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ABSTRACT: We analyzed the operative outcome of extensive surgery for invasive thymoma, especially in those with thymomas invading the superior vena cava, the left innominate vein, or both.
We treated 41 patients with invasive thymoma, including 34 stage III, 5 stage IVa, and 2 stage IVb thymomas. Thirty-eight patients received radiotherapy preoperatively or postoperatively. In 12 patients with invasion of the superior vena cava or innominate vein, we performed angioplasty, reconstruction, or both.
The overall 5-year survival rate was 77% and the 10-year survival rate was 59%. In the stage III group, there was a significant difference between those with complete and those with incomplete resection. Ten of 12 patients who had angioplasty with or without reconstruction of the superior vena cava or innominate vein survived without recurrence of the tumors.
Angioplasty and vascular reconstruction are recommended because successful treatment for invasive thymomas depends on complete resection of the tumors.
The Annals of Thoracic Surgery 03/1996; 61(2):521-4. · 3.74 Impact Factor
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ABSTRACT: Eighteen patients underwent combined preoperative irradiation and radical resection for a Pancoast tumor at the Department of Thoracic Surgery, Chest Disease Research Institute, Kyoto University between 1977 and 1993. Four patients were applied a full radiation dose of 50-70 Gy and fourteen patients were applied a reduced dose of 33-40 Gy preoperatively. Eleven of these fourteen were applied a supplemental dose postoperatively up to a total dose of at least 50 Gy. Fourteen lobectomies, three partial resections, and one pneumonectomy were performed with combined resection of chest wall or adjacent structures: rib in 14, vertebra in 4, brachiocephalic vein in 3, subclavian artery in 2, spinal nerve in 3, sympathetic truncus in 2, phrenic nerve in 2 cases. Chest walls were reconstructed with marlex mesh in 5 patients, and two subclavian arteries and one brachiocephalic vein were repaired with artificial grafts. In 13 patients complete resections were achieved, but in the other 5 only incomplete resections leaving residual tumor were achieved. Incomplete resections consisted of 4 positive stumps at the brachial plexus of the apex and one aortic involvement by a metastatic lymph node. There was one operative death. Median survival was 21.6 months and the 5-year-survival rate was 38.5% for all 18 patients. In the complete resection group 5-year-survival was 56.4%, but in the incomplete-resection group 0%, showing a significantly more favorable result for the complete resection group. It is considered that evidence of incomplete resection influences the prognosis and that particularly tumor invasion to the brachial plexus may serve as a limiting factor for surgery.
The Thoracic and Cardiovascular Surgeon 11/1995; 43(5):284-6. · 0.88 Impact Factor
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ABSTRACT: Thoracoscopy was performed in a total of 424 patients at our institute from January 1970 to December 1993. The indications for thoracoscopy were pneumothorax (121 cases), primary lung cancer (98 cases), mediastinal tumor (45 cases), metastatic lung tumor (23 cases), pleuritis (35 cases), diffuse lung disease (38 cases), tuberculosis (20 cases), benign lung tumor (10 cases), and other (34 cases). By 1990, diagnostic thoracoscopy had been performed in 383 patients. Since 1991, thoracoscopy has been used therapeutically for spontaneous pneumothorax (24 cases), mediastinal and chest wall tumors (9 cases), pulmonary nodules (2 cases), and others (8 cases). Findings useful for diagnosis were obtained in 326 cases and biopsy was performed in 173 cases. Thoracoscopy was especially useful in the diagnosis of diffuse lung disease, pleuritis, and small pulmonary nodules. Recent advances in endoscopic equipment and refinement of thoracoscopic techniques have expanded the application of this procedure. Our experience indicates a markedly expanded role for thoracoscopy in the diagnosis and treatment of thoracic diseases, with less postoperative morbidity.
Nihon Kyōbu Shikkan Gakkai zasshi 01/1995; 32 Suppl:164-8.
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ABSTRACT: Postpneumonectomy fistula is one of the most serious complications in general thoracic surgery and remains difficult to manage. From 1984 to 1991, we successfully used pedicled omentum for the treatment of postpneumonectomy bronchopleural fistulas (omentoplasty) in five patients, four of whom had thoracic empyema. For bronchopleural fistulas without early postoperative infection, single-stage closure was performed which was then covered with pedicled omentum. Omentoplasty was performed successfully in patients with thoracic empyema, after open or closed drainage. Open thoracotomy was useful when closed drainage was ineffective. Even after open thoracotomy, closure of the wound was achieved. All five patients could be discharged. Omentoplasty was useful in the therapy of postpneumonectomy bronchopleural fistula even in the presence of thoracic empyema.
