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| 1.
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渡辺, 洋宇 ; 小田, 誠 ; 太田, 安彦 ; 渡辺, 俊一 ; 呉, 哲彦 ; 野崎, 善成 ; 亀水, 忠 ; 野沢, 寛 ; 田村, 昌也 ; Watanabe, Yoh ; Oda, Makoto ; Ohta, Yasuhiko ; Watanabe, Shun-ichi ; Go, Tetushiko ; Nozaki, Y. ; Kamesui, Tadashi ; Nozawa, Hiroshi
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金沢大学医薬保健研究域医学系<br />Systematic lymph node dissection was performed for every patients undergoing surgical intervention.
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Since 1981, there were 218 stage IIIA-N2 patients who underwent resection with two operative mortality. The five-year survival rate of whole cases was 22.6%, and that of 152 completely resected cases was 30.0%. Favorable factors on long-term survival of pN2 patients were cN0, T1-2 N2M0, single mediastinal node involvement, and tumor less than 20 mm or less. The five-year survival rates of stage IIIA-N2 patients with tumor diameter of < or = 20 mm, 21-30 mm, 31-50 mm, and > or = 51 mm were 48.1%, 27.7%, 31.2%, and 16.7%, respectively. When micrometastases to lymph node in the p-stage I patients (diagnosed by H-E staining) were examined by immunohistochemical staining, 36 patients (27%) out of 132 verified micrometastases in the lymph nodes.
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| 2.
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清水, 淳三 ; 渡辺, 洋宇 ; 小田, 誠 ; 林, 義信 ; 渡辺, 進一郎 ; 龍沢, 泰彦 ; 岩, 喬 ; Shimizu, Junzo ; Watanabe, Yoh ; Oda, Makoto ; Hayashi, Yoshinobu ; Watanabe, Shin-ichiro ; Tatsuzawa, Y. ; Iwa, Takashi
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This report analyzes the operative indication for the small lesion of advanced lung cancer. The subjects consisted of 25 patients with T1N2 lung cancer, one T1N3, four T1M1 and five small lung cancer lesion with dissemination, which was
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regarded as the small lesion of advanced lung cancer. The cumulative 5-year survival rate after operation for 25 patients with T1N2 lesion was 30.6%. Of 25 patients, 18 were selected patients who underwent a curative operation with a 5-year survival of 37.0%. In the remaining 7 patients, who underwent a non-curative operation, 5-year survival was 0%. As to mediastinal lymph node involvement, it is possible that metastasis to more than two levels of mediastinal lymph nodes or to the upper mediastinal lymph nodes (#1-3) are poor prognostic factors in T1N2 lesion. Another group except T1N2 could not be the comparative materials because they were much fewer in number. But T4 cases associated with small lung cancer lesion with dissemination and T1M1 cases associated with intrapulmonary metastasis encountered at thoracotomy could be expected to have a long-term survival. We conclude that T1N2 patients with metastasis to within one level of mediastinal lymph node, which will possibly have a curative operation, is a proper operative indication for the small lesion of advanced lung cancer.
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森田, 克哉 ; 清水, 淳三 ; 村上, 眞也 ; 林, 義信 ; 荒能, 義彦 ; 徳楽, 正人 ; 永峯, 洋 ; 大和, 太郎 ; 渡辺, 洋宇 ; 水上, 勇治 ; 安井, 正英 ; Morita, Katsuya ; Shimizu, Junzo ; Murakami, Shinya ; Hayashi, Yoshinobu ; Arano, Yoshihiko ; Tokuraku, Masato ; Nagamine, Hiroshi ; Yamato, Taro ; Watanabe, Yoh ; Mizukami, Yuji
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金沢大学医薬保健研究域医学系<br />Chondrosarcoma of rib origin is rare in Japan. We treated two cases of chondrosarcoma of rib origin.
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Case 1: A 68-year-old man with anterior chest wall mass and chest pain was underwent aspiration biopsy in Inami General Hospital. The histological examination showed Class V. Operation was done in our department and the histological diagnosis was chondrosarcoma. The tumor was 30 x 20 x 20 mm in size arising from the left fourth rib. The defect of bony chest wall was repaired with a double layer of Marlex mesh. His postoperative course was uneventful. Case 2: 66-year-old man noticed a tumor in left anterior part of the chest 7 months ago. He was underwent incisional biopsy and the histological diagnosis was chondrosarcoma. Radical resection was performed. The tumor was 70 x 50 x 50 mm in size arising from the left rib. His postoperative course was uneventful.
