Biomedical subjects

F Konishi

Publications and source records attributed to F Konishi.

At least 55 records · Page 3Linked to original sources

PubMed1999

Intraoperative localization of colorectal tumors in the early stages using a marking clip detector system.

In laparoscopic colectomy the identification of the site of a tumor is often difficult. The topical injection of india ink or blue dye by preoperative colonoscopy is the most prevalent method to mark the tumor site; however, such a procedure also includes the intrinsic danger of possibly injecting dye into the peritoneal cavity. In addition, the injected marker may also spread so widely that the intended site may become obscure. A marking clip detector system was used to detect metallic marking clips in the luminal side that had been applied to the mucosa adjacent to the lesion during the course of preoperative colonoscopy. This method was able to identify the marked site in 40 percent of cases in which only one clip was applied to the mucosa. However, when the lesion sites were marked with two or three clips, then the detection rate increased to 100 percent. Based on our findings, this procedure was found to be a safe and reliable method for identifying lesions during laparoscopic-assisted colectomy.

Colectomy↗

PubMed1999

Prospective observation of small "flat" tumors in the colon through colonoscopy.

PURPOSE: No prospective observations of "flat" tumors of the colon have yet been reported. The purpose of this study was to investigate the progression of small flat tumors by prospective observations using colonoscopy. METHODS: The shapes of flat tumors were classified into three types, including slightly elevated lesions with a flat top (flat-top type), slightly elevated lesions with a wide depression in the center (wide-depressed type), and slightly elevated lesions with a slit-like depression in the center (slit-depressed type). A total of 14 flat tumors of the colon in 13 patients (2 women; median age, 58; range, 46-72 years) were examined in this project. All cases were followed up prospectively using colonoscopy, and all underwent a resection using the submucosal saline injection and snaring technique. RESULTS: Because two patients were eventually dropped from the follow-up, only 12 lesions were studied. The observation period ranged from 11 to 26 (median, 19) months. At the time the observations started, the diameter of the tumors varied from 2 to 6 (median, 4) mm, and the shapes were flat-top type in five lesions, wide-depressed type in three lesions, and slit-depressed type in four lesions. Of the 12 flat tumors, 8 showed various changes in their shape. However, only two lesions demonstrated an increase in diameter of the tumor from 2 to 4 mm. In the other ten tumors any change in size was less than 2 mm. No lesions were carcinomas according to the final histologic diagnosis, but all were adenomas. CONCLUSIONS: Flat tumors of the colon did not rapidly progress when they measured approximately 5 mm in diameter. Such flat tumors did tend to change their shapes; however, such changes did not indicate invasion to the submucosal layer.

Adenoma↗

PubMed1999

Efficacy of magnifying endoscopy in the differential diagnosis of neoplastic and non-neoplastic polyps of the large bowel.

PURPOSE: We have introduced magnifying colonoscopy into clinical practice and analyzed its diagnostic efficacy, especially regarding the ability to distinguish neoplastic from non-neoplastic polyps. METHODS: The materials consisted of 923 polyps. After identifying the lesions during normal colonoscopy, a dye was sprayed, and then the zoom apparatus of the colonoscope was used to make a magnified observation at a maximum 100 times magnification. We classified the crypt orifices into six categories and labeled them A to F as follows: A, a medium round appearance; B, an asteroid appearance; C, an elliptic appearance; D, a small, round appearance; E, a cerebriform appearance; F, no apparent structural appearance. RESULTS: Forty-two of 923 polyps did not reveal any clear images of crypt patterns. The percentage of histologically neoplastic change in the lesions classified as A, B, C, D, E, and F were 10, 15.9, 93.7, 100, 94.8, and 87.5 percent, respectively. When we considered types A and B to represent a crypt pattern of non-neoplastic lesions, and types C, D, E, and F to represent neoplastic lesions, and when the lesions that did not show any clear images were classified as a misjudgment, the diagnostic accuracy of neoplastic lesions (sensitivity) was 92 percent and that of non-neoplastic lesions (specificity) was 73.3 percent. Overall, the diagnostic accuracy in differentiating neoplastic from non-neoplastic lesions was 88.4 percent. Twenty-three neoplastic lesions that were misjudged to be non-neoplastic were histologically adenoma with mild atypia in 22 and adenoma with moderate atypia in 1. CONCLUSION: Magnifying colonoscopy was considered to be useful in determining the indications for colonoscopic removal.

Adenomatous Polyps↗

PubMed1999

Rectal cancer in a 13-year-old boy without a detectable germline mutation in FAP and HNPCC genes.

