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Volume 36, Issue 7
Displaying 1-16 of 16 articles from this issue
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Niro Okimoto, Rinzo Soejima, Takashi Teramatsu1996 Volume 36 Issue 7 Pages 863-871
Published: December 20, 1996
Released on J-STAGE: August 10, 2011
JOURNAL FREE ACCESSAs adjuvant chemotherapy in patients whose non-small cell lung carcinoma was completely resected, we studied a combination therapy consisting of CDDP+VDS+ UFT (group A) or administration of UFT alone (group B) with respect to whether group A or group B might have longer survival as compared with surgery alone (group C), using five-year survival as an indicator.
Five-year survival rates (follow-up rate of 5-year survival: 100%) of eligible 310 cases were as follows: group A (109 cases), 60.6%; group B (103 cases), 64.1%; group C (98 cases), 49.0%; and the survival rates of both group A and group B significantly improved as compared with group C (surgeryalone), as evidenced byp=0.053 (logrank test) and p=0.044 (generalized Wilcoxon test) among the three groups. In particular, the patients in group B had higher 5-year survival than those in group C (p=0.022 by the logrank test and p=0.019 by the generalized Wilcoxontest).
Subset analysis showed that patients in stage III A or patients with adenocarcinoma benefited the most from adjuvant chemotherapy.
Based on the results presented above, we concluded that administration of CDDP+VDS+UFT and administration of UFT alone (which we selected as adjuvant chemotherapy) prolonged the survival period clearly as compared with surgery alone, suggesting the possibility that administration of UFT alone can be particularly useful as postoperative adjuvant chemotherapy for non-small cell lung carcinoma.View full abstractDownload PDF (801K) -
Tadashi Matsukura, Kazumi Itoi, Shinichi Itoi, Keiji Okada, Masayoshi ...1996 Volume 36 Issue 7 Pages 873-877
Published: December 20, 1996
Released on J-STAGE: August 10, 2011
JOURNAL FREE ACCESSEndoscopic polypectomy was successfully used to treat three patients with tracheobronchial obstruction. Two cases were lung cancer and the other one was neurilemoma of the trachea. The neck of the polypoid tumors was strangulated by the snare, and then electrocautery was performed. The cut tumor was removed by the fiberscope. Following the procedure, symptoms of all patients disappeared. There were no significant complications.
Endoscopic polypectomy has few respiratory complications. It seems that the most severe complication is bleeding. We think that a tracheal spiral long tube with a cuff and local injection of pure ethanol is useful.View full abstractDownload PDF (5680K) -
Kazuhiro Kimura, Hiroshi Sakai, Hidetoshi Sumimoto, Suguru Hibino, Isa ...1996 Volume 36 Issue 7 Pages 879-883
Published: December 20, 1996
Released on J-STAGE: August 10, 2011
JOURNAL FREE ACCESSOut of a total of 1586 lung cancer cases treated since1977, 22 cases clinically diagnosed to have leptomeningeal carcinomatosis (LMC) wereexamined. The incidence was 1.4%, and the frequency of LMC in small cell carcinoma was significantly higher than in adenocarcinoma or squamous cell carcinoma. The diagnosis of LMC was established ante-mortem in 16 patients, and cerebral sings and symptoms (headache, mental disorder) were most frequent, although cranial sings and symptoms were rare. Median survival (MST) was 3 months with ante-mortem diagnosis, one month with post-mortem diagnosis, and there was no significant difference. The MST was 6 months with operation, 2 months without operation, also without statistical difference.
