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Biomedical subjects

A Munakata

Publications and source records attributed to A Munakata.

At least 91 records · Page 5Linked to original sources
PubMed1996

Difficulty in estimating localized bowel contraction by colonic manometry: a simultaneous recording of intraluminal pressure and luminal calibre.

To examine whether or not intraluminal pressure changes at a site in the human colon reflect with fidelity the local bowel wall contractions or relaxation, endoscopic recording of the changes in colonic calibre as a parameter of the motor events with simultaneous manometry was performed at a fixed site in a prepared sigmoid colon during the interdigestive state. In four of the 12 subjects, a total of 20 phasic pressure waves with an amplitude of 13-22 mmHg and a duration of 13-18 sec were obtained in a 20 min recording session. Eighteen of the 20 phasic pressure waves (90%) were associated not with a decrease (contraction) but with an increase in the calibre (relaxation). The pressure change began 0.2-8.4 sec (mean: 4.5 sec) behind and ended-1.8 to 8 sec (mean: 3.5 sec) ahead of the calibre change. In the other eight subjects, no phasic pressure change was recorded in the presence of an overt calibre change. We conclude that manometric phasic pressure change recorded at a site in the empty human colon is not necessarily correlated with the localized contractile activity. Extrapolation of pressure profiles in the colon to motor events at the manometric site should be cautious.

Adult↗
PubMed1996

Phyllodes type of atypical prostatic hyperplasia.

This report documents an uncommon prostatic hyperplasia which developed within a thick capsule between the bladder and rectum grossly showing a phyllodes type of growth. It was simply excised, but recurred locally two years later. A total prostatectomy was performed, and microscopic examination of the tissue revealed no malignant transformation.

Adult↗
PubMed1996

Absence of measles viral genomic sequence in intestinal tissues from Crohn's disease by nested polymerase chain reaction.

The aetiology of Crohn's disease remains unknown, although evidence for a viral cause has long been sought. Recent studies have shown inflammation of the submucosal microvascular endothelium and granulomata, and endothelial cell cytoplasmic inclusions, consistent with paramyxovirus, were identified by electron microscopy suggesting a persistent measles virus infection in Crohn's disease. Measles, mumps, and rubella viruses were tested for Crohn's disease by polymerase chain reaction (PCR). RNA was extracted from resected intestinal specimens from 15 patients with Crohn's disease, 14 with ulcerative colitis, and 14 controls without inflammatory bowel disease. This was used to perform nested PCR after reverse transcription (RT) of the RNA to cDNA with primer pairs directed against two regions in the genome of the measles virus and one region in the mumps and rubella viral genomes. Despite enhanced sensitivity of nested RT-PCR, measles, mumps, and rubella viral genomic sequences were not found in any intestinal specimen.

Adolescent↗
PubMed1996

Enzymes in intestinal juice from patients with liver diseases and colon polyps: measurement of bilirubin, alkaline phosphatase, aspartate aminotransferase and lactate dehydrogenase.

Since the amounts of hepatogenous enzymes discharged into the intestinal tract remain unknown, this study was initiated to evaluate the amounts of the enzymes in the intestinal tract. Whole gut lavage fluid (polyethyleneglycol electrolyte solution) was administered orally to 42 subjects, consisting of 5 patients with hepatoma, 10 with chronic hepatitis, 10 with colon polyps, and 17 control subjects without liver disease. Two hr after the large intestinal lavage, the digestive tract juice was aspirated by colonoscopy, and the bilirubin (Bil), alkaline phosphatase (ALP), aspartate aminotransferase (AST), and lactate dehydrogenase (LDH) in the aspirates were measured. A positive correlation between the AST and LDH values was found, and a significant difference in these values between the hepatic disorders and the normal controls was noticed. A significant positive correlation between the ALP and Bil values was found, and a statistical difference in these values between the group of colon polyps and the controls and other groups was observed. This lavage fluid technique enables to estimate the amounts of hepatic enzymes discharged into the intestinal tract, thereby opening a new avenue for future enzyme research.

Adult↗
PubMed1996

[Clinical evaluation of grade 3 superficial bladder cancer].