Hereditary non-polyposis colorectal cancer (HNPCC) is characterized by familial clustering and early onset. It is unclear, however, whether the early onset of colorectal cancer necessarily represents HNPCC. A 13-year-old patient had rectal cancer and underwent curative surgery. DNA from this patient was examined for replication errors (RER) and genes related to familial colorectal cancer (APC, hMSH2, and hMLH1). The patient had a negative family history of colorectal cancer, did not show the RER phenotype, and had no germline mutation of the APC, hMSH2, and hMLH1 genes. The present case suggests that an unusually young patient with colorectal cancer is not always an HNPCC proband. Observation over time, however, will be needed, as a first mutator of familial colorectal cancer could be missed.

Adenocarcinoma, Mucinous↗

PubMed1999

Perforation of the sigmoid colon with ischemic change due to polyarteritis nodosa.

A 60-year-old man who developed a perforation of the sigmoid colon with ischemic change due to polyarteritis nodosa is described. Histological examination of the resected colon led to the diagnosis of polyarteritis nodosa. Although the gastrointestinal tract is frequently involved with polyarteritis nodosa, it is extremely rare for polyarteritis nodosa to be accompanied by a perforation of the colon, particularly at the initial presentation.

Adrenal Cortex Hormones↗

PubMed1999

Improved outcome following preoperative radiochemotherapy: 40.5 Gy accelerated hyperfractionation and 5-fluorouracil suppositories for patients with carcinoma of the lower rectum.

The aim of this study was to determine the long-term effects of administering preoperative radiochemotherapy to patients with carcinoma of the lower rectum. The outcomes of 29 patients who underwent curative surgery for carcinoma of the lower rectum after receiving radiochemotherapy in the form of 40.5 Gy accelerated hyperfractionation and a total dose of 3 400 mg 5-fluorouracil given as suppositories, with or without hyperthermia, and 48 patients who underwent surgery alone, were retrospectively compared. The tumors in all the patients were histologically diagnosed as stage T3. The cumulative 5-year survival rate and 5-year local recurrence-free rate of the patients treated with radiochemotherapy plus surgery were significantly better than those of the patients treated by surgery alone, the respective values being 80.5% vs 59.8% (P = 0.0325) and 95.7% vs 61.4% (P = 0.0041). Dehiscence of the perineal wound, anastomotic leakage, and postoperative ileus occurred at similar frequencies in both groups; however, perineal wound healing after abdominoperineal resection was delayed in the patients treated with radiochemotherapy plus surgery at 42.7 days vs 25.4 days (P = 0. 0062). In conclusion, although the wound healing was delayed, preoperative radiochemotherapy is considered to be beneficial for patients with carcinoma of the lower rectum.

Administration, Rectal↗

PubMed1999

Anomalous systemic arterial supply to normal basal segments of the left lower lobe.

BACKGROUND: Anomalous arterial supply to the normal basal segments of the lower lobe without sequestration is a rare congenital abnormality, and whether it belongs to the broad spectrum of sequestration disorders remains controversial. METHODS: The cases of all 4 patients who were treated surgically by us were reviewed together with 8 previously reported cases. RESULTS: The anomalous artery originated from the descending thoracic aorta, distributed to the basal segments of the left lower lobe, and drained to a normal inferior pulmonary vein in each case. The anomalous artery was thick and elastic walled. From the review of all 12 cases, male gender, left side, descending thoracic aorta as the aberrant arterial origin, absence of pulmonary blood flow to the basal segments, and normal pulmonary venous drainage were predominant. Despite some differences, the findings seemed closely related to intralobar sequestration. Surgical treatments were lung resection, anastomosis, and ligation of the anomalous artery. CONCLUSIONS: This anomaly is probably one type of sequestration complex. Both aortic and pulmonary arterial angiographic studies are needed to plan the definitive surgical procedure.

Adult↗

PubMed1999

Dermatomyositis associated with rapidly progressive fatal interstitial pneumonitis and pneumomediastinum.

We describe two cases of dermatomyositis (DM), which subsequently developed into rapidly progressive fatal interstitial pneumonitis and pneumomediastinum during steroid therapy. Both cases showed the classical cutaneous manifestations of DM, but the muscular symptoms were absent or mild. Both rapidly progressive interstitial pneumonitis and pneumomediastinum can occur in DM showing less inflammatory changes in the muscles. Patients with this form should be treated with extreme caution.

Adult↗

PubMed1999

A novel case of a sporadic desmoid tumour with mutation of the beta catenin gene.