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小田, 誠 ; 石川, 紀彦 ; 菊地, 勤 ; 渡辺, 俊一 ; 関戸, 伸明 ; 太田, 安彦 ; 村上, 眞也 ; 渡辺, 洋宇
概要:
金沢大学大学院医学系研究科血管病態制御学<br />肺悪性腫瘍患者手術における2日間の予防的抗菌薬投与法の有効性を検討した.対象は肺悪性腫瘍手術例連続61例で, これを年代順に前半の31例(1群)と後半の30例(2群)に分けて比較検討した.
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抗菌薬は第2世代セフェムのflomoxefを1回1g, 1群では3日間, 2群では2日間点滴静注した.投与時期は1回目は麻酔導入時, 2回目は手術終了時としそれ以降は8時間毎に投与した.各群ともに1例で抗菌薬の変更, 投与期間の延長を要したが, 他の全例で予定期間の抗菌薬投与が行われた.創部感染は各群ともに1例づつ認めた.38℃以上の熱発日数は両群ともに1日未満であり, 術後膿胸, 手術死亡, 在院死は両群ともに認めなかった.平均白血球数, 平均CRP値ともに術前, 術後7日目および14日目において両群間で有意差を認めなかった.以上より肺悪性腫瘍手術において第2世代セフェムの2日間の予防投与は創部および深部感染予防に有効であると考えられた. The aim of this study was to determine whether a 2-day antibiotic prophylaxis regimen with a second-generation cephalosporin was effective in pulmonary operations for malignancies. We enrolled 61 consecutive patients who underwent elective thoracic surgery for lung cancer(n=55) or metastatic lung tumors(n=6). All the patients were given flomoxef(1.0 gm intravenously) at the time of anesthetic induction. Patients in group 1(n=31) were given flomoxef intravenously every 8 hounrs for a total of 8 times for 3 days immediately after ICU arrival. Patients in group 2(n=30) were given flomoxef intravenously every 8 hours for a total of 5 times for 2 days immediately after ICU arrival. Thirteen of 31 patients received 3-day antibiotic prophylaxis in group 1 and 29 of 30 patients received 2-day antibiotic prophylaxis in group 2. Antibiotics were altered in 1 patient in each group and the duration of antibiotic administration became longer than the planned duration in the same patients. No significant difference was seen in duration of fever more than 38℃ after surgery between the two groups. Wound infection was seen in 1 patient in each group. Empyema, death within 30 days after operation, and hospital death were not seen in either group. On day 7 and day 14 after operation, white blood cell counts and plasma CRP levels showed no significant differences between the two groups. These results suggest that 2-day antibiotic prophylaxis with a second-generation cephalosporin is of benefit for wound and other infections in pulmonary operations for malignancies.
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小田, 誠 ; 渡辺, 俊一 ; 塚山, 正一 ; 富田, 剛治 ; 太田, 安彦 ; 村上, 眞也 ; 渡辺, 洋宇 ; Oda, Makoto ; Watanabe, Syun-ichi ; Tsukayama, Sho-ichi ; Tomita, Y. ; Ohta, Yasuhiko ; Murakami, Shinya ; Watanabe, Yoh
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金沢大学医薬保健研究域医学系<br />The purpose of this study was to evaluate the results of surgical treatment of T3N0-2M0 non-small ce
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ll lung cancer according to involved organ and nodal status. Between 1973 and July 1997, 157 patients with T3 non-small cell lung cancer were surgically treated in our department. Five-year survival was 23% for all cases, 35% for patients with curative resection, and 0% for patients with non-curative resection (p < 0.001). Five-year survival rate of patients with T3N0, T3N1, and T3N2 was 37%, 39%, and 3%, respectively (T3N0 vs T3N2, T3N1 vs T3N2, p < 0.01). According to the depth of chest wall involvement of T3N0 tumor, 5-year survival rate was 50% in the patients with the involvement of parietal pleura, 39% in the patients with the involvement of intercostal muscle, and 15% in the patients with the involvement of rib or more (parietal pleura vs rib or more, p < 0.05). In T3N0 patients with the involvement of only parietal pleura, the 5-year survival rate of parietal pleurectomy and en bloc chest wall resection was 43% and 46%, respectively (N.S.). Five-year survival rate of T3N1 patients with invasion in main stem bronchus was 46% and 3 of 5 patients of T3N0-1 tumor with pericardial invasion survived more than 5 years. From these results, T3N0 tumor involving chest wall without rib invasion, and T3N0-1 tumor involving main bronchus and pericardium are expected good survival. However, the prognosis of the patients with coexistent N2 disease or with incomplete resection remains poor in regardless with the type of involved organ. To correctly evaluate the surgical results of other types of T3 tumor, it is required to collect more cases or to perform multicenteric study.