We must consider that earlier diagnosis and combined modality can improve MST of the LMC patients, though it is a rare complication.View full abstractDownload PDF (517K) -
Hiroichi Ishikawa, Hiroaki Satoh, Takashi Naito, Yasunori Funayama, Hi ...1996 Volume 36 Issue 7 Pages 885-891
Published: December 20, 1996
Released on J-STAGE: August 10, 2011
JOURNAL FREE ACCESSA total of 1100 patients with primary lung cancer who were diagnosed at Tsukuba University Hospital and 8 affiliated hospitals in Ibaraki prefecture, were analyzed with reference to the reasons for detection of the cancer. The outcome in 165 cases detected by mass screening was compared with the outcome in 783 patients who presented with symptoms. In the mass screening group, 50.3% of cases were detected at stage I, while only 8.8% of patients with symptoms were in stage I (p=0.0001). Surgical treatment was employed more frequently in the mass screening group (p=0.0001). The outcome of patients with lung cancers detected by mass screening was more favorable than that of the symptomatic group. The early detection of lung cancer via mass screening contributes to improvement of the outcome.View full abstractDownload PDF (786K) -
Eiji Yatsuyanagi, Satoshi Hirata, Hiroshi Moriyama, Susumu Koshiko, Ya ...1996 Volume 36 Issue 7 Pages 893-898
Published: December 20, 1996
Released on J-STAGE: August 10, 2011
JOURNAL FREE ACCESSOf the 86 patients with non-small cell lung cancer who had mediastinal lymph node metastases, 23 patients (27%) had “skip metastases”. There was no statistical significance in the incidence of skip metastases with regard to the histopathologic classification. The incidence of skip metastases in patients with upper lobe lesions (35%) was statistically higher than that in patients with lower lobe lesions (15%) (p<0.05). The sign of pleural involvement was found in 19 patients (83%) during operation. The number of metastatic mediastinal lymph nodes in patients with skip metastases (2.4±2.1) was statistically smaller than that in patients with lobar or hilar node metastases (4.4±3.6) (p<0.01). The 5-year survival rate of the patients with skip metastases (43%) was higher than that of the patients with lobar or hilar node metastases (23%), but this difference was not statistically significant. These results suggest that the absence of lobar and hilar node metastases does not exclude the necessity of mediastinal dissection, because 20-30% of patients with mediastinal metastases might have skip metastases. However, when a tumor is localized in the lower lobe and there is no sign of pleural involvement, the incidence of skip metastases is very low. Especially when a tumor is localized in the left lower lobe and there is no lobar, hilar or # 7 node metastases, mediastinal lymph node dissection can be omitted.View full abstractDownload PDF (691K) -
Keio Lung Cancer Study Group, Koichi Kobayashi, Tsuneo Ishihara1996 Volume 36 Issue 7 Pages 899-907
Published: December 20, 1996
Released on J-STAGE: August 10, 2011
JOURNAL FREE ACCESSA randomized, controlled trial was performed to determine whether postoperative adjuvant chemotherapy with CDDP+VDS can improve the survival rate in patients with non-small cell lung cancer (NSCLC) undergoing curative or relatively non curative resection. Stage I patients were divided in Group A (CDDP+VDS and 2 years of 5-FU p. o.) and Group B (no treatment). Stage II, III patients were divided in Group C (2 courses of CDDP+VDS and 2 years of 5-FU p. o.) and Group D (2 years of 5-FU p. o. only). The numbers of patients in Groups A, B, C and D were 63, 66, 32 and 31 respectively. Postoperative 5-year-survival rates were 79.4% for Group A, 86.3% for Group B, 25.0% for Group C and 22.6% for Group D. Thus postoperative adjuvant chemotherapy with CDDP+VDS did not improve the 5-year survival rate.View full abstractDownload PDF (779K) -
Yasuteru Sugino, Yumiko Suzuki, Masamitsu Iwata, Takuhei Murase, Kazuh ...1996 Volume 36 Issue 7 Pages 909-918