A 42 year old man without familial adenomatous polyposis had recurrent desmoid tumours in the left subclavicular site. Histological examination showed a typical desmoid tumour. Molecular analysis was performed in genomic DNA from this tumour, using polymerase chain reaction-single strand conformation polymorphism (PCR-SSCP) and direct sequencing methods. No mutation could be detected in the entire coding sequence of the APC gene, nor in H-ras, K-ras, N-ras, or p53 genes. On seeking a mutation of the beta catenin gene (CTNNB1), an activating mutation from ACC (Thr) to GCC (Ala) at codon 41 was found. Immunohistochemical staining showed that accumulated beta catenin protein was predominantly localised in the nuclei of desmoid cells. This is the first example of a sporadic desmoid tumour in which a mutation of the beta catenin gene was revealed.

Adult↗

PubMed1999

Cardiomyocytes can be generated from marrow stromal cells in vitro.

We have isolated a cardiomyogenic cell line (CMG) from murine bone marrow stromal cells. Stromal cells were immortalized, treated with 5-azacytidine, and spontaneously beating cells were repeatedly screened. The cells showed a fibroblast-like morphology, but the morphology changed after 5-azacytidine treatment in approximately 30% of the cells; they connected with adjoining cells after one week, formed myotube-like structures, began spontaneously beating after two weeks, and beat synchronously after three weeks. They expressed atrial natriuretic peptide and brain natriuretic peptide and were stained with anti-myosin, anti-desmin, and anti-actinin antibodies. Electron microscopy revealed a cardiomyocyte-like ultrastructure, including typical sarcomeres, a centrally positioned nucleus, and atrial granules. These cells had several types of action potentials, such as sinus node-like and ventricular cell-like action potentials. All cells had a long action potential duration or plateau, a relatively shallow resting membrane potential, and a pacemaker-like late diastolic slow depolarization. Analysis of the isoform of contractile protein genes, such as myosin heavy chain, myosin light chain, and alpha-actin, indicated that their muscle phenotype was similar to that of fetal ventricular cardiomyocytes. These cells expressed Nkx2.5/Csx, GATA4, TEF-1, and MEF-2C mRNA before 5-azacytidine treatment and expressed MEF-2A and MEF-2D after treatment. This new cell line provides a powerful model for the study of cardiomyocyte differentiation.

Action Potentials↗

PubMed1999

Role of an ATP-sensitive potassium channel opener, YM934, in mitochondrial energy production in ischemic/reperfused heart.

We examined a possible mechanism of action of an ATP-sensitive potassium (K(ATP)) channel opener, YM934, for the improvement of energy metabolism in hearts subjected to 35-min ischemia and 60-min reperfusion. The treatment with 30 nM YM934 for the final 15 min of preischemia enhanced postischemic recovery of left ventricular developed pressure, attenuated the postischemic rise in left ventricular end-diastolic pressure, and suppressed the release of creatine kinase and ATP metabolites during reperfusion. The treatment also restored myocardial ATP and creatine phosphate contents and attenuated the decrease in mitochondrial oxygen consumption rate during reperfusion. The higher mitochondrial function was also seen in YM934-treated hearts at the end of ischemia. In another set of experiments, myocardial skinned bundles were incubated for 30 min under hypoxic conditions in the presence and absence of YM934, and then mitochondrial oxygen consumption rate was determined. Hypoxia decreased the mitochondrial oxygen consumption rate of skinned bundles to approximately 40% of the prehypoxic value. In contrast, the treatment of skinned bundles with 30 nM YM934 preserved the mitochondrial oxygen consumption rate during hypoxia. The effect of YM934 on the hypoxic skinned bundles was abolished by combined treatment with either the K(ATP) channel blocker glyburide or the mitochondrial K(ATP) channel blocker 5-hydroxydecanoate in a concentration-dependent manner. The results suggest that YM934 is capable of attenuating ischemia/reperfusion injury of isolated perfused hearts due to preservation of mitochondrial function during ischemia, probably through opening of mitochondrial K(ATP) channels.

Adenosine Triphosphate↗

PubMed1999

Transcriptionally targeted in vivo gene therapy for carcinoembrionic antigen-producing adenocarcinoma.

Inoperable adenocarcinoma in colon or lung shows resistance to conventional anti-cancer therapy. For these cancers, the feasibility of transcriptionally targeted killing of carcinoembryonic antigen (CEA)-producing adenocarcinoma cells was investigated. Adenovirus vectors carrying a CEA promoter to express E. coli lacZ (AdCEALacZ) or herpes simplex thymidine kinase (AdCEATK) were made and their in vitro and in vivo tumoricidal effects on CEA-producing or non-producing colon and lung cancer cells were evaluated. In vitro infection with AdCEALacZ showed significantly higher CEA promