This study was conducted to establish the optimum postoperative adjuvant chemotherapy with 5-FU in patients with gastric cancer. Seventy gastric cancer patients were treated after surgery with one of the following regimens; 5-FU 10 mg/kg/24 hrs c.i.v. x 24 days (arm A, n = 25); 5-FU 20 mg/kg/24 hrs c.i.v. x 4 days/w x 3 courses (arm B, n = 16); 5-FU 30 mg/kg/24 hrs c.i.v. x 2 days/w x 4 courses (arm C, n = 25). Blood 5-FU concentration, adverse effects and prognosis in each arm were compared. Changes in blood 5-FU concentrations were dose-related. The three-year survival rates in arms A, B and C were 15.0, 13.5 and 0.0%, respectively; they tended to be greater in arms A and B, but differences were not statistically significant. The most frequent adverse effects of the treatments were gastrointestinal, such as stomatitis. The incidence of reactions tended to be low in arm C, i.e., high-dose intermittent administration. Arm B (4 days-on, 3 days-off) was modified to 4 days-on, 6 days-off (arm B'), because severe stomatitis developed. The severity and incidence of stomatitis were reduced in the modified arm B group. We believe that intensive postoperative adjuvant chemotherapy for patients with gastric cancer should be designed using the arm B' approach.

Adult↗

PubMed1996

[Replacement of descending thoracic aorta using open proximal anastomosis under hypothermic circulatory arrest].

Open proximal anastomosis under hypothermic circulatory arrest was applied to eleven consecutive patients with descending aortic diseases. These patients included five aortic dissections and six thoracic aortic aneurysms. Fourth and 7th intercostal spaces were opened by left posterolateral thoracotomy. Cardiopulmonary bypass was established by right atrial drainage via femoral vein and main pulmonary artery. Arterial blood was perfused via femoral artery. The descending aorta was opened under hypothermic circulatory arrest with anal temperature of 20 degrees C, and the anastomosis of the proximal site of the graft was performed with bloodless field. After the proximal anastomosis was finished, the main graft was clamped and perfused via the branch of the graft. The distal anastomosis was performed during circulatory arrest of the lower body. Mean circulatory arrest time of the upper body was 31 min, and that of the lower body was 37 min. Nine of the patients arrive without any major complications, but two of them died due to postoperative low cardiac output syndrome and postoperative pneumonia. Open proximal anastomosis under hypothermic circulatory arrest may be useful for the replacement of the diseased descending aorta due to dissection or aortic aneurysm with mural thrombi because of the advantage of non-clamping anastomosis with bloodless surgical field.

Adult↗

PubMed1996

[Study on the combined preoperative treatment with CDDP and HCFU for gastric cancer].

Explore the source record for details and available documents.

Adult↗

PubMed1996

[Biliary pancreatitis].

Explore the source record for details and available documents.

Acute Disease↗

PubMed1996

[A case report of St. Jude medical aortic valve prosthesis thrombosis].

We report a case of successful semi-emergent redo aortic valve replacement for thrombosed prosthetic valve. Patient was a 59-year-old male who had undergone aortic valve replacement of St. Jude Medical prosthetic valve and open mitral commissurotomy 14 years ago. He suffered from pneumonia with hemosputum and admitted a neighbor hospital. But he was reffered to our medical center because of progressing dyspnea. We found the immobility of one of the leaflets of the prosthetic valve by cinefuluoroscopy. He was also diagnosed as prosthetic valve thrombosis and mitral valve restenosis using ultrasonic echocardiography. The thrombi were developed on the hinge of one of the leaflets, and they might be formed during the time he had got inappropriate anticoagulation therapy at the former hospital. We emphasise the importance of strict anticoagulation control for the patients valve replaced.

Aortic Valve↗

PubMed1996

[Relationship between postoperative prognosis and preoperative immunological factors in aortitis syndrome].