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池田, 真浩 ; 永峰, 洋 ; 富田, 重之 ; 牛島, 輝明 ; 竹村, 博文 ; 榊原, 直樹 ; 川筋, 道雄 ; 渡辺, 洋宇 ; Ikeda, M. ; Nagamine, Hiroshi ; Tomita, Shigeyuki ; Ushijima, Teruaki ; Takemura, Hirofumi ; Sakakibara, Naoki ; Kawasuji, Michio ; Watanabe, Yoh
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金沢大学医薬保健研究域医学系<br />Ischemic preconditioning (IP) protects the myocardium from subsequent sustained ischemic insults. Te
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mporary occlusion of the coronary artery is indispensable for anastomosing the graft vessel during coronary artery bypass operation without cardiopulmonary bypass. In the canine model of ischemia and reperfusion, we measured myocardial tissue oxygen saturation (SO2) continuously using near-infrared spectroscopy to determine the effect of IP on myocardial oxygen metabolism. Nine dogs underwent occlusion of the left descending coronary artery for three 5-minute periods, followed by three 5-minute periods of reperfusion. The dogs were then subjected to a 20-minutes periods of sustained coronary artery occlusion, followed by prolonged reperfusion. The myocardial SO2 was 82 +/- 2% at the baseline before coronary occlusion and was decreased to 74 +/- 2%, 76 +/- 2%, 77 +/- 3%, 77 +/- 3% at the first, second, third and sustained coronary occlusion, respectively. The increase in the minimum myocardial SO2 value at the second and third coronary occlusion suggested the effect of IP. Near-infrared spectroscopy is a useful method of continuously monitoring myocardial oxygenation and of evaluating the effect of IP during off-pump heart surgery.
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太田, 安彦 ; 清水, 淳三 ; 小田, 誠 ; 林, 義信 ; 梶田, 剛司 ; 渡辺, 洋宇
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金沢大学医薬保健研究域医学系<br />最近われわれは, 稀な胸腺腫瘍の2例を経験した.症例1は72歳, 女性の胸腺に発生した悪性黒色腫であった.悪性黒色腫の胸腺発生例は本邦報告史上2例を認めるのみであり, 本例は第3例目に相当した.腫瘍は
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6.5×5.5×3.5cm大の被包化された充実性腫瘍であった.周囲組織への浸潤はなく, 周囲のリンパ節に転移はなかった.原発巣不明黒色腫の転移の可能性は否定しきれないが, 胸腺原発を最も疑った.正常胸腺を含めて腫瘍を摘出した。術後5ヵ月を経て再発なく生存中である.症例2は21歳男性に発生した胸腺脂肪腫であり, 周囲の脂肪組織を含めて腫瘍を摘出した.摘出腫瘍の重量は390gであり, 重症筋無力症の合併はなかった.
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| 8.