European Journal of Cardio-Thoracic Surgery 02/1994; 8(3):122-4. · 2.55 Impact Factor
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ABSTRACT: We have summarized the results of international data from many institutes. In 1983 in Toronto, Canada, Cooper performed that first successful clinical case lung-transplantation. Subsequently, there have been more than 1,500 cases of lung transplantation. One reason for Cooper's success was the use of cyclosporin, the other was the performing of omentopexy. Among the total lung transplant cases, single lung transplant comprised 66%, bilateral sequential lung transplant comprised 26%, and en-blocdouble lung-transplant, (8%). Of the 1,540 recipients, the most common underlying of sease was emphysema (360 cases), followed by fibrosis (289 cases), cystic fibrosis (206 cases), alpha-1 antitripsin deficiency (210 cases) and rare diseases including pulmonary hypertension, lymphagiomyomatosis and sarcoidosis. The survival rate of all patients was 68% at 1 year, and 60% at two years.
Nihon Kyōbu Shikkan Gakkai zasshi 01/1994; 31 Suppl:69-72.
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ABSTRACT: One hundred and four cases of thymomas were treated between 1967 and 1991 at the Chest Disease Institute, Kyoto University. Forty-two cases were clinical stage I, 12 cases were stage II, 42 cases were stage III and 8 cases were stage IV. Nineteen patients had MG, 17 patients had SVC syndrome. Ninety-six cases were surgically resected combined with radiation therapy. Overall survival was 77.9% at 5 years and 62.5% at 10 years. The survival of 62 cases of invasive thymoma was 77.5% at 5 years and 54.8% at 10 years. We've got better prognosis when total or subtotal resection of invasive thymoma could be accomplished, i.e. 88.8% at 5 years and 72.6% at 10 years.
Kyobu geka. The Japanese journal of thoracic surgery 02/1993; 46(1):21-5.
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ABSTRACT: The immunosuppressive potency and the side effects of combination therapy with FK 506 and cyclosporine A were studied in dogs that had undergone lung transplantation. The animals were divided into four groups: group A (one third optimal FK 506 dose: FK 506, 0.03 mg/kg intramuscularly) (n = 5), group B (one third optimal cyclosporine dose: cyclosporine 6 mg/kg orally) (n = 5), group C (one third FK 506 and one third cyclosporine optimal doses): FK 506, 0.03 mg/kg intramuscularly plus cyclosporine 6 mg/kg orally) (n = 5), and group D (half FK 506 plus half cyclosporine optimal doses: FK 506, 0.05 mg/kg intramuscularly, plus cyclosporine, 10 mg/kg orally) (n = 10). Assessments including chest x-ray film, fiberoptic bronchoscopy, hematologic and biochemical tests, FK 506 and cyclosporine blood trough level measurement, right pulmonary artery occlusion test, and histopathologic observations were performed. In group A two of five dogs survived 28 days and three died on postoperative days 7, 14, and 21. In group B one dog survived 28 days and four died on postoperative days 9 (two dogs), 14, and 21. Histologic examination showed severe rejection in both group A and group B. In group C all five dogs survived 28 days but showed mild rejection. In group D one dog died of intestinal bleeding on postoperative day 7 and nine survived 28 days. No pathologic changes were observed except in one case of mild rejection. The ventilation function of the transplanted lung was poor in groups A, B, and C but good in group D. No abnormal rise of FK 506 and cyclosporine trough levels was observed. There were no significant side effects and abnormal hematologic and biochemical data except in one dog in group D. We concluded (1) the combination of FK 506, 0.03 mg/kg, and cyclosporine, 6 mg/kg, is much more effective than either drug used singly, (2) the combination of FK 506, 0.05 mg/kg, and cyclosporine, 10 mg/kg, prevents rejection with tolerable side effects, and (3) no worse side effects are caused by combination therapy with FK 506 and cyclosporine than by either one used singly.
Journal of Thoracic and Cardiovascular Surgery 12/1992; 104(5):1340-8. · 3.41 Impact Factor
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ABSTRACT: A 64-year-old woman was admitted with the chief complaints of severe back pain. Chest X-ray film on admission showed an abnormal mass lesion in the right upper mediastinum. Chest tomography and chest CT films revealed destruction of thoracic vertebrae (Th 2 and 3) and paravertebral abscess. Chemotherapy containing RFP was started under diagnosis of active tuberculous spondylitis of thoracic vertebrae. Three months later, curative operation for spondylitis were performed. She underwent the resection of necrotic bone and the anterior spinal fusion using transplanted bone autograft. Her post-operative course was good and she discharged three months after curative operation. Tuberculous spondylitis is still important diseases at the differential diagnosis from metastatic vertebral tumors. This report describes a successful case of surgical treatment for tuberculous spondylitis of thoracic vertebrae.