Published: December 20, 1996
Released on J-STAGE: August 10, 2011
JOURNAL FREE ACCESSWe studied two men with advanced primary lung cancer (stage N) who presented with marked leukocytosis. The patients were aged 39 and 77 years old. The pathological subtypes were large cell carcinoma (giant cell type) and adenosquamous cell carcinoma. The white cell counts on admission were 65, 300/mm3 and 29, 800/mm3. Abnormally high serum levels of G-CSF and GM-CSF by EIA were found in both patients (G-CSF: 732.0, 534. 0pg/ml, GM-CSF: 71.8, 43.4pg/ml). In the analyses of autopsied tumor tissue extract, neither G-CSF nor GM-CSF were detected by Western blot, but ELISA showed the levels of G-CSF in case 1 and G-, GM-CSF in case 2 were higher than those in the normal control. An immunoperoxidase staining method using specific monoclonal antibody against rhGCSF did not obtain positive staining in autopsy specimen tumor cells. RT-PCR analysis with total cellular RNA (5μg) prepared from the autopsied tumor tissue showed apparent expression of GM-CSFmRNA in case 1 and G-, GM-CSFmRNA in case 2. These results suggest that from the point of view of gene expression leukocytosis found in the two patients might be caused by autonomous production of G-CSF and/or GM-CSF by lung cancer cells.View full abstractDownload PDF (7345K) -
Tomohisa Yasukawa, Yutaka Yamaguchi, Hisayuki Aoyagi, Kyousan Yoshikaw ...1996 Volume 36 Issue 7 Pages 919-926
Published: December 20, 1996
Released on J-STAGE: August 10, 2011
JOURNAL FREE ACCESSIn order to evaluate the usefulness of positron emission tomography using 11Cmethionine in the diagnosis of lymph node metastasis, 11C-met. PET studies were performed before operation in 29 patients with primary lung cancer.11C-met. PET studies were assessed quantitatively by the tumor muscle contrast ratio (TMR). A total 101 lymph nodes, including 24 lymph nodes pathologically diagnosed as metastatic, were recognized and assessed by 11C-met. PET. The TMR in metastatic lymph nodes (n=24) was 4.73±1.53 while that of non-metastatic lymph nodes (n=77) was 2.95±0.76, indicating a significant difference (p<0.0001). The most adequate cutoff value for diagnosis of metastasis, based on the ROC curve, was 4.4. The sensitivity, specificity and accuracy of 11C-met. PET were 70.8%, 94.8% and 89.1%, superior to those of computed tomography (50.0%, 93. 5% and 83.2%). Metastatic lymphnodes of 5mm and over could be detectable by 11C-met. PET.View full abstractDownload PDF (5412K) -
Tadashige Fujii, Masao Tanaka, Yosikazu Yazaki, Hiroshi Kitabayashi, M ...1996 Volume 36 Issue 7 Pages 927-935
Published: December 20, 1996
Released on J-STAGE: August 10, 2011
JOURNAL FREE ACCESSUsing perfusion lung scintigrams with Tc-99m macroaggregated alubumin at maximal inspiration (I) and expiration (E), images of the ventilatory lung motion, which was calculated and delineated by an expression as (E-I)/I, were obtained in 84 cases with primary lung cancer, and its clinical significance in the diagnosis of primary lung cancer was studied.
1) The image of (E-I VI consisted of positive and negative components. The former visualized the motion of the regional intrapulmonary areas and the latter showed the motion of the lung border.
2) The sum of positive (E-I) I in the lung with the primary lesion which was lower than that in the contralateral lung, was significantly low in cases with hilar mass, pleural effusion and TNM classification of T3+T4.
3) The sum of positive (E-I)/I in both lungs and vital capacity was relatively low in cases with hilar mass, pleural effusion, TNM classification of T3+T4 and M1.
4) The distribution pattern of pulmonary perfusion and positive (E-I)/I was fairly matched in 48 cases, but mismatch was observed in 36 cases.
5) In the image of negative (E-I)/I, decreased motion of the lung border including the diaphragm was shown in cases with pleural adhesion and thickening, pleural effusion, phrenic nerve palsy and other conditions with hypoventilation.
