The Journal of the Japanese Association for Chest Surgery
Online ISSN : 1881-4158
Print ISSN : 0919-0945
ISSN-L : 0919-0945
Volume 10 , Issue 1
Showing 1-15 articles out of 15 articles from the selected issue
  • Tatsuo Fukuse, Kazuhiro Yanagihara, Fumihiro Tanaka, Youzou Kouno, Tak ...
    1996 Volume 10 Issue 1 Pages 2-7
    Published: January 10, 1996
    Released: November 11, 2009
    JOURNALS FREE ACCESS
    The survival rate and important prognostic factors were studied in patients 10 or more years after surgery for lung cancer. The records of 398 patients operated on at Kyoto University Chest Disease Research Institute between January 1976 and May 1984 and followed since then were reviewed. The 5-year and 10-year survival rates were 33.5% and 25.6%, respectively. The survival of adenocarcinoma patients was significantly higher than that of those with large cell or adenosquamous carcinoma. Significant differences were noted in the survival curves between stages I and II, stages II and IIIA, and stages IIIA and IIIB cancers. The survival curves of stage IIIA patients with T3NOMO or T3N1M0 cancers was significantly higher than that of those with T1N2M0 or T2N2M0 cancer. A significant difference in the survival curve was also observed between those with complete and with incomplete resection. Stage IIIA patients with T3NOMO, T3N1M0 or T3N2M0, survived significantly longer after complete than after incomplete resection. Twelve of the 20 patients who died between 5 and 10 years after surgery had recurrent lung cancer. Of the 60 patients who survived disease-free for 10 or more years after surgery, none died of new recurrence. Multivariate analysis with Cox proportional model showed that the dominant factors in survival appear to be age, sex, pathological N factor and complete resection. It appears that 5-year survival does not indicate complete cure after surgery for lung cancer.
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  • Akinori Akashi, Kazuya Nakahara, Yoshitaka Fujii, Akihide Matsumura, H ...
    1996 Volume 10 Issue 1 Pages 8-13
    Published: January 10, 1996
    Released: November 11, 2009
    JOURNALS FREE ACCESS
    We studied the changes in the content of total adenine nucleotides and purine compounds in ischemic rat lungs. 1) The stoichiometric relationship between the total loss of adenine nucleotides and the production of purine catabolites indicates that adenine nucleotides are degraded into purine in ischemic lungs. The sum of the cellular contents of adenine nucleotides and purine catabolites remained almost constant in a range 12.8 to 13.9 μmol/g dry weight. 2) Intracellular ATP returned to normal when air was supplied through the air way to ischemic deflated rat lungs. 3) The content of purine compounds in bronchoalveolar fluid was 28 to 38% of that in ischemic rat lung tissue. The intracellular total adenine nucleotide content could be calculated from the concentration of purine compounds in the bronchoalveolar fluid of ischemic lungs. In the future it may be possible to determine the relation between biochemical changes and pulmonary function after lung transplantation.
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  • Masao Umemoto, Yukihito Saitoh, Hiroji Imamura, Akiharu Okamura
    1996 Volume 10 Issue 1 Pages 14-22
    Published: January 10, 1996
    Released: November 11, 2009
    JOURNALS FREE ACCESS
    Our strategy for the treatment of primary mediastinal NSGCT includes surgical removal and high dose chemotherapy combined with PBSCT. Ten patients with mediastinal NSGCT were treated in our department. They were 9 males and one female, aged 14-63 years, 3 with embryonal carcinomas, 2 with teratocarcinomas, 1 with yolk sac tumor, 2 with choriocarcinoma and 2 with mixed germ cell tumors. All 10 patients underwent chemotherapy (mainly PVB and VAB-6) and surgery (surgery first in 5 and chemotherapy first in 5). One patient was treated with high dose chemotherapy with PBSCT. Three patients are surviving. One had embryonal carcinomas (139 months), another had choriocarcinoma (74 months) and the other had teratocarcinoma (63 months). The other 7 patients died of the tumor. The median survival period was 22 months. We conclude that NSGCT should be treated mainly with chemotherapy. Surgical therapy is considered to be important for the resection of elements refractory to chemotherapy in tumors with diversity of tissues, for the en blok extirpation of a tumor, and for mediastinal lymph node dissection. Furthermore, it is necessary to devise a strategy for improving the prognosis of this disease which incorporates high dose chemotherapy with PBSCT before the tumor can become resistant to chemotherapy and an operative technique which includes mediastinal dissection.
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  • Naoyoshi Ohnuki, Takamasa Ohnuki, Masahide Murasugi, Sumio Nitta
    1996 Volume 10 Issue 1 Pages 23-30
    Published: January 10, 1996
    Released: February 25, 2010
    JOURNALS FREE ACCESS
    A series of 263 patients with surgically resected non-small cell lung cancer was analyzed retrospectively. The p53 expression was examined immunohistochemically with monoclonal antibody DO-1 in formalin-fixed, paraffin-embedded tissues. The growth fraction was determined by the labeling index of 1 for the proliferation-associated antigen Ki-67. Tumors with p53 expression had a higher growth fraction than did those without p53 expression (p<0.001). Stage I and II patients with p53 expression tended to have a lower 5-year survival rate. Stage III and IV patients with p53 expression had a significantly shorter 5-year survival than did those without p53 expression (p<0.01). These findings indicate that p53 expression may accelerate tumor cell proliferation and may be a poor prognostic factor in non-small cell lung cancer.
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  • Toshihiko Iizasa, Yutaka Yamaguchi, Masayuki Baba, Mitutoshi Shiba
    1996 Volume 10 Issue 1 Pages 31-38
    Published: January 10, 1996
    Released: November 11, 2009
    JOURNALS FREE ACCESS
    We studied the factors involved in the long-term survival (more than 10 years) of 640 patients with lung cancer resected between 1965 and 1984. The results showed 134 patients who survived more than 10 years after surgery (10-year survival rate : 22.0%). Sixty four of the 305 patients with adenocarcinoma survived more than 10 years (22.3%), and likewise 46 of the 239 patients with squamous cell carcinoma (19.9%) survived. The 10-year survival rate was lower in patients with more advanced stages : 43.1% for stage I, 24.9% for stage II, 10.9% for stage III, and 2.8% for stage IV. The 10-year survival rate was 24.2% (89 of 368 patients) for the period 1975-1984, better than 16.5% (45 of 272 patients) (p<0.05) shown by the former period (1965-1974). One reason for the improvement was not accounted for by any difference in histological type, but rather by the higher incidence of stage I cases that occurred during the period from 1975 to 1984. The ratio of women with stage I who survived more than 10 years was higher than that of the average of all cases in stage I (p<0.025), and a chi-square value was statistically significant in surviving for more than 10 years between patients of less than 65 years and 65 or more (p<0.001). In measuring tumor factors, there was no difference in the prognosis between patients with adenocarcinoma and those with squamous cell carcinoma. However, the results showed more long term survivors with stage I adenocarcinoma than those with stage I squamous cell carcinoma (p<0.05).
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  • Kyota Iijima, Yasufumi Hayashi, Nobuo Ogawa, Hideyuki Satou, Takamitsu ...
    1996 Volume 10 Issue 1 Pages 39-45
    Published: January 10, 1996
    Released: November 11, 2009
    JOURNALS FREE ACCESS
    Since October 1993, autologous blood donation was performed in 7 patients (ABD group) prior to pulmonary decortication or pleuropneumonectomy for chronic empyema. All eligible patients had hemoglobin concentrations above 11.0g/dl, and no abnormalities of quantity and quality of platelets, or of the coagulation, or fibrolytic systems. The efficacy of autologous blood transfusion was compared with the results of surgery before September 1993, in 13 patients in whom above-mentioned factors for donation were present but whose autologous blood was not donated (control group).
    The Mean volume of the preoperative donated blood was 1090±182g in the ABD group. Three patients in the ABD group (43%) and 13 (100%) in the control group were transfused with homologous blood perioperatively. The ABD group received 154±201 g of homologous blood compared with 1390±779g for the control group. The differences between two groups in regard to reaction and to volume of homologous blood transfusion were significant. We conclude that autologous blood transfusion before radical surgery for chronic empyema is effective.
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  • Yoshiaki Narita, Kanji Nagai, Junji Yoshida, Mitsuyo Nishimura, Kenro ...
    1996 Volume 10 Issue 1 Pages 46-51
    Published: January 10, 1996
    Released: November 11, 2009
    JOURNALS FREE ACCESS
    From January 1972 to June 1994, 116 patients with peripheral lung cancer, which measured less than 2 cm in diameter and accompanied neither by nodal involvement nor by distant metastasis clinically, underwent lobectomy and mediastinal node dissection in our institute. The cohort did not include patients with multiple cancers. There were 54 men and 62 women and their age ranged from 22 to 85 years old. The number of patients increased every year.
    A retrospective study of the clinico-pathological characteristics of the patients revealed that the majority of the patients were female, under 70 years of age and had adenocarcinoma. In comparison with the other histologic types, patients with adenocarcinoma were characterized by significantly lower Brinkman indexes and significantly more females.
    There were 20 (17 %) patients with pathologically proven nodal metastasis. Those patients showed significantly more frequent vessel invasion microscopically than patients without nodal involvement. Multivariate analysis revealed vesel invasion, pathological stage, lymph node metastasis and surgical curability to be independent prognostic factors.
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  • Masaaki Kuroya, Kenji Inui, Hiroyasu Yokomise, Osamu Ike, Hiroshi Mizu ...
    1996 Volume 10 Issue 1 Pages 52-56
    Published: January 10, 1996
    Released: November 11, 2009
    JOURNALS FREE ACCESS
    A 50 year-old woman was found to have a mass-like shadow about 1.0 cm in diameter in the left lower lung field on a routine chest X-ray examination. She was referred to our department for further examinations. Chest X-ray and Chest CT indicated a probable lung tumor in the left lingular segment. No definite diagnosis could be made, so exploratory surgery was performed and a floating object was found in the pleural space.
    It was measured 2.0×1.0×1.0cm and was as hard as cartilage. Its color was milk-white and its surface was glossy. The sectioned surface showed concentric rings, resembling a pearl with a black core. Histological examination revealed dust and hyaline connective tissue at the center and connective tissue surrounding the core in a pearl like pattern. We thought it was probably an early stage of thoracolithiasis.
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  • Kyoji Hirai, Shinji Matsushima, Tetsuo Shibuya, Shigeo Tanaka, Nobutak ...
    1996 Volume 10 Issue 1 Pages 57-61
    Published: January 10, 1996
    Released: November 11, 2009
    JOURNALS FREE ACCESS
    A 45-year-old female complained of back pain and dysphagia. An abnormal shadow was noted on her chest X-ray film. It was diagnosed as a posterior mediastinal tumor. Lt lower lobectomy was performed because of the possibility of malignancy. Malignant lymphoma or small cell carcinoma was suspected at operation. Hematoxyline eosine stained sections showed typical small cell carcinoma. All neuroendocrine markers were negative immunohistochemically except for keratin. Electronmicroscopy showed no neuroendocrine secretory granules, but desmosomes and tonofilaments were recognized. It is said that small cell carcinoma usually has neuroendocrine characteristics. Our patient had an epithelial rather than a neuroendocrine characteristics. On the other hand it might be thought to be a very anaplastic adenocarcinoma or squamous cell carcinoma. The histogenetic features were also interesting.
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  • Satoshi Yodonawa, Hiroo Okazaki, Susumu Yoshida, Katsumi Yamabe, Isao ...
    1996 Volume 10 Issue 1 Pages 62-66
    Published: January 10, 1996
    Released: November 11, 2009
    JOURNALS FREE ACCESS
    A 36-year-old man was admitted because an abnormal shadow in the right superior mediastinum was seen on a chest X-ray film. His chest CT scan revealed a well-defined, low -density mass surrounded by the trachea, esophagus, aortic arch and azygos vein. The tumor was resected completely by right postero-lateral thoracotomy. It measured 7.5×6.5×3.5 cm in size. The pathological diagnosis was cavernous lymphangioma. Mediastinal cavernous lymphangioma is rare and only 7 cases have been reported in the Japanese medical literature.
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  • Keiji Kushibe, Kunimoto Nezu, Takashi Tojo, Sawabata Noriyoshi, Makoto ...
    1996 Volume 10 Issue 1 Pages 67-71
    Published: January 10, 1996
    Released: November 11, 2009
    JOURNALS FREE ACCESS
    A 48-year-old male who had had recurrent pneumonia and empyema due to bilateral bronchiectasis underwent two-staged pulmonary resection. First, he underwent left lower lobectomy. The vital capacity was 2.9l before left lower lobectomy, and 2.5l after the operation. Lung perfusion scans showed the uptake in the right lower lung field to be low, so a second operation, right middle lobectomy plus basal segmentectomy was performed. After the second operation, the vital capacity further decreased to 1.9l. Following the two-staged operation, although lung function decreased, the exercise capacity was maintained and the Hugh-Jones classification also improved from III to II. In addition, the amount of sputum significantly decreased and the quality of life improved significantly. For severe bilateral bronchiectasis, careful bilateral operations can be successful.
