April 20, 1995
    Released on J-STAGE: August 10, 2011
    JOURNAL FREE ACCESS
    We compared conventional CT (C-CT) and helical CT (H-CT) with regard to their capabilities in the detection of lesions in the lung fields.The subjects were 15 patients with metastatic lung tumors in whom nodules were detected by chest radiography. To scan the entire lung, we first employed C-CT (10-mm slice thickness, 10-mm slide), and then used H-CT with table speeds of 20mm/sec and 25mm/sec. We assessed each type of image to compare detection capabilities in the lung. In terms of the number of lesions detected by C-CT which could also be visualized on H-CT images reconstructed at 25mm, 20mm, 12.5mm, and 10-mm intervals, and also in terms of the number of lesions detected by C-CT which could also be visualized on H-CT images reconstructed at 20mm and 10-mm intervals using the 180-degree or 360-degree algorithm.
    On images at intervals of 10-mm (10-mm images), 147 of the 152 lesions were detected. Lesions were detected nearly as well as by C-CT. On 10-mm images, no difference was seen in the detection capability between 360-degree and 180-degree reconstruction.However, images acquired using the 180-degree algorithm depicted lesions with greater sharpness than those acquired using the 360-degree algorithm. In conclusion, H-CT may be useful in detecting pulmonary nodules, and the optimal conditions for maximizing detectability of nodules are as follows: table speed, 20mm/sec;and image reconstruction, 10mm for the 180-degree algorithm.
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  • Shinichi Hayasaka, Etsuo Kinuwaki, Takahiro Hamada, Shoichiro Kawano, ...
    1995 Volume 35 Issue 2 Pages 157-162
    Published: April 20, 1995
    Released on J-STAGE: August 10, 2011
    JOURNAL FREE ACCESS
    In a phase II study, we investigated the efficacy and safety of a cisplatin-carboplatin combination therapy regimen in previously untreated non-small cell lung cancer patients. Of the 56 patients enrolled in the study, 55 met the treatment criteria; 30 had adenocarcinoma, 20 squamous cell carcinoma, and 5 large cell carcinoma. Based on the results of an earlier phase I study, cisplatin 80mg/m2 and carboplatin 350mg/m2 were used, and 8, 33, and 14 patients received 1, 2, and 3 treatment courses, respectively. The antitumor effect was determined and 1 patient showed a complete response, 15 a partial response, 31 no change, 5 progressive disease, and 3 not evaluated; the over all efficacy rate was 30.8%. Mean survival time was 81 weeks for patients with stage III A cancer, 37 weeks for those with stage III B and IV cancer, and 42 weeks overall. Adverse reactions inclued leukopenia of grade ≥ 3 (20% of patients), thrombocytopenia (63.6%), and anemia (50%); gastrointestinal toxicity was also high, although there were no treatment related deaths. Therefore the treatment was considered tolerable. We concluded that this cisplatin-carboplatin chemotherapy regimen is effective for the treatment of non-small cell lung cancer.
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  • Seigo Teraoka, Mitoshi Akiyama, Michio Yamakido
    1995 Volume 35 Issue 2 Pages 163-172
    Published: April 20, 1995
    Released on J-STAGE: August 10, 2011
    JOURNAL FREE ACCESS
    The purpose of our study is to determine the efficacy of immunotherapy using human lymphokine activated killer (LAK) cells against a human-lung squamous-cell carcinoma cell line (RERF-LC-AI) implanted into severe combined immunodeficient (SCID) mice. A statistically significant growth suppressive effect on RERF-LC-AI implanted into SCID mice was observed when human LAK cells were administered into the caudal vein of the mice treated with a continuous supply (initiated prior to LAK cell injection) of rIL-2. Human LAK cells stained with PKH2, a fluorescent dye, for later detection using flow cytometry were administered into the caudal vein of RERF-LC-AI bearing SCID mice; the cells persisted for 7 days in the implanted lung cancer tissue and in the mouse peripheral blood, and for 5 days in the mouse spleen.The injection-dose dependency of infiltrated human LAK cells in each tissue is shown.The results indicate that the antitumor effect most likely occurred during the early implantation period of the human LAK cells.These results demonstrate the applicability of this model to the in vivo study of human lung cancer therapy.