This technique seems to be useful for the estimation of regional pulmonary function of pulmonary perfusion and lung motion, the extent and pathophysiology of primary lung cancer.View full abstractDownload PDF (6959K) -
Makoto Suzuki, Toshihiko Iizasa, Yutaka Yamaguchi, Hideki Kimura, Hiro ...1996 Volume 36 Issue 7 Pages 937-943
Published: December 20, 1996
Released on J-STAGE: August 10, 2011
JOURNAL FREE ACCESSExpression of matrix metalloproteinase (MMP)-2, MMP-9, tissue inhibitor of metalloproteinase (TIMP)-1, and TIMP-2 was investigated in operated cases of primary lung cancer by immunohistochemical staining with anti-human MMP-2, MMP-9, TIMP-1, and TIMP-2 monoclonal antibodies. Thirty five patients of lung cancer consisted of 19 adenocarcinomas, 13 squamous cell carcinomas, and 3 large cell carcinomas. Of these 14 were stage I, 1 was stage II, 18 were stage III, and 2 were stage N. The positive rate of MMP-2 (51%) was higher than that of MMP-9 (26%). Immunoreactivity for MMP-2 tended to diminish as the disease progressed (64% stage I and 40% stage III and IV), on the other hand, stromal fibroblasts were all positive for MMP-2. Immunoreactivity for TIMP-2 was higher in advanced cases (50% stage I and 80% stage III and IV), with statisticall significance (p=0.071). These data indicate that the expression of MMP-2 plays a more important role in degrading the extracellar matrix than that of MMP-9 in lung cancer. In advanced cases of lung cancer, tumor cells are considered to invade with the help of MMP-2 derived from the stromal fibroblasts more than from tumor cells. It suggests that TIMP-2 reacts not only as an inhibitor of MMPs but also as a cell growthpromoting factor.View full abstractDownload PDF (6299K) -
Yukio Chiba, Yasushi Kato, Yoshinori Hiramatsu, Masato Sasaki, Hirokaz ...1996 Volume 36 Issue 7 Pages 945-950
Published: December 20, 1996
Released on J-STAGE: August 10, 2011
JOURNAL FREE ACCESSA 68-year-old man was admitted to our hospital because of productive cough, chest and back pain. His chest roentgenogram revealed a tumor shadow in the left upper lobe. His laboratory data showed leukocytosis (18, 200/μl), anemia and increased CRP (9.10mg/ml). Left upper lobectomy with the 3rd, 4th and 5th rib resection was performed. Histological examination revealed large cell carcinoma with invasion to the 4th rib and the intercostal muscle between the 3rd and 4th ribs (pT3N0M0 stage III a).
A year after the operation tarry stool accompanying marked leukocytosis (48, 300/μl), anemia (RBC: 2, 290, 000/μl, Hb: 7.2g/dl) and increasedCRP (12.0mg/ml) was found. Enterectomy was performed on a diagnosis of small intestinal metastasis by roentgenographic examination with oral intake of barium and selective angiography through superior mesentric artery. Enzyme immunoassay demonstrated an apparent increase of G-CSF in the serum. Immunohistochemical examination of the tumor cells of both lung and small intestine showed positive staining forand recombinant human G-CSF monoclonal antibody. He is very well, without recurrence, 4 years after the lobectomy.View full abstractDownload PDF (8265K) -
Hisashi Tsukada, Yuuko Komase, Hiroaki Osada, Kumio Yokote, Toshihito ...1996 Volume 36 Issue 7 Pages 951-956
Published: December 20, 1996
Released on J-STAGE: August 10, 2011
JOURNAL FREE ACCESSA 30-year-old woman presented with cough. A chest X-ray film disclosed an abnormal shadow. Bronchoscopic examination revealed a mass at the orifice of the middle lobe of the bronchus. Biopsy failed to give definitive diagnosis. The pathological diagnosis was made by an ultrasonography-guided percutaneous needle biopsy of the mass. She underwent right middle lobectomy as well as mediastinal lymph node dissection on December 7, 1995. The pathological diagnosis of biphasic pulmonary blastoma was confirmed by immunohistochemical analysis. After resection, adjuvant chemotherapy was initiated, consisting of Cisplatin, Adriamycin, Actinomycin-D, Cyclophosphamide, Vincristine.
At the time of writing, the patient is active with no evidence of tumor recurrence.