Valve detachment or pseudoaneurysm is a well known complication of surgical treatment for cardiovascular disease due to aortitis syndrome. Although the preoperative management of inflammation by steroid therapy is very important, occasionally, the operation in active phase might be recommended because of progressive heart failure or impending rupture of aortic aneurysm. The pathology of aortitis syndrome is related to immunological abnormality, but there has been little information concerning the immunological factors. In order to evaluate the relationship between immunological factors and surgical results in patients with aortitis syndrome, immunological examination was obtained before surgery in 12 patients. Cardiovascular lesions due to aortitis syndrome were aortic regurgitation in 6 patients, annuloaortic ectasia in 1 patient, aortic arch aneurysm in 1 patient, mitral regurgitation in 2 patients, and coronary artery disease in 2 patients. Hospital mortality including initial operative death was not found. However, 6 late death (50%) occurred at late time with the mean of 23.8 months because of severe complications such as valve detachement or pseudoaneurysm after operation. In a comparison of the preoperative immunological values between survival group and late death group, immunoglobulins such as IgG, IgA, C3 and C4 were significantly higher in late death group. According to the recurrence of inflammation, the patients were divided into three groups. Group A included 3 patients who remains in active phase after initial operation in active phase. Group B included 3 patients who changed to active phase after initial operation in inactive phase. Group C included 6 patients who remains in inactive phase after initial operation. In a comparison among 3 groups, IgG and C4 showed no significant difference. However, IgA and C3 of group C were significantly lowest among three groups. This outcome is considered to be related to existence of latent inflammation. At operation, insertion of rigid prosthesis to fragile position due to latent inflammation may stimulate immunological reactions. We conclude that the preoperative values of the immunological factors, especially IgA and C3, are reliable predictors in postoperative prognosis.

Adult↗

PubMed1996

High prevalence of antibodies to glutamic acid decarboxylase in comparison to islet cell antibodies in patients with long-standing insulin-dependent diabetes mellitus.

To elucidate the clinical significance of antibodies to glutamic acid decarboxylase (GAD Ab) compared to islet cell antibodies (ICA) in recent-onset and long-standing insulin-dependent diabetes mellitus (IDDM). We examined GAD Ab and ICA in 29 recent-onset and 85 long-standing patients with IDDM. GAD Ab was detected by a radioimmunoassay kit using purified pig brain GAD as an antigen. The prevalence of GAD Ab in the recent-onset diabetic patients was 55.2%, slightly lower than that of ICA (65.5%). In contrast, the prevalence of GAD Ab in long-standing diabetic patients was 42.4%, which was significantly higher than that of ICA (23.5%) (p < 0.01). GAD Ab were consistently detected in approximately 40% of patients with long-standing disease, while ICA decreased according to duration of disease. The GAD Ab titer in ICA-positive patients (mean +/- SD, 1588.2 +/- 6755.1; range, 6-38574) was significantly higher than that in ICA-negative patients (mean +/- SD, 13.4 +/- 17.9; and range, 5-72 units) (p < 0.001). These findings suggest that GAD Ab are more useful than ICA to know participation of immune disorders in long-standing patients with IDDM.

Adult↗

PubMed1996

[A case of primary tissue failure in aortic bioprosthesis due to pannus formation].

A 22-year-old man, who had received aortic valve replacement with a 21 mm of Carpentier-Edward S.A.V Bioprosthesis for aortic regurgitation at 19 years of age, was readmitted to our hospital because of a new systolic murmur and his chest roentgenogram showed remarkable cardiomegaly. Cardiac catheterization showed a 55 mmHg pressure gradient across the bioprosthesis. Under the diagnosis of primary tissue failure, reoperation was undergone. At reoperation, the sewing ring and leaflets of the prosthesis were covered with pannus, which adhered to leaflets, and the thickness of these leaflets was seen. It was thought that these changes caused aortic stenosis. Primary tissue failure due to pannus formation has been reported a little, but if bioprosthesis is implanted in the supra-annular position, pannus formation may occur because cusps of bioprosthesis are attached to the host's annulus.

Adult↗

PubMed1996

Fibromuscular dysplasia of the visceral arteries.

Fibromuscular dysplasia (FMD) commonly involves the renal and carotid arteries. However, visceral arterial involvement is rare. We report a 39-yr-old male who developed ischemic bowel disease twice (once in the jejunal artery and once in the sigmoid artery) as a result of FMD. First ischemic change occurred in the sigmoid colon with manifestation of melena and abdominal pain, and the second occurred in the jejunum, with severe abdominal pain and intestinal stenosis. Angiography revealed the "string of beads" appearance, characteristic of FMD, in those two arteries responsible for the ischemic lesions. Fasting therapy with intravenous hyperalimentation improved both lesions, but secondary stenosis caused by ischemia occurred in the jejunum. Surgical resection of the stenotic jejunum was required. Although the abnormal arteries that had been imaged as a "string of beads" on angiography were not resected, the postoperative course has been uneventful and satisfactory.

