Biomedical subjects
E Sakai
Publications and source records attributed to E Sakai.
[Chronic recurrent pulmonary embolism].
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[Clinical utility of computed radiography (CR) for the diagnosis of lung cancer].
To clarify the clinical utility of computed radiography (CR) for the diagnosis of lung cancer, several kinds of image-processed CR images were compared with conventional radiographs (CXR). The images in the three patients with peripheral lung cancer were processed by the following six types: 1) processing close to CXR (plain CR), 2) wide latitude and high frequency emphasis (wide CR), 3) advanced high frequency emphasis (HE-CR), 4) lower frequency emphasis (LE-CR), 5) single exposure dual energy subtraction (ES) and 6) ES with lower frequency emphasis (LE-ES). In the two cases of hilar lung cancer, 1) plain CR, 2) wide CR, 3) CR tomographs similar to CXR tomographs (plain CR-TOMO) and 4) high frequency emphasized CR tomographs (HE-CR-TOMO) were processed. Twenty-six radiologists rated the image-processed CR images using a 5 point rating scale method. The following results were found for the evaluation of lung anatomy: almost all image-processed CR images were equal or superior to CXR; especially scores for plain CR were better than those for CXR in all anatomical structures studied; scores for ES were superior to those for plain CR in the bilateral main bronchi, left upper lobe bronchus and right paratracheal stripe; and scores for CR tomographs were better than those for CXR tomographs. In peripheral lung cancer, plain CR and ES were superior to CXR. Especially ES had the best scores. In hilar lung cancer, plain CR and CR tomographs were judged better than CXR and CXR tomographs. These findings indicate the usefulness of CR images for the diagnosis of lung cancer.
[A study of the utility of the MR image for the diagnosis of thymic tumors--imaging and pathologic correlation].
MR imaging was performed in 25 patients with thymic tumors (five with non-invasive thymomas, 15 with invasive thymomas, and five with thymic carcinomas), and the MR imaging appearance was compared with the pathological findings. Non-invasive thymomas showed generally oval or round masses with well-defined margins and homogeneous intensity on T1- and T2-weighted images. Invasive thymomas showed a multinodular appearance in 79% (11/15) of cases, and an internodular difference in signal intensity (IDSI) in 64% (7/11) on T2-weighted images. It was considered that the IDSI on T2-weighted images correlated pathologically with the hemorrhagic and/or necrotic areas and hyalinization. The IDSI seemed to be a characteristic finding of invasive thymomas. The histological findings and MR imaging appearance of thymomas were compared. The predominantly epithelial type showed a low incidence of nodular appearance but showed marked IDSI on T2-weighted images. Therefore, it is more likely that the predominantly epithelial type induced more varied intratumoral changes than other types. Extension of thymic carcinomas was similar to that of invasive thymomas on MR imaging, but thymic carcinomas showed no definite nodular appearance. In conclusion, MR images in thymic tumors were useful for not only determining the morphology of the tumor but also the tissue characteristics. Therefore, MR imaging can be a useful modality to correlate with the histological findings and biological behavior of thymic tumors.
[Surgical treatment of aortic arch aneurysm associated with coronary artery disease].
Graft replacement of the aortic arch aneurysms and concomitant coronary artery bypass grafting (CABG) were performed in the consecutive seven patients for the past five years between 1987 and January 1992, including three (43%) emergency operations. The etiology of aneurysms was atherosclerosis in 4, and aortic dissection in 3. There were one early death (14%) due to MRSA pneumonia, and one late death due to rupture of the abdominal aortic aneurysm 8 months postoperatively. Respiratory failure was frequently complicated immediately after the surgery. Vein grafts were anastomosed to coronary artery during the initial core cooling, and sequential cardioplegia was given through the bypass grafts. Selective cerebral perfusion was carried-out during the reconstruction of the transverse aortic arch and arch vessels in all cases. To achieve sufficient myocardial protection, and to get good postoperative hemodynamics and long-term survivors, it was important to perform the simultaneous CABG at the time of the repair for the aortic arch aneurysm in cases complicated with coronary artery disease.
Clinical utility of Gd-DTPA-enhanced magnetic resonance imaging in lung cancer.