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  • Takuji Fujinaga, Tatsuo Fukuse, Hiroyasu Yokomise, Osamu Ike, Hiroshi ...
    1996 Volume 10 Issue 1 Pages 72-75
    Published: January 10, 1996
    Released: November 11, 2009
    JOURNALS FREE ACCESS
    A 56-year-old female had suffered from paroxysmal upper back pain for 10 years.
    A chest X-ray and chest CT scan revealed a superior mediastinal mass, 5.0×3.5cm in size. The preoperative diagnosis was neurinoma. It was resected completely.
    Histological examination showed numerous vascular spaces lined with sheets of epithelial cells (glomus cells), so it was diagnosed glomus tumor. Histological reexamination of a tumor of the left foot resected 4 years earlier also showed glomus tumor. Multiple glomus tumors have rarely been reported. Her paroxysmal pains diminished after operation, but she should be followed closely for recurrences.
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  • Hiroshi Osawa, Hiroshi Shimota, Kazuki Nakahara, Akio Yamasaki, Masao ...
    1996 Volume 10 Issue 1 Pages 76-81
    Published: January 10, 1996
    Released: November 11, 2009
    JOURNALS FREE ACCESS
    A 76-year-old man was admitted because of an abnormal shadow on chest X-ray. An intra abdominal tumor was revealed by abdominal CT, and intestinal bleeding developed. Angiography of the supra mesenteric artery showed a hypervascular tumor in the intestine, leiomyosarcoma was suspected. The patient was diagnosed as having synchronous double cancer, intestinal leiomyosarcoma and lung cancer, or leiomyosarcoma with pulmonary metastasis.
    Jejunectomy was performed first, because bleeding continued. The 5.0×4.0×4.5 cm intestinal tumor was diagnosed histologically as leiomyosarcoma. Right lower lobectomy was performed 1 month later. The histology of the 3.0×2.5×2.5 cm pulmonary lesion was diagnosed histologically as well differentiated adenocartinoma. The postoperative course was uneventful and the patient is now being followed.
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  • Shinji Koyama, Shigeki Sugiyama, Kazuhiro Minou, Tomohiko Ikeya, Naoki ...
    1996 Volume 10 Issue 1 Pages 82-86
    Published: January 10, 1996
    Released: November 11, 2009
    JOURNALS FREE ACCESS
    A 69-year-old man was referred to our department in February, 1993, because of a nodular lesion (2 cm in diameter) in his left lower lung field noted on chest X-ray and suspected of being a metastasis of rectal cancer which had been removed in June, 1990. His right thorax was deformed by thoracoplasties performed for tuberculosis, in 1956 and 1958. Partial lung resection with VATS of S9 completely removed the tumor and spared the chest muscles. Pathological examination of the removed lung (4.5×2.5×2.5 cm) and the tumor revealed metastatic rectal cancer. The postoperative course was uneventful.
    In August, 1994, however, chest X-ray and chest CT showed a peanut-sized mass in S9, which was suspected of being a recurrent metastatic tumor. Partial lung resection with VATS of S9, including the tumor, was performed through a muscle sparing thoracotomy. Pathological examination of the tumor again revealed rectal cancer metastasis. The postoperative course was uneventful. His lung function was only slightly reduced in spite of two lung resections with VATS. Two and a half years have passed since the first VATS for lung metastasis, and his performance status (PS) and quality of life (QOL) have not changed despite two operations. This case shows stepped lung resection is an effective strategy for metastatic lung tumor in patients with impaired lung function.
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  • Keiji Kushibe, Keiji Iuchi, Masaru Koma, Hisaichi Tanaka, Yasushi Tana ...
    1996 Volume 10 Issue 1 Pages 87-91
    Published: January 10, 1996
    Released: November 11, 2009
    JOURNALS FREE ACCESS
    A 72-year-old male was admitted to our hospital with the chief complaint of stridor. Bronchoscopy revealed severe tracheal stenosis due to tuberculosis. We performed tracheal reconstruction surgery using a percutaneous cardiopulmonary support system. The femoral artery and vein were cannulated for bypass under local anesthesia, and an endotracheal tube was inserted near the stenosis. As ventilation was not complete, we performed thoracotomy using a percutaneous cardiopulmonary support system. The post-operative course was uneventful. We believe PCPS to be a simple and useful aid in tracheal stenosis repair when endotracheal ventilation is difficult.
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