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  • Akira Yamanaka, Morihisa Kitano
    1995 Volume 35 Issue 2 Pages 173-179
    Published: April 20, 1995
    Released on J-STAGE: August 10, 2011
    JOURNAL FREE ACCESS
    Resection of pulmonary metastases was performed in 38 patients. The cumulative 5-year survival rate after thoracotomy was 26.5%. The number of pulmonary metastases (N), tumor doubling time (TDT), size of pulmonary metastases (R), disease-free interval (DFI), primary tumor histology, the use or non-use of postoperative chemotherapy, and the presence or absence of metastases in other organs showed no significant correlation with postoperative survival. The relationship of survival to compound indices calculated by the arithmetical combination of prognostic factors was also investigated. TDT/N (p=0.0045) and TDT/R (p=0.0150) were significantly related to longer survival. Other compound indices were not related to survival; DFI/N and DFI/R. Statistically significant criteria can be determined by the arithmetical combination of prognostic factors. TDT/N, which can be explained as the reciprocal of the product of the growth rate and the lung colonizing potential, was found to be the most valuable prognostic indicator. Resection of metastatic pulmonary tumors is indicated for patients with ratios greater than 30.
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  • Takashi Seto, Hiroshi Semba, Yuji Fukai, Mayumi Seto, Atzushi Inayoshi ...
    1995 Volume 35 Issue 2 Pages 181-186
    Published: April 20, 1995
    Released on J-STAGE: August 10, 2011
    JOURNAL FREE ACCESS
    Abnormal shadows were seen in the chest X-ray film of a 78-year-old asymptomatic male. Chest plain X-rays revealed an irregular coin lesion in left S3. Under a preoperative diagnosis of adenocarcinoma by transbronchial brush cytology, resection of the left superior lobe involving the intercostal muscle was performed. On the resected specimen, a mucinous carcinoma portion and an atypical carcinoid (or small cell carcinoma) portion were recognized. Grimelius stain and electron microscopy confirmed the presence of neuroendocrine granules in both portions, which led to a diagnosis of mucinous neuroendocrine carcinoma primarily arising from the lung. This extremely uncommon case was discussed with special reference to the relevant literature.
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  • Takayasu Kurata, Teruomi Miyazawa, Masao Doi, Masamichi Mineshita, Hir ...
    1995 Volume 35 Issue 2 Pages 187-193
    Published: April 20, 1995
    Released on J-STAGE: August 10, 2011
    JOURNAL FREE ACCESS
    A 65-year-old man was admitted to our hospital because of cough, fever and left chest pain. A chest X-ray film showed a tumor shadow in the left hilum and findings suggestive of obstructive pneumonia in the left upper lobe. Bronchofiberscopy revealed large cell carcinoma of the lung. Because metastatic subcutaneous lesions were detected, we performed chemotherapy and radiotherapy, but the patient died as a result of respiratory failure. The white blood cell count rose to 83, 600/mm3 and the serum granulocyte colony-stimulating factor (G-CSF) level increased to 5, 237pg/ml as the tumor grew. An immunoperoxidase study showed that the tumor cells of the autopsied specimen stained positively with specific monoclonal antibodies against G-CSF. These findings indicated production of G-CSF by the tumor cells.
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  • Matsuro Fukushima, Takao Tsushima, Mikiya Ito, Tatsuro Hashegawa, Ikko ...
    1995 Volume 35 Issue 2 Pages 195-202
    Published: April 20, 1995
    Released on J-STAGE: August 10, 2011
    JOURNAL FREE ACCESS
    The first case was a 24 year-old male who complained of anterior chest pain. On admission, chest X-ray and CT scan showed a huge tumor mass in the right anterior mediastinum, and the tumor infiltrated surrounding tissues. Serum α-fetoprotein (AFP) was 6387ng/ml. Needle biopsy suggested a yolk sac tumor. Combination chemotherapy with cisplatin (CDDP), etoposide (VP-16) and bleomycin (BLM) obtained partial remission (29% reduction in the bidimensional tumor size) and serum AFP also decreased to 922ng/ml. The tumor was completely removed with en-bloc resection of the right lung and pericardium. Pathological findings of the resected tumor showed eosinophilic hyaline bodies, Schiller Duval bodies and AFP-positive tumor cells. Postoperative chemotherapy with the same regimen was administered. The patient is alive and well, 3 years after operation and serum AFP is within normal levels.
    The second case was a 30 year-old male who complained of pain in the left neck and anterior chest.Roentgenological examination showed a huge tumor mass in the anterior mediastinum and bilateral lung metastases. CT scan showed the tumor to be heterogeneous in density. The serum AFP level was 1406ng/ml. Needle biopsy yielded a histologic diagnosis of yolk sac tumor. After CDDP-based combination chemotherapy and radiation therapy, the tumor size reduced to some extent and the shadows suggesting lung metastases disappeared completely. On chest CT, the density of the tumor changed to a homogeneous pattern and serum AFP decreased to a normal level. The tumor was then removed completely and pathological findings of the tumor showed manifest necrosis but some viable tumor cells. Two cycles of postoperative chemotherapy with a similar regimen were administered. The patient had no relapse and is alive 7 months after the operation.Serum AFP is within the normal range.