Magnetic resonance (MR) imaging has both advantages and disadvantages in its application in lung cancer staging. Because of its ability to provide superior contrast resolution and to display structures in many planes, MR imaging is better than computed tomography (CT) for the detection of mediastinal and chest wall invasion. MR imaging also is more sensitive than CT for detection of hilar and mediastinal lymph node enlargement. Multiplanar T1- and T2-weighted images are optimal for differentiating lymph nodes from large vessels without the need for contrast enhancement; in these cases administration of Gd-DTPA provides no more information than plain MR images. MR studies should be used for examining patients with suspected mediastinal or chest wall invasion and those who have equivocal hilar or mediastinal adenopathy. The shortening effect of Gd-DTPA on the T1 value results in a high signal. This effect is dependent upon both the perfusion and diffusion of the contrast agent and the amount of extracellular fluid. The distribution of Gd-DTPA is similar to that of iodinated water-soluble contrast media. Gd-DTPA examination should be tailored to provide information regarding blood flow, vascularity, and permeability, none of which is easily appreciated on CT or plain MR images. Applications for which Gd-DTPA enhancement may be helpful include differentiating between malignant and benign pulmonary masses, differentiating between hilar lung cancer and peripheral postobstructive atlectasis or pneumonia, determining therapeutic effect after radiation therapy, and differentiating between recurrent or residual tumor and radiation pneumonitis.
The p53 tumor-suppressor gene and ras oncogene mutations in oral squamous-cell carcinoma.
The frequencies of mutations in the p53 tumor-suppressor gene and ras proto-oncogenes were investigated systematically in surgically resected oral squamous-cell carcinomas (SCCs) using single-strand conformation polymorphism (SSCP) and/or dot-blot hybridization analysis of DNA fragments which had been amplified by the polymerase chain reaction (PCR). p53 gene mutations, within the region of exons 5 to 8, were detected in 17 out of 27 (63%) tumor specimens. The role of p53 mutations in cell-line establishment was investigated. p53 gene mutations were detected in 5 out of 6 tissue samples from which cell lines were established and in 4 out of 5 specimens from which cell lines could not be established, suggesting that the presence of p53 gene mutations is not by itself sufficient for cell-line establishment. Tumor samples were also analyzed for point mutational activation of the ras proto-oncogenes. One out of 30 (3%) tumors showed an activating point mutation in codon 12 of H-ras, this being consistent with reports from Europe and USA but not with any from India. Compared to frequencies of the other genetic changes so far reported for oral SCC, the p53 mutations have been observed most often to undergo genetic change. p53 gene mutation is thus intimately involved in the genesis of oral SCC and consequently should be useful as a marker for the diagnosis of this neoplasm.
[Utility of helical CT for the secondary mass screening of lung cancer].
From December 1991 to 1992, helical CT scan was performed in 55 patients with having abnormal shadow in the chest X-ray on the secondary screening for lung cancer. In all patients with suspected pulmonary lesions at first screening, helical CT scan was performed with 10 mm slice thickness for 300 mm. The moving speed of the patients table is 20 mm/l rot./1.5 sec for 300 mm in a single breath-hold. Helical CT allowed shortening of examination time and providing both better data continuity and resolution than conventional CT. In conclusion, helical CT can be useful for secondary screening of lung cancer but it was considered that there are some problems such as method of final pathological diagnosis and treatment for small nodular lesion.
Detection of p53 gene mutations in human ovarian and endometrial cancers by polymerase chain reaction-single strand conformation polymorphism analysis.
The presence of mutations in the p53 gene was examined in ovarian cancers by a polymerase chain reaction-single strand conformation polymorphism (PCR-SSCP) analysis. The primers were designed to amplify exons 5 through 9 that contain phylogenetically conserved domains of the p53 gene. Mutations were detected in 5 out of 10 cases, one of which contained a deletion in the second allele. A single base substitution was detected in 4 cases at codons 162, 175, 205 and 273 and a single base insertion in one case within codon 315. A high frequency of p53 mutations in ovarian cancers and lack of mutation in 6 benign ovarian tumors and 2 normal ovaries suggested that the mutation of the p53 gene was associated with the genesis and/or progression of ovarian cancer. In 1 of 7 endometrial cancers, two mutations at codons 239 and 254 were detected.
[Randomized trial of cisplatin plus ifosfamide versus cisplatin plus vindesine for non-small cell lung cancer (NSCLC)].
Between 2/87 and 10/89, 83 patients (pts) with previously untreated NSCLC were assigned at random to receive either the PI regimen (cisplatin 80 mg/m2 dl and ifosfamide 2 g/m2 d 1, 2, 3, q 3-4 wks) or the PV regimen (cisplatin 80 mg/m2 d 1 and vindesine 3 mg/m2 d 1, 8, 15, q 3-4 wks). Three pts (2 PI regimen, 1 PV regimen) were ineligible for the study and 13 pts (7 PI regimen, 6 PV regimen) did not complete it. Thirty-three PI regimen pts and 34 PV regimen pts completed 2 or more cycles of the treatment and were evaluated. Patient characteristics were almost identical in both groups in terms of sex, age, pathological types, stage, performance status and number of chemotherapy cycles. For the PI regimen, there were 1 C.R. and 6 P.R., and the response rate was 21.2% (7/33). In the PV regimen, there were 11 P.R., and the response rate was 32.4% (11/34). The median survival time (MST) for PI regimen was 29 weeks (range 12-156 wks) and for PV regimen 40 weeks (range 8-138 wks). The difference in the survival curves for the 2 regimens was not statistically significant. Toxicities for the 2 regimens were similar except for greater leukopenia and one treatment-related death due to renal toxicity on PI regimen. These results suggest that PI regimen is not superior to PV regimen in the treatment of NSCLC.