Kekkaku: [Tuberculosis] 11/1992; 67(10):659-62.
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ABSTRACT: A 32-year-old man was admitted to hospital for investigation of bloody sputum. Chest roentgenogram showed a decrease in the volume of the right lung, with mediastinal shift to the right. Chest CT examination revealed narrowing of the right main pulmonary artery. Bronchofiberscopic examination was normal. Pulmonary arteriogram demonstrated complete absence of the right pulmonary artery. Cardiac catheterization showed no concomitant cardiac malformation. Therefore, this case was diagnosed as congenital absence of the right main pulmonary artery.
Nihon Kyōbu Shikkan Gakkai zasshi 10/1992; 30(9):1728-31.
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Transplantation Proceedings 09/1992; 24(4):1399-400. · 1.00 Impact Factor
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Transplantation Proceedings 09/1992; 24(4):1401-2. · 1.00 Impact Factor
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ABSTRACT: The immunosuppressive potency of FK 506 was studied after left lung transplantation in adult mongrel dogs in comparison with cyclosporine. Fiberoptic bronchoscopy, bronchial mucosal blood flow measurement with laser Doppler velocimetry, and chest x-ray and pathologic examinations were performed. Group A had no immunosuppression (n = 5); group B received FK 506 (0.10 mg/kg/day intramuscularly (n = 5); group C received cyclosporine (20 mg/kg/day orally) (n = 5). In group A four dogs died of rejection on the seventh to the twenty-first postoperative days. Another one was killed on the fourteenth postoperative day because bronchial dehiscence occurred at the anastomosis. In group B one died of alveolar rejection on the seventh postoperative day. The remaining four survived 28 days and were put to death. In group C all five dogs survived 28 days and were put to death. In group A bronchial stenosis or dehiscence at the anastomosis was found in every one during the early postoperative period. In group B stenosis did not develop in any of the dogs, including the one that died on the seventh postoperative day. In group C slight stenosis was seen in one dog, severe narrowing in another, and good healing in the remaining three. The transplanted lungs were almost normal histologically in four animals of group B, and one showed alveolar phase rejection. In all animals of group A severe rejection was observed, and in group C two of five animals showed vascular phase rejection, two latent phase, and one fibrosis. Histologic examination of the bronchial anastomosis in group B showed almost normal bronchial epithelium and slight submucosal infiltration of mononuclear cells. In group A there was desquamation of epithelium and mild to moderate mononuclear cell infiltration. In group C hyperplasia of the epithelium was observed in two animals, an abscess at the site of anastomosis in one, and mild to moderate mononuclear cell infiltration in all five. With use of laser Doppler velocimetry, bronchial blood flow in group B was found to be the same as in group C. Laser Doppler velocimetry values reached preoperative levels by the twenty-eighth postoperative day in both groups. Although diarrhea developed in two dogs of group B, no other significant side effect of FK 506 was seen.
Journal of Thoracic and Cardiovascular Surgery 07/1992; 103(6):1127-35. · 3.41 Impact Factor
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Transplantation Proceedings 01/1992; 23(6):3302-3. · 1.00 Impact Factor
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Transplantation Proceedings 01/1992; 23(6):3306-7. · 1.00 Impact Factor
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ABSTRACT: A 48-year-old male was referred to our division, on the suspicion of lung cancer with bone metastasis. Chest radiography showed a mass shadow and bone scintigram demonstrated multiple scattered regions of increased uptake. However bronchial and bone biopsy specimens revealed granuloma with epithelial cells and giant cells. A diagnosis of tuberculous osteomyelitis was made, and antituberculous therapy was begun. Chest radiography and bone scintigrams one year later showed marked improvement.
Nihon Kyōbu Shikkan Gakkai zasshi 07/1991; 29(6):753-7.
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ABSTRACT: Healing after bronchoplasty was evaluated by assessing the bronchial mucosal blood flow by laser Doppler velocimetry in dogs. Bronchoplastic surgery at the right main bronchus was performed and bronchial mucosal blood flow was determined by laser Doppler velocimetry at proximal and distal sides of the anastomosis before and after operation. Four experimental groups were established. After operation the blood flow was adequately preserved, and healing of the anastomosis site was satisfactory in the minimum detachment group and steroid-treated group. Mucosal blood flow was markedly reduced in both proximal and distal sides in the extensive detachment group. The extent of the reduction in the blood flow was smaller in the omentum dressing group than in the extensive detachment group. The state of healing of the anastomosis site was closely related to the bronchial mucosal blood flow.