PURPOSE: To evaluate the treatment of grade 3 superficial bladder tumor, retrospective analysis of superficial bladder tumors was performed with special references to tumor progression and prognostic factors. MATERIALS AND METHODS: From 1976 to 1994, 247 cases with pTa-pT1 superficial bladder tumor were treated. Mean duration of follow up 77.3 months. These patients were divided into pTa (196), pT1 (52), grade 1 (61), grade 2 (196) and grade 3 (62). The prognostic factors were calculated with multivariate and univariate analysis. Tumor progression was defined as muscle invasion or distant metastasis. RESULTS: G3 tumor showed poor prognosis and was more frequent in tumor progression compared with G1 and G2 tumors (19.4% vs 0% and 1.6%). According to multivariate analysis, significant variables for actual survival rate were patient age and tumor grade. Tumor grade, recurrence and tumor configuration were also significant risk factor for cause-specific survival rate. By univariate analysis, patient age, tumor configuration, tumor size, multiplicity and concomitant CIS in G3 group were different from the other two G groups. In the G3 group, only recurrence was the predictable factor for progression. Analysis of prognosis and therapeutic modality revealed that G1 and G2 tumors were sufficiently controlled by endoscopic treatment. On the other hand, 21 cases (33.9%) of G3 tumor required total cystectomy after all. 11 cases of G3 group died of bladder cancer. Lymphatic involvement was detected in some cases of G3 tumor even if superficial. This factor showed a little relevance to poor prognosis of G3 tumor. CONCLUSION: Tumor grade was thought to be the most important risk factor of superficial bladder tumor. These results suggested that total cystectomy should be considered for the treatment of superficial G3 bladder cancer when recurrence occurs or conservative treatment is though to be failed.

Aged↗
PubMed1996

[Two cases of autosomal dominant polycystic kidney disease treated with hemodialysis associated with polycystic liver complications related to the cause of death].

As long-term survival has become possible in patients with autosomal dominant polycystic kidney disease (ADPKD) with progress in hemodialysis (HD), complications by various extrarenal diseases has presented new problems. Recent experience of two rare cases of ADPKD ending fatally due to complications by polycystic liver is presented. Case 1: A 60-year-old female with a family history of ADPKD without a past history of liver disease, was diagnosed as ADPKD at the age of 45 years. Hemodialysis was started at the age of 58 years. From 6 months prior to her death, abdominal circumference increased (body height: 149 cm, abdominal circumference: 100 cm). Dyspnea, abdominal pain and anorexia appeared and she died of hepatic failure leading to cachexia. Case 2: A 76-year-old female with a family history of ADPKD without a past history of liver disease, was started on HD at the age of 73 years. Abdominal circumference was 84 cm (body height: 138 cm). She was repeatedly admitted to and discharged from the hospital due to febrile episodes. Infection of polycystic liver was complicated by DIC and she died of gastrointestinal hemorrhage. Autopsy revealed abscess in some of the cysts in the liver. Hepatic cysts most frequently complicating ADPKD so far have presented with scarcely any clinical problems. Recently, however, cases of infection of hepatic cysts, portal hypertension and hepatic insufficiency have been reported. The relationship between these hepatic diseases and the prognosis of ADPKD has received attention. Increase in the number of cases of complications similar to the present cases is anticipated.

Aged↗
PubMed1996

Ecabet sodium eradicates Helicobacter pylori infection in gastric ulcer patients.

Ecabet sodium (ecabet), a new agent that has protective effects on the gastric mucosa has anti-Helicobacter pylori effects, binding with urease to inhibit H. pylori activity, and causing the bacterial to become non-viable. Ecabet monotherapy eradicates H. pylori infection in Japanese monkeys. We investigated a new regimen that included ecabet to eradicate H. pylori infection in gastric ulcer patients. Fifty-five H. pylori-positive patients with gastric ulcer were randomly assigned to one of two groups: group 1 received dual therapy with lansoprazole (30 mg o.d.) for 8 weeks plus clarithromycin (200 mg b.i.d.) or amoxicillin (250 mg q.i.d.) for 2 weeks. Group 2 received triple therapy with lansoprazole (30 mg o.d.) and ecabet sodium (1.0 g b.i.d.) for 8 weeks plus clarithromycin (200 mg b.i.d.) or amoxicillin (250 mg q.i.d.) for 2 weeks. Four weeks after the treatment was withdrawn, H. pylori status was evaluated by histological examination, rapid urease test, and culture. The eradication rate was 26% (7 out of 27 patients) in group 1 and 79% (22 out of 28 patients) in group 2. All patients completed the treatment. The addition of ecabet to the regimen increased the eradication rate of H. pylori infection, and there were no associated major side effects.