[Case report of angiomyolipoma of the posterior upper mediastinum].
A case of posterior upper mediastinal angiomyolipoma is reported. The patient was an asymptomatic 63-year-old female, in whom an abnormal shadow was detected on chest x-ray at medical examination. On computed tomogram, the mass was located in the right paravertebral upper mediastinum, and its density had a CT-number of 12. It had high MRI intensity. Since there remained a possibility of malignancy, thoracotomy was carried out. The resected tumor was soft in consistency and the size was 20 x 23 x 37 mm. Histological examination showed that the mass was composed of fatty tissue, smooth muscle, and vascular tissue. Therefore, the tumor was diagnosed as angiomyolipoma. Although angiomyolipomas are often found in the kidney, those in the mediastinum are very rare and there have been only 2 cases reported in the literature. We consider that angiomyolipoma is rare, but important in the differential diagnosis of mediastinal tumors.
Most human squamous cell carcinomas in the oral cavity contain mutated p53 tumor-suppressor genes.
Oral squamous cell carcinoma cell lines and tumor tissues used for cell line establishment were examined for p53 tumor-suppressor gene mutation using cellular DNAs and RNAs. For sensitive and rapid detection, a newly designed two-stage filtration strategy was used. Full advantage was taken of the single-strand conformation polymorphism (SSCP) of cDNA and cellular DNA fragments amplified by the polymerase chain reaction (PCR), followed by DNA sequencing of mutated fragments. Fourteen out of 15 cells lines and the corresponding five tumor tissues had p53 mutations within the region of exons 5-8. Loss of normal alleles was noted in 14 lines, but not in one in which only mutated transcripts were detected. DNA sequencing indicated six out of 14 mutations to be in positions that have so far not been reported. In two special cases, novel mutations were found in the splicing donor sequence of exon 6, and consequently the cryptic splice site had to be used. Extremely frequent p53 gene mutations indicated that the mutations are likely be intimately involved in the carcinogenesis of oral squamous cell carcinoma.
[Surgical treatment of Marfan's syndrome with annulo aortic ectasia and mitral regurgitation].
This report is concerned with results of surgical treatment for Marfan's syndrome combined with annulo-aortic ectasia (AAE) and mitral regurgitation (MR). Of the 23 patients with Marfan's syndrome who received Bentall's procedure during 14 year period, seven (30%) of these patients had both AAE and MR. The MR grade of seven patients by cardiac Doppler or left ventriculographic studies were grade 1 in 2, 2 in 1, 3 in 1, and 4 in 3. Atrial fibrillation was present in 4 patients. New York Heart Association Functional Class on admission in these 7 patients were II in 1, III in 4, and IV in 2. The mitral valve was replaced with mechanical valve in 4 patients by left atrial approach whose MR grade were over 3. In the 4 patients the mitral annuli were extremely dilated, both valve leaflets were massively redundant, and all chordae were elongated and turned chordae and vegetation were detected due to infective endocarditis. Only Bentall's procedure was performed in 3 patients whose MR were minimal. There were no early death, but two late deaths. One of them died of cardiac failure 2.3 years after Bentall's procedure because grade 2 MR was increased. Another one died from ventricular arrhythmia 1.6 years after MVR and Bentall's procedure. The remaining 5 patients are doing well for 3 months to 11.5 years after operation. For Marfan's syndrome combined with AAE and MR, early operation is recommended before left ventricular impairment. Mitral valve repair was not performed, both to save time and because anticoagulant therapy was need for aortic valve replacement. Concomitant MVR was to be done for moderate to severe MR.
[Changes of immunity in the patients undergoing surgery for esophageal cancer].