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  • Yoshimasa Yoshida, Yutaka Mizushima, Kazuhiko Sassa, Masashi Kobayashi
    1995 Volume 35 Issue 2 Pages 203-207
    Published: April 20, 1995
    Released on J-STAGE: August 10, 2011
    JOURNAL FREE ACCESS
    A 79-year-old man, complaining of weakness of the right upper and lower extremities, was referred to our hospital for evaluation of a left hilar tumor and multiple brain tumors which had been detected by a local doctor. The diagnosis of small cell carcinoma of the lung was made by lung biopsy, with metastasis to the brain (stage IV=T4NOM1). After chemotherapy (CBDCA+VP-16) plus radiotherapy (brain, 40Gy), he was discharged after partial response had been obtained. However, he was readmitted 4 months later because of gait disturbance. Weakness of both legs and disturbance of deep sensations could not be explained solely by the presence of brain metastases. The spinal cord MRI revealed intramedullary metastases at Th8 and Th10 levels. Lumber punctures (three times) were negative for cytology, and hematogenous metastasis was suggested. Case reports on lung cancer associated with intramedullary metastasis are rare, especially in cases diagnosed before death.
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  • Yuji Morita, Kazuhiro Yoshida, Hisao Harada, Masahiko Yamagishi, Masak ...
    1995 Volume 35 Issue 2 Pages 209-214
    Published: April 20, 1995
    Released on J-STAGE: August 10, 2011
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    A 74-year-old male with idiopathic pulmonary fibrosis was admitted to our hospital on suspicion of acute exacerbation.Chest CT on admission demonstrated a solid mass about 5 cm in diameter located in front of the left main pulmonary artery. Because of the location corresponding to the region of #10 lymph node and the high serum levels of CEA and CA 19-9 (15.5ng/ml and 429U/ml respectively), the mass was suspected to be a metastatic hilar lymph node from a primary lung cancer. Neither a primary nor a metastatic lesion were detected, however, in the lung or in other organs of the body. As the mass grew, with gradual increases in the serum levels of tumor markers, resection was performed. This case was classified as a T0N1M0 adenocarcinoma of the lung because of the histological findings, which demonstrated adenocarcinoma proliferating in a lymph node. On special and immunohistochemical stainings, Al-PAS and CEA showed positive findings but stainings were negative for CA19-9, SP-A, SP-D and CC10. The serum levels of CEA and CA19-9 continuously increased, even after the operation, and reached respective levels of 104ng/ml and 1020U/ml at the time of discharge, seven months after admission.
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  • Tadashi Yokosuka, Norihisa Tamiya, Masayuki Baba, Yutaka Yamaguchi, Hi ...
    1995 Volume 35 Issue 2 Pages 215-220
    Published: April 20, 1995
    Released on J-STAGE: August 10, 2011
    JOURNAL FREE ACCESS
    A 10-year-old male had chief complaints of repeated obstructive pneumonia and hemoptysis. Bronchoscopic findings revealed a tumor mass diagnosed as a non-malignant tumor by cytologic examination of TBAC materials, therefore, endoscopic Nd: YAG laser irradiation was attempted.However, in the course of the treatment, histologic examination of the samples obtained by snaring revealed mucoepidermoid carcinoma. As a result right middle and lower lobectomy was carried out. The tumor was a polyp 22×10×9mm in size arising from the membranous portion of the right basal bronchus and invading only the bronchial wall. Histological examination showed lowgrade malignancy and no lymphatic metastasis. Eight months after the operation, no evidence of tumor recurrence was recognized. The 27 cases reported in the Japanese literature including this case were reviewed.
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  • Tohru Hasumi, Yasuki Saito, Shunsuke Kobayashi, Gunji Okaniwa, Shigefu ...
    1995 Volume 35 Issue 2 Pages 221-226
    Published: April 20, 1995
    Released on J-STAGE: August 10, 2011
    JOURNAL FREE ACCESS
    A 63-year-old man underwent right upper lobectomy for lung cancer. Two months later he suffered from increasing fatigue and dyspnea. Chest radiography showed an enlarged cardiac silhouette and echocardiography showed a large pericardial effusion. Pericardiocentesis yielded 770ml of milky fluid.Laboratory analysis of the fluid disclosed a high concentration of triglyceride (1288mg/ml), confirming the diagnosis of chylopericardium. The patient was treated with pericardial drainage, severe restriction of fat intake and intravenous injection of Blood coagulation factor El (Fibrogammin®). Consequently, pericardial effusion reduced dramatically. He recovered uneventfully and there has been no evidence of recurrence during a 3-year follow-up period.
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  • 1995 Volume 35 Issue 2 Pages 227-237
    Published: April 20, 1995
    Released on J-STAGE: August 10, 2011
    JOURNAL FREE ACCESS
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