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浦山, 博 ; 片田, 正一 ; 竹村, 博文 ; 土田, 敬 ; 渡辺, 洋宇 ; Urayama, Hiroshi ; Katada, Sho-ichi ; Takemura, Hirofumi ; Tsuchida., K. ; Watanabe, Yoh
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金沢大学医薬保健研究域医学系<br />Postoperative brain dysfunction was studied for 18 patients who survived more than 30 days after ope
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rations of aortic arch aneurysms. The operative procedures were graft replacement in 12 patients, resection with direct or patch closure in 3, and thromboexclusion in 3. Except for thromboexclusion, adjuncts were used: temporary bypass in 1, partial EPC (extracorporeal circulation) in 2, and selective cerebral perfusion during EPC in 12. As for intra-operative monitoring, the temporal artery blood pressures were more than 50 mmHg in all, but the electroencephalogram changed to flat wave just after clamping the aorta in one patient. Postoperative brain dysfunction occurred in 5 patients, including temporary loss of consciousness in 2, lasting loss of consciousness in 1, and paralysis with loss of consciousness in 2. Postoperative brain dysfunction occurred more often in old aged men with atherosclerotic aneurysms. Patients with temporary brain dysfunction had no remarkable change in CT scan, but patients with lasting brain dysfunction had low density areas. It is recommended to prevent this complication as follows: 1) pre-operative evaluation of cerebral vascular disorders, 2) gentle maneuver of atherosclerotic lesions, 3) bilateral cerebral perfusions and intra-operative monitorings, 4) intensive perioperative care of circulation and respiration.<br />11
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榊原, 直樹 ; 浦山, 博 ; 松永, 康弘 ; 竹村, 博文 ; 村上, 眞也 ; 上山, 圭史 ; 川筋, 道雄 ; 渡辺, 洋宇 ; Sakakibara, Naoki ; Urayama, Hiroshi ; Matsunaga, Yasuhiro ; Takemura, Hirofumi ; Murakami, Shinya ; Ueyama, K. ; Kawasuji, Michio ; Watanabe, Yoh
概要:
金沢大学医薬保健研究域医学系<br />We analyzed cerebral protection of twenty-five patients, 11 of whom underwent ascending-arch aortic
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replacement and 14 underwent aortic arch replacement, supported with cardiopulmonary bypass. Twenty of patients underwent selective cerebral perfusion (SCP) with moderate hypothermic circulatory support; 12 of single SCP, 8 of double SCPs. Major arch branch reconstruction were performed with 11 patients; 3 of triple branches, 2 of double branches and 6 of single branch reconstruction. Cerebral impairment was found in 7 patients (25%) with SCP; 3 of them died of low output syndrome and major bleeding during perioperative period. Four of 17 patients, who survived more than one month, showed cerebral infarction in 2 patients and temporary neurological deficit in 2 patients. Our strategies for cerebral protection are (1) careful cerebral four vessels study, (2) SCP with perfusion pressure more than 40 mmHg and flow rate of 7-10 ml/kg/min under moderate hypothermia, (3) bilaterally double branches perfusion minimally for arch replacement, (4) intensive cerebral monitoring from multiple aspect, (5) pharmacological support with barbiturate or aprotinin, (6) gentle maneuver and reliable major branch cannulation to prevent debris embolism.
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小林, 孝一郎 ; 清水, 淳三 ; 小田, 誠 ; 村上, 眞也 ; 林, 義信 ; 家持, 健一 ; 関戸, 伸明 ; 荒能, 義彦 ; 高橋, 敦 ; 渡辺, 洋宇 ; Kobayashi, Ko-ichi ; Shimizu, Junzo ; Oda, Makoto ; Murakami, Shinya ; Hayashi, Yoshinobu ; Ietsugu, Ken-ichi ; Sekido, Nobuaki ; Arano, Yoshihiko ; Takahashi, O. ; Watanabe, Yoh
概要:
金沢大学医薬保健研究域医学系<br />Seventeen lung cancer patients over 80 years of age were treated surgically at Kanazawa University H
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ospital from 1973 to 1991. The operative procedures were lobectomy (six patients), segmentectomy (seven patients), partial resection (three patients) and exploratory thoracotomy (one patient). Absolutely curative resection was done in two patients, relatively curative resection in two, relatively non-curative resection in ten, absolutely non-curative resection in two. The three-year survival rate after operation for all seventeen patients was 60.2%. Postoperative complication developed in eleven patients (64.7%). Patients who had lobectomy with mediastinal lymph node dissection had a high incidence of postoperative complications. In recent years, pulmonary resections have been performed in patients over 80 years of age who have been managed with pulmonary rehabilitation, resulting in better course. It is concluded that the limited resections produce good prognosis in patients over 80 years of age with lung cancer.<br />2
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