Biphasic pulmonary blastoma is recognized to be the main subgroup of pulmonary blastoma. Surgery alone cannot usually cure this disease, but a generally accepted adjuvant chemotherapy regimen has not yet been established.View full abstractDownload PDF (5169K) -
Yoshitaka Masaki, Takumi Sasai, Yoshimitu Yamano, Shinji Abe, Shigeo T ...1996 Volume 36 Issue 7 Pages 957-962
Published: December 20, 1996
Released on J-STAGE: August 10, 2011
JOURNAL FREE ACCESSA 62-year-old man was admitted because of detection of a tumor shadow on health screening chest X-ray films. Chest CT showed a tumor shadow in the right S2 and swollen mediastinal lymph nodes. The tumor was diagnosed pathologically as squamous cell carcinoma by TBLB, and right upper lobectomy with mediastinal lymph node dissection was performed under a diagnosis of primary lung cancer. Postoperative sections of the pulmonary nodular lesion showed an atypical growth of the neoplastic cells composed of a variety of histological features. The immunohistological stains were HCG (+), AFP (+), HPL (+), and CEA (+). The final pathological diagnosis of the tumor was germ cell tumor (choriocarcinoma, yolk sac tumor andembryonalcarcinoma). Since there were no abnormal findings in testes or other organs, the primary site of the malignant germ cell tumor was concluded to be the right lung. Despite postoperative chemoradiotherapy, the patient died 12 months postoperatively due to multiple pulmonary metastasis.View full abstractDownload PDF (7446K) -
Masaaki Tsukagoshi, Yoichi Hirakata, Jun Kobayashi, Satoshi Kitamura, ...1996 Volume 36 Issue 7 Pages 963-969
Published: December 20, 1996
Released on J-STAGE: August 10, 2011
JOURNAL FREE ACCESSTwo cases of lung cancer, complicated by herpes simplex encephalitis, are reported. A 58-year-old man with T4N0M0 small cell carcinoma was treated by 4 courses of chemotherapy, irradiation, and subsequent prophylactic whole brain irradiation. Steroids were used for the treatment of complicated radiation pneumonitis, however he suddenly presented with speech disturbance after 40 days of steroid treatment. He was clinically diagnosed as having herpes simplex encephalitis based on CT and CSF antibody findings. A 50-year-old man, with T4N3M1 small cell carcinoma was treated by 4 courses of chemotherapy and irradiation. Whole brain radiation was also performed for brain metastasis. Steroids were used to prevent brain edema for 1 month. He suddenly presented with bulbar palsy and consciousness disturbance, then died 7 days later. Autopsy findings showed typical findings of herpes simplex encephalitis. Patients with lung cancer are in an immunocompromised state due to influence of chemotherapy, radiotherapy, and immunosuppressive agents. It is important to consider possible complications of herpes simplex encephalitis when they present with progressive neurological manifestations.View full abstractDownload PDF (10367K) -
Masafumi Enoki, Hirokazu Tojima1996 Volume 36 Issue 7 Pages 971-977
Published: December 20, 1996
Released on J-STAGE: August 10, 2011
JOURNAL FREE ACCESSA 73-year-old man presented with dyspnea, cough, fever, appetite loss and stridor due to bronchial stenosis. Fiberoptic bronchoscopy revealed an endobronchial lesion in the right main bronchus and biopsy specimens showed poorly differentiated squamous cell carcinoma. The clinical stage of lung cancer was IIIB (T4N2M0). The patient received 60 Gy in 30 fractions over 43 days to a field including the right hilum and mediastinum. The tumor decreased in size and stenosis of the bronchus disappeared. A week after completion of radiation the patient began to have high grade fever and dyspnea, and progressive hypoxia developed. A chest radiograph showed diffuse bilateral interstitial infiltrates. Despite mechanical ventilation with PEEP and the administration of steroids, he died of respiratory failure three weeks after completion of radiation. Necropsy specimens obtained from the left lung revealed massive deposition of fibrin in the alveolar airspaces associated with hyaline membranes and hyperplasia of type II cells indicating diffuse alveolar damage. The patient had mild pulmonary fibrosis on a CT scan taken before the start of radiotherapy. We conclude that care should be taken if the case has pulmonary fibrosis because radiation therapy can precipitate severe radiation pneumonitis and acute respiratory distress syndrome in such cases.View full abstractDownload PDF (4520K) -
1996 Volume 36 Issue 7 Pages 978-985
Published: December 20, 1996
Released on J-STAGE: August 10, 2011
JOURNAL FREE ACCESSDownload PDF (1061K)
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