Kenji Inoue

Involvement of nipple and areola in early breast cancer.

In 141 mastectomy specimens, performed for invasive or noninvasive carcinomas, histopathologic study was performed to assess the extent of nipple‐areola involvement by the tumor. In this study, patients were excluded if (1) the tumor was located beneath the areola; and (2) nipple and/or areola abnormalities were clinically present. Tumor involvement of the nipple and/or areola was found in 44 of 141 specimens (31%), with intraductal growth in 36 (82%) of 44, stromal invasion in 3 (7%), and ductal and stromal invasion in 5 (11%). Analysis of nipple‐areolar involvement with consideration of the different variables indicates that it occurred in association with tumor size, tumor‐areola distance, and histologic type. Such information provides clinically relevant guidelines in decision making for limited breast surgery.

Use of sulfur hexafluoride, SF6, in the management of the postpneumonectomy pleural space.

After a pneumonectomy in patients of advanced age with lung cancer, overinflation of the contralateral lung causes a further emphysematous change. This aggravation of emphysematous disturbances occasionally leads to serious cardiopulmonary dysfunctions. Therefore, we have devised a new therapeutic method which consists in injecting sulfur hexafluoride, SF6, an inert gas, into the postpneumonectomy pleural space so as to maintain the chest cavity. As SF6 gas is slowly absorbed through the pleura, gas injection at intervals of 6 months can maintain a clear pleural space with neither retention of pleural effusion nor deformity of the thorax. As a result, in 23 patients who were treated by this method, overinflation of the contralateral lung after unilateral pneumonectomy could be prevented, and respiratory functions could be improved, i.e., the vital capacity increased about 20% and the residual volume decreased over 20% after SF6 gas injection. All patients have been in good condition of their performance status, and it was not disadvantageous to continue the SF6 gas injection for a long term such as several years.

An evaluation of mass screening for breast cancer

In Tokushima Prefecture, Japan, 41,922 women (26,669 in actual number) were subjected to mass screening with physical examination from 1970–1977. In 42 including 10 of so-called “interval cancer”, breast cancer was detected. Those with breast cancer detected by mass screening were in the earlier stage of the discase as compared to those diagnosed through regular medical care at our out-patient clinic during the same period. Procedures such as inspection and palpation are readily carried out and early occurrences of breast cancer can be detected.

Experimental pendulum air in the flail chest.

Conditions for occurrence of pendulum airflow under spontaneous ventilation were studied in adult dogs with flail chest experimentally constructed by removing three ribs and the chest wall. Pendulum air flow was recorded pneumotachometrically from outside the body by intubation to the bronchi. Despite objections to the occurrence of pendulum air by many investigators, we found that pendulum airflow occurrs under various conditions. The main factors facilitating the occurrence included 1) Significant differences in airway pressure and ventilatory volume between the lungs on the injured and the opposite side. 2) A high frequency of respiration. 3) Increased resistance in the upper airway. The pendulum airflow occurred not only at the area of tracheal bifurcation but also in the peripheral bronchial airway in the ipsi-lateral thorax of the flail chest. However, pendulum airflow was observed only transiently coinciding with the time of change from one phase of respiration to the other, and volume of pendulum airflow was considered to be so minimal that it had no significant deleterious influence on the alveolar ventilation. In cases of marked dysfunction of the chest wall or with increasing upper airway resistance, pendulum airflow may disturb alveolar ventilation to a considerable extent.

Postoperative deep body temperature rhythm.

The postoperative deep body temperature rhythms of fifteen patients who received aorto-coronary bypass surgery (group I), and of seven patients who received non-cardiac major surgery (group II), were studied. Postoperative patients, especially those who received aortocoronary bypass surgery, showed greatly disturbed deep body temperature rhythm. There existed infradian and ultradian rhythm in both groups, and there existed two patients in group I who did not show sinusoidal rhythm. The patients of group I also showed a longer period of rhythm than did those of group II. The mesor and amplitude of the patients in group I showed a greater individual variation than did those in group II. The acrophase of both groups deviated widely. The patients who underwent cardiac surgery needed a longer time for temperature rhythm recovery than did those who underwent general surgery.