Journal of Thoracic and Cardiovascular Surgery 05/1990; 99(4):614-9. · 3.41 Impact Factor
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ABSTRACT: Thirty four small cell lung cancer (SCLC) patients underwent operation in Kyoto University from 1976. The mean age was 62 years old; 25 male cases, 9 female, respectively. All case were limited disease (LD) except 2 patients with rib metastasis. Seventeen patients had a performance status (PS) of 0 and 17 PS 1, twenty eight patients were treated with chemotherapy. Of the remaining 5 patients, 2 were treated by only oral 5-FU derivatives, one died within 30 days of operation, one could not be treated owing to old-age, and one refused chemotherapy. Except one operational death 33 cases were able to be evaluated. Out of 28 patients, 16 patients were treated by only postoperative chemotherapy. Concerning operational radicality, 21 cases out of 31 were operated radically (68%). The survival rates of these 33 patients were 78% 37% at 1, 3 and 5 years respectively. The MST was 26 months. The neoadjuvant group head better results than the non-adjuvant group.
Nihon Kyōbu Shikkan Gakkai zasshi 03/1990; 28(2):197-202.
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ABSTRACT: The relationship between healing of a bronchial anastomosis and regional blood flow was studied in adult mongrel dogs after allotransplantation of the left lung. Animals were divided into the following three groups according to the immunosuppressive regimen. Group A: no immunosuppressive treatment (n = 7); Group B: azathioprine (5 mg/kg/day) and prednisolone (2 mg/kg/day) (n = 4); Group C: cyclosporine (20 mg/kg/day) (n = 4). The mucosal blood flow was examined serially after transplantation with laser Doppler velocimetry (LDV) at the tracheal bifurcation of the recipient (1st LDV) and at the bifurcation of the upper lobe bronchus of the transplanted lung (2nd LDV). The LDV values were expressed as a ratio to the preoperative values at the same site. Healing of the bronchial anastomosis was also assessed macroscopically with a fiberoptic bronchoscope and microscopically. The 2nd LDV value of the animals in group A at 13 days after transplantation remained low (32.9 +/- 27.6%). The 2nd LDV value in group B, although not significantly different from group A, had recovered to the preoperative level by that time (93.7 +/- 23.4%). By contrast, the 2nd LDV value in group C remained significantly higher than that in group A (119.9 +/- 23.0%, P less than 0.05). The 1st and 2nd LDV values were reduced in animals having infection at the bronchial anastomosis, even those in groups B and C. Bronchial mucosal blood flow appeared to be affected by infection and rejection of the transplanted lung, and to correlate closely with the healing of the bronchial anastomosis. This LDV method is useful to evaluate bronchial mucosal blood flow in experimental, and possibly in clinical, fields.
Transplantation 11/1989; 48(4):550-4. · 4.00 Impact Factor
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ABSTRACT: Since 1980, we have treated 71 patients with malignant tumors and benign lesions by the Nd-YAG laser. The flexible fiberoptic bronchoscope with the local anesthesia was used for the treatments. Fifty-four cases were malignant tumors and 17 were benign lesions involving trachea and/or hilar bronchus. In malignant tumors, 41 cases were lung cancers, 24 of which were squamous cell carcinomas. Of 17 cases of benign lesions, 10 (58.5%) were introgenic stenoses. Palliative treatments were done for 36 cases of lung cancers, of which 23 died within 1 year after treatments. Four of 5 cases, which survived beyond 2 years, were adenoid cystic carcinomas. In 17 benign cases, 13 (76.5%) showed distinct improvements of symptoms and findings after treatments. Three patients died of massive bleedings. In these cases, severe stenoses were observed, which required treatments repeatedly. With the proper knowledge of the indications, limitations and complications, of YAG laser therapy it can be a beneficial mean for the management of benign lesions and malignant tumors in trachea and hilar bronchus.
Nippon Geka Gakkai zasshi 10/1989; 90(9):1582-4.
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ABSTRACT: Thirty-four small cell lung cancer (SCLC) patients underwent surgery in Kyoto University from 1976 to 1989. The mean age was 62 years males numbered 25 cases, and females 9. All cases were LD except 2 rib-metastasized patients. Seventeen patients were in PS 0, and 17 in PS 1. Twenty-eight patients were treated with chemotherapy. In the remaining 5 patients 2 were treated by only oral 5-FU derivatives, one died upon operation, one was unable to be treated because of advanced age, and the last one refused chemotherapy. Except for the one operational death, 33 cases were able to be evaluated. Out of 28 patients, 16 were treated only by post-operative chemotherapy. As for operational radicality, 21 out of 31 cases were operated radically (68%). The survival rate of these 33 patients reached 78% for 1 year, 37% for and 5 years, with MSI at 26 months. The neoadjuvant (+) group showed a better prognosis than the non-non-neoadjuvant group.
Gan to kagaku ryoho. Cancer & chemotherapy 09/1989; 16(8 Pt 1):2537-43.