2-Pyridinylmethylsulfinylbenzimidazoles↗
PubMed1995

A study of the histological criteria for ulcerative colitis: retrospective evaluation of multiple colonic biopsies.

It is clinically important to distinguish idiopathic inflammatory bowel disease (IBD) from other colitides, and ulcerative colitis (UC) from Crohn's disease (CD); however only a few histological criteria based on colonic biopsies have been established. We investigated 209 consecutive series of biopsies taken from 38 patients with UC, 12 with CD, and 105 with other colitides, to evaluate whether combinations of histological features, selected on the basis of our experience, and listed below, could be useful criteria for the differential diagnosis of IBD, and, more specifically, of UC: (A) chronic inflammation with a predominant increase of plasma cells, (B) crypt distortion, (C) crypt atrophy, (D) diffuse chronic inflammation within a biopsy and between biopsies, and (E) diffuse mucin depletion within a biopsy and between biopsies. Findings that fulfilled all or two of A-C distinguished IBD from the other colitides with high sensitivity (94.3%) and specificity (95.8%). When the findings fulfilled the additional criteria of D and/or E, UC was differentiated from CD or the other colitides with high sensitivity (86.4%) and specificity (99.3%).

Adolescent↗
PubMed1995

Endoscopic and histologic correlates of colorectal polyp bleeding.

Until now, the exact mechanism of bleeding from colorectal polyps has not been demonstrated. The present study aimed to identify macroscopic factors and the main source of polyp bleeding. One hundred fifty-seven cases of single colorectal polyp from a variety of clinical situations were investigated to determine whether surface area, shape, color, and location in the colon were correlated with a positive result in the fecal occult blood test. We also searched for the site of bleeding on the surface of polyps under a dissecting microscope and investigated the relationship between bleeding and microerosion and thin surface epithelium on the maximal vertical cross-section of the polyp. The presence of fecal occult blood was found to be correlated with the surface area of colonic polyps. We demonstrated that a red color tone of polyps was caused largely by microerosion and that the area of both microerosion and thin surface epithelium was significantly larger on polyps associated with a positive fecal occult blood test result. The extent of microerosion and thin surface epithelium was found to be correlated with the polyp surface area and villous component. These observations strongly suggest that the area of microerosion and thin surface epithelium tends to increase as the surface area expands, resulting in a higher rate of detection of polyps with malignant potential by the fecal occult blood test.

Adenocarcinoma↗
PubMed1995

Eradication of Helicobacter pylori with lansoprazole and clarithromycin in gastric ulcer patients.

This study attempted to determine the efficacy of lansoprazole plus clarithromycin therapy in the eradication of Helicobacter pylori in gastric ulcer patients. The influence of H. pylori eradication on healing and relapse of ulcers was also studied. Thirty-nine patients received either lansoprazole 30 mg daily for 8 weeks (group 1) or clarithromycin 200 mg twice daily for 2 weeks and lansoprazole 30 mg daily for 8 weeks (group 2). Before treatment, H. pylori status was evaluated by a rapid urease test and histologic examination. H. pylori clearance and eradication were evaluated by a rapid urease test, polymerase chain reaction, and a [13C]urea breath test. Clearance of H. pylori was 0% in group 1 and was 33% in group 2. Eradication of H. pylori was 0% in group 1 and 21% in group 2. Although all five ulcers were healed in patients with H. pylori eradication, ulcers were not healed in the five patients without eradication. Relapse of ulcer was observed in three patients in whom eradication had failed. In this study, for H. pylori-positive gastric ulcer patients, better results were obtained when lansoprazole plus clarithromycin therapy was used, and H. pylori eradication was achieved.

2-Pyridinylmethylsulfinylbenzimidazoles↗
PubMed1995

Effects of dietary fiber on gastrointestinal transit time, fecal properties and fat absorption in rats.

The gastrointestinal transit time of food was determined by x-ray fluoroscopy using barium sulfate in rats fed with diets of various dietary fiber contents, and the effects of dietary fiber on the transit time, properties of feces, and fat absorption were examined. In 4- and 16-month-old rats fed with the diet for 3 and 15 month, respectively, the transit time of the cecum and colon in those receiving 20 and 40% wheat bran diets was shortened compared with that in the 0% group. The fecal pellet number and volume increased as the wheat bran content of the diet increased. In another experiments, the daily total fat excretion was found to be the greatest in rats receiving 15% pectin diet, followed by rats receiving 15% cellulose and non-fiber diets, respectively. These results suggest that shortening of the transit time through the cecum and colon with increase of fecal volume and suppression of fat absorption all participate in the mechanism of the inhibitory action of wheat bran on carcinogenesis and on the development of diverticulum of the large intestine.

Aging↗
PubMed1995

[Clinical investigation of renal pelvic and ureteral cancer with special reference to adjuvant chemotherapy].

Clinical investigation of 93 patients with histologically confirmed renal pelvic and ureteral cancer were performed. These patients consisted of 55 males and 38 females with a mean age of 64.8 years. There were 61 cases of renal pelvic cancer, 55 cases of ureteral cancer and 23 with cancers of both sites. Thirty-four cases were associated with bladder cancer and 41 of 82 patients had multiple tumors. The overall 5-year survival rate was 46.0%. 5-year survival of stages pTa, pT1, pT2, pT3, and pT4, was 93.3%, 71.8%, 37.5%, 30.4% and 10.5%, respectively. In this report, we evaluated various prognostic factors according to the survival rate. Sex, age, tumor localization, multiplicity, associated bladder cancer and concomitance of CIS had no influence on survival. In the ABC analysis, the B group showed a tendency for a poor prognosis. However it may be explained from the fact that the B group contained more patients at advanced stages than the other groups. Tumor grade, tumor stage, pV factor and pL factor had a significant effect on survivals. But tumor grade, pV and pL factors were closely related to the tumor stage. Thus the stage was thought to be the most important factor in the prognosis of upper urinary tract cancer. Different surgical procedures and irradiation also did not affect the prognosis of the patients with the same degree of invasion. Chemotherapy for all stages had no effect on survivals compared with non-chemotherapeutic group. However only for pT3 and higher stage cases, cisplatin-based chemotherapy improved the prognosis compared with patients not given chemotherapy. In conclusion, chemotherapy containing cisplatin should be considered for treatment of high stage upper urinary tract cancer.

Aged↗
PubMed1995

Does portal hypertension modify colonic mucosal vasculature? Quantification of alteration by image processing and topology.

OBJECTIVE: Endoscopic images of the colonic mucosal venous structure in eight cirrhotic patients with esophageal varices and in eight noncirrhotic subjects were analyzed to qualitatively determine whether or not the vasculature be altered by persisting portal hypertension. METHODS: On the endoscopic images, a venous network consisting of confluent venous branches draining into one penetrating vein was as a whole defined as one "venous unit." For each venous unit, the area of vein bed was calculated by means of an image processor. Each venous network was idealized to be a graphic representation consisting of lines (venous routes) and dots (origins, terminations, branching or anastomosing), on which two topological variables, the total number of zero-dimensional cells (a0) and the Betti number of dimension-1 (beta 1[K]), signifying the complexity and the number of venous anastomoses, respectively, were determined. RESULTS: The area of vein bed (mean +/- SD) was significantly greater (p < 0.01) for the cirrhotic patients (41 +/- 37 mm2) than for the noncirrhotic subjects (24 +/- 12 mm2). The a0 was also greater (p < 0.01) for the patients (68 +/- 29) than for the noncirrhotic subjects (42 +/- 17). The beta 1[K] for the patients was significantly greater (p < 0.01) for the cirrhotic subjects (7.1 +/- 4.4) than for the noncirrhotic subjects (2.6 +/- 2.9). CONCLUSION: The image processing and topological analysis of the colonic mucosal veins demonstrated that persistent portal hypertension alters the colonic mucosal venous structure by increasing the caliber of the veins and the number of merges (branching or anastomosing) between them.

Case-Control Studies↗
PubMed1995

Double-blind comparative study of sulfasalazine and controlled-release mesalazine tablets in the treatment of active ulcerative colitis.

To evaluate the effect of a controlled-release mesalazine tablet, in patients with ulcerative colitis (UC), a multicenter double-blind study was carried out, using sulfasalazine (500 mg tablet) as the control drug. The mesalazine tablet contained 250 mg of ethyl cellulose-coated mesalazine granules. The patients were assigned to two groups, one to receive mesalazine tablets (1500 mg/day) and a sulfasalazine placebo (group M) and the other to receive sulfasalazine tablets (3000 mg/day) and a mesalazine placebo (group S). The test medications were administered orally for 4 consecutive weeks. The study subjects were selected from among patients with mild to moderate active UC, and 118 patients were enrolled. Concomitant use of steroids and immunosuppressors was prohibited during the study period. Of the 118 patients, 9 dropped out. A total of 109 complete records were thus obtained, 52 in group M and 57 in group S. There was no difference in the improvement of clinical symptoms and endoscopic findings between the two groups. The overall safety, based on adverse reactions and laboratory data, was higher, at 86.5%, for group M (n = 52), compared to 66.7% for group S (n = 57). The general usefulness, based on the improvement and safety, was higher, at 65.3%, for group M (n = 49), compared to 45.6% for group S (n = 57). The controlled-release mesalazine tablet thus appears to be useful in the treatment of mild to moderate active UC.

Adult↗
PubMed1995

Adverse effects of sulfasalazine and treatment of ulcerative colitis with mesalazine.

We investigated the adverse effects of sulfasalazine in the treatment of inflammatory bowel disease in Japan. In our first survey, adverse effects were observed in 52 out of 751 patients with ulcerative colitis (6.9%) and in 8 out of 221 patients with Crohn's disease (3.6%); i.e., such effects were observed in 60 out of 972 patients with inflammatory bowel disease. In our second survey, we examined 94 adverse reactions in 64 patients with ulcerative colitis. The main adverse reactions were exanthema, fever, nausea and vomiting, angioedema, and liver damage, in decreasing order of frequency; these reactions accounted for about 80% of the adverse reactions. Most of the reactions (62%) occurred within 1 month after the beginning of sulfasalazine intake. Mesalazine is thought to effectively release the 5-ASA molecule in the colon and has already proven of value in patients with mild active ulcerative colitis. We evaluated the effect of mesalazine in patients intolerant to sulfasalazine. Effectiveness was observed in 14 out of 18 patients with active ulcerative colitis (78%) and in 3 out of 3 patients in the quiescent state. These results suggest that mesalazine is effective for the treatment of patients with ulcerative colitis who are intolerant to sulfasalazine; this drug could be a gleam of hope to those patients.

Adverse Drug Reaction Reporting Systems↗
PubMed1995

The role of proinflammatory and immunoregulatory cytokines in the pathogenesis of ulcerative colitis.

We investigated the production of proinflammatory cytokines (IL-1 beta, IL-6, IL-8, and TNF-alpha) and immunoregulatory cytokines (IL-2, IFN-gamma, and IL-10) in the colonic mucosa of patients with active ulcerative colitis (UC), inactive UC, and non-inflammatory bowel disease (IBD) colitis by organ culture. The production of proinflammatory cytokines was significantly increased in all the studied groups compared with controls. In active UC, levels of these cytokines, except for IL-1 beta, were markedly increased compared with non-IBD colitis, and the levels were positively correlated with the degree of inflammation. Patients with non-refractory active UC receiving steroids showed levels of IL-1 beta and TNF-beta production similar to those in controls. IL-10 production was also significantly increased in all the studied groups, the value of being the highest in active UC. In contrast, IL-2- and IFN-gamma production was significantly decreased in both active and inactive UC compared with controls, and the values in active UC were inversely correlated with the degree of inflammation. In non-IBD colitis, decreased IL-2 production was observed, but IFN-gamma production did not differ from that in controls. In an experimental study, each of the proinflammatory cytokines was injected into the colonic mucosa of rats. All of these proinflammatory cytokines, except for IL-1 beta induced colonic mucosal damage that showed some histologic features similar to those of UC. These results suggest that the increased production of proinflammatory cytokines, particularly of IL-6 and IL-8, and the decreased production of IL-2- and IFN-gamma, probably downregulated by the enhanced production of IL-10, play an important role in the pathogenesis of UC.

Animals↗
PubMed1994

Colonoscopic polypectomy with local injection of methylene blue.

For safer and complete colonoscopic polypectomy of large broad-based adenomas, we attempted submucosal injection of methylene blue before electrosurgical snare excision. Twenty-five large broad-based sessile adenomas 20 mm or more in diameter were resected. Methylene blue was injected about 2 mm away from the edge of the lesion. After injection, the lesion appearing as a blue bleb was resected by snare polypectomy. All the lesions were completely resected by single-step polypectomy. During and after polypectomy, no complication occurred. Endoscopic resection of large sessile adenomas with the aid of submucosal injection of methylene blue thus appears to be safe and effective.

Adenomatous Polyps↗