Intraarterial lymphocytes injection for treatment of lymphedema

We noted a marked improvement of lymphedema in a patient with recurrence of cancer 3 years after amputatio recti and with post-thrombotic syndrome of the leg, as the result of injection of a suspension of lymphocytes administrated as therapy against advanced cancer. Subsequently lymphocytes-injections were given 39 times to 7 patients with lymphedema of one limb, of various causes. A suspension of lymphocytes was injected repeatedly into the proximal artery of the affected limb. In one patient, lymphocytes were injected 4 times at intervals of 1 or 3 weeks. In most cases, this injection resulted in a marked reduction in the swelling of the affected limb and improvement was seen for several weeks or months. In all cases, there was a marked, continuous softening of the tissue.

Restoration of Pulmonary Functions after Reinflation in Chronic Atelectasis

Recovery of the lungs after the reinflation of chronic atelectasis was studied experimentally using adult dogs. Obstructive absorption atelectasis was induced by banding the left main bronchus with a thin metallic plate. Tests were conducted 1 month after reinflation of the lungs. In the group of dogs which had suffered atelectasis for 3 months, static compliance and pulmonary blood flow were decreased by half at 1 month after reinflation; the conditions of reduced PO2, increased A-aDO2, and increased shunt flow rate in the affected lung persistently continued, and histological findings also showed collapse of the majority of alveoli and dilatation of the peripheral bronchioli, while macroscopically the lungs appeared to be aerated. It was therefore assumed that further aeration of the alveolar areas was impossible. The pulmonary function of the dogs within 1 month of atelectasis was restored to the same degree as that of the control group.

Biopsy of the breast.

A study on surgical biopsy for treatment of breast cancer was done by sending out questionnaires to membership institutions of the Japan Mammary Cancer Society. The problems related to diagnostic biopsy of the breast mainly concern the following two points; the first is the methodology, incisional or excisional, the second, whether delay between biopsy and radical mastectomy influences survival. The prognostic features in patients with excisional biopsy were significantly superior. As for the lapse of time between biopsy and radical mastectomy, 14 days were considered safe, and under conditions such as T2 or n0, this maximum was 7 days.

Viability of Canine Lung after Temporary Ischemia under Cooling

To evaluate the viability of the lung for transplantation, we observed in dogs the ultrastructural alterations after temporary ischemia with cooling and after subsequent reestablishment of ventilation and pulmonary circulation. Initial alterations were vacuolization and condensation in the alveolar lining of the epithelial cells. At this stage, gross lung edema did not occur after the subsequent reestablishment of ventilation and pulmonary circulation. According to the prolongation of the ischemia, edematous changes extended over the alveolar structure. In cases of gross lung edema after the reestablishment of pulmonary circulation, alterations such as swollen endothelial cytoplasm and coarse interstitium appeared in the lung before recirculation, in addition to changes in the pneumocytes. Our observations clearly show the importance of changes in the endothelium as a cause of gross lung edema, hence such should be considered when evaluating the viability of a donor lung.

Preservation of cadaver organs with the use of a heart massage unit

SummaryThe new biventricular cardiac assister designed to compress selectively both ventricles of the brain-death dog was evaluated. The parameters determined in the present investigation were cardiac output, aortic pressure, pulmonary arterial pressure, blood gases, blood pH, serum glucose and body temperature. In the brain-death dogs, the cardiac output and the aortic pressure were kept relatively well, but the blood pressure was about 20 per cent lower than that of the non brain-death dogs with ventricular fibrillation, in which blood supply to the brain was intact and EEG was normal. The pulmonary hypertension was not noted, but various changes in blood pH, blood gases, serum glucose and body temperature may have been due to absence of brain function. The lung, heart, liver and kidney can be preserved in situ under mechanical cardiac massage with the use of our new cardiac assister, set in thorax of the brain-death dogs after cardiac arrest. In cases where organ preservation was done at room temperature, each organ can be kept for 6–8 hours in good condition for organ transplantation. But thereafter hypoxic changes were noted in these organs, particularly in liver and kidney, but less in lung and heart. The usefulness of our new cardiac assister for preservation of liver and kidney is at the present time limited to 6 to 8 hours and that for lung preservation is limited to 12 hours at room temperature.