Abdominal Pain↗

PubMed1996

HLA-B27 subtypes in Japanese with seronegative spondyloarthropathies and healthy controls.

OBJECTIVE: To determine HLA-B27 subtype frequencies in Japanese patients with seronegative spondyloarthropathies (SpA) and healthy controls. METHODS: We determined HLA-B27 subtypes of 20 Japanese patients with ankylosing spondylitis and one with Reiter's syndrome, and 11 healthy Japanese individuals using a polymerase chain reaction sequence specific oligonucleotide hybridization method specifically designed for the discrimination of B*2701-09. RESULTS: 14 of 21 (67%) patients and 9 of 11 (82%) controls were typed as B*2704. The remainder were B*2705. CONCLUSION: HLA-B*2704 and B*2705 are present in the Japanese population, the former being the predominant subtype of HLA-B27. Both subtypes are associated with SpA.

Asian People↗

PubMed1996

[Pit fall of aprotinin administration during open heart surgery].

Aprotinin administration during open heart surgery has been attempted at various institutions to reduce hemorrhage and improve the rate of no-transfusion operations, and has been reported to be effective. The treatment has been effective also in the 45 patients operated on at our institution. However, we experienced LOS at weaning from extracorporeal circulation (8 cases) considered to be due to aprotinin administration, suggesting unexpected risk of the treatment. Evaluation was made by classifying the patients according to the aprotinin dose; A high-dose group administered aprotinin at 300 x 10(4) units (20 patients), a low-dose group administered aprotinin at 100 x 10(4) units (8 patients), and a control group not administered aprotinin (15 patients). The volume of postoperative hemorrhage increased with the dose of aprotinin, and was significantly lower in the high dose and medium-dose groups than in the control group, but was not significantly different in the low-dose group. The postoperative peak CPK and CPK-MB were not significantly differ but increased slightly with the aprotinin dose. Probably for this reason, IABP was needed in 8 (17.8%) of the 45 patients because of LOS at weaning from extracorporeal circuration. A diagnosis of perioperative myocardial infarction (PMI) was made in 7 of these patients. Factors other than aprotinin are unlikely to be the cause of LOS, and the condition is considered to have been induced by micro-embolism during extracorporeal circulation with aprotinin administration. We propose two points as basis for this speculation. The first is that the body temperature during extracorporeal circuration, which was 30-35 degrees C in the bladder, promoted antifibrinolytic activity of aprotinin. The second is poor control of ACT during extra corporeal circulation. Thus, we suggest the risk of the use of aprotinin without further reduction in the body temperature during extracorporeal circuration. At present avoidance of high body temperatures and strict control of ACT during extracorporeal circulation are important preventive measures against micro-embolism possibly caused by aprotinin.

Aprotinin↗

PubMed1996

[Liver resection in a case of multiple liver metastases of gastric cancer following hepatic arterial infusion chemotherapy].

A 61-year-old-man underwent subtotal gastrectomy (D2) for advanced gastric cancer with multiple liver metastases. After the operation, repeated hepatic arterial infusion chemotherapy was performed employing implantable catheter and port system with CDDP and MMC. The result was that the liver tumors showed a remarkable regression in size, and the serum CA 19-9 level decreased within normal range. But the tumor in the lateral segment grew and the CA 19-9 level increased again. There was no evidence of metastasis or recurrence except in the liver, and the metastatic tumors in right lobe became smaller by hepatic arterial infusion chemotherapy at this time. Therefore, lateral segment resection was performed for reductive surgery 14 months after the first operation. After that, the liver tumors did not grow and CA 19-9 kept within the normal range, while hepatic arterial infusion chemotherapy could be given. Thus, it seems that liver resection for reduction surgery following hepatic arterial infusion chemotherapy should be considered as a treatment for multiple liver metastases.

Adenocarcinoma↗

PubMed1996

The two-fire, one-cartridge stapling method using a modified Endo-GIA.

The endoscopic stapler (Endo-GIA) was designed to divide tissue between two triple-stapled lines. The endoscopic surgeon frequently encounters situations where only stapling is required. Kirby described a staple closure method that uses a knifeless Endo-GIA cartridge. This method, although useful, has the problem of the modified Endo-GIA unit locking. Therefore, we devised a new technique for endoscopic stapling that involves two consecutive staplings using one cartridge without cutting. This method requires modification of the Endo-GIA system by removing the safety-lock system. In addition to enabling endoscopic stapling techniques without the risk of locking, the method can effect a significant cost savings.

Endoscopy↗