The kinetics of subpopulations and functional subsets of circulating immune cell, humoral antibody and complement were examined in the 18 patients undergoing surgery with thoracotomy and laparotomy for esophageal cancer. The following results were obtained. 1. Preoperative IgG-Fc-receptor (+) T cell (Tr cell) level was higher than normal level. 2. From 1st post operative day (1POD) to 14POD, WBC counts have increased, lymphocyte counts (especially T cell counts) have decreased significantly as compared with preoperative level. 3. In T cell subsets, counts of Tr cell have decreased significantly from 1POD to 3POD as compared with preoperative counts. 4. Counts of OKT8 positive cells (suppressor or cytotoxic T cell) and OKT4 positive cells (helper or inducer T cell) have decreased significantly from 1POD to 3POD as compared with preoperative count. OKT4/OKT8 ratio increased at 3POD (2.31 +/- 1.33). 5. In B cell subsets divided into using the type of cell surface immune antibody (sIgG, sIgA, sIgD), all subsets have decreased significantly as compared with preoperative counts. 6. Immune globulin (IgG, IgA, IgM, IgD) have decreased significantly from 1POD to 7POD, but at 14POD they increased significantly as compared with preoperative levels. 7. Complements (C3, C4) have decreased significantly from 1POD to 7POD. 8. The count of sIgG positive B cell had significant, negative correlation with carcinogenic factor and positive correlation with preoperative serum total protein. The other immune factors had no correlation with the factors before and during operation. These results suggest that cellular immunity of patients undergoing surgery with thoracotomy and laparotomy for esophageal cancer lose its autoregulation function especially in T cell, it does not recover until 14POD.
Reproduction of turbinate atrophy in pigs by intranasal consecutive-day inoculation with suspensions of a toxigenic serotype D strain of Pasteurella multocida.
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Safety and efficacy of the cell-associated vaccine prepared by an attenuated infectious laryngotracheitis virus.
The safety and efficacy of the cell-associated (C-A) vaccine prepared by chicken embryo fibroblast (CEF) cells infected with the tissue-culture-modified strain of infectious laryngotracheitis (ILT) virus were studied in chickens. Over seventy percent of chickens inoculated with the C-A vaccine by the subcutaneous (S.C.) or intramuscular (I.M.) route at 1 day of age was protected against challenge with a virulent strain of ILT virus without any clinical signs. Chickens vaccinated with the C-A vaccine at 1 day of age acquired immunity within 6 days after vaccination, and the protection rate maintained more than 60% until 10 weeks post-vaccination. The C-A vaccine was invariably effective for chickens at various age. There was no evidence that the development of immunity was hindered by further vaccination with Newcastle disease and infectious bronchitis combined live vaccine. In addition, the C-A vaccine was safe when chickens were inoculated with 10 doses. In the field trials of the C-A vaccine, no adverse reaction was observed, and over 65% of vaccinated chickens was protected against the challenge of the virulent ILT virus at 8 weeks after vaccination.
[Effects of denopamine on hemodynamics and blood gases in secondary pulmonary hypertension].
The acute hemodynamic and blood gas changes caused by denopamine (2 micrograms/kg/min, d.i.) were investigated in 13 patients with chronic respiratory failure and secondary pulmonary hypertension. Denopamine significantly reduced mean pulmonary arterial pressure from 25 +/- 7 to 23 +/- 7 mmHg (p less than 0.05), and pulmonary vascular resistance from 314 +/- 166 to 276 +/- 168 dyne/sec/cm-5 (p less than 0.05), while mean systemic arterial pressure and systemic vascular resistance showed no significant change. Pulmonary-systemic vascular resistance ratio was reduced significantly from 0.22 +/- 0.09 to 0.18 +/- 0.09 (p less than 0.05). These findings suggest that denopamine has more marked effects on the pulmonary artery than on systemic arteries. Arterial oxygen tension (PaO2) increased significantly from 59.0 +/- 8.1 to 62.5 +/- 10.5 Torr (p less than 0.01), and arterial carbon dioxide tension (PaCO2) decreased significantly from 49.1 +/- 6.8 to 44.6 +/- 7.0 Torr (p less than 0.01) by denopamine. Mixed venous oxygen tension (PvO2), which is an indicator of tissue oxygenation, increased significantly from 33.3 +/- 3.5 to 34.4 +/- 3.3 Torr (p less than 0.05). We conclude that denopamine is thought to be useful for the improvement of hemodynamics and tissue oxygenation in patients with secondary pulmonary hypertension. However, further long-term studies are necessary to establish its therapeutic efficacy.
[A case of asymptomatic paraganglioma diagnosed by abnormal shadow on chest X-ray].
A 65-year-old man was noted to have an abnormal shadow on chest X-ray at mass screening examination, and was seen at Douhoku Byoin National Sanatorium. Chest X-ray showed a homogeneous mass shadow and a lytic lesion of the right 5th rib with extra-pleural tumor sign at the right upper and middle lung fields. Retroperitoneal tumor of 5 cm in diameter was detected in the right adrenal area by ultrasonography. Because of increasing plasma levels of norepinephrine and dopamine, the diagnosis of malignant pheochromocytoma with rib metastasis was made. Histologically, chromogranin staining was positive in each resected specimen. The retroperitoneal tumor was separate from the right adrenal gland. We report a rare case of malignant paraganglioma which was asymptomatic in spite of increasing plasma levels of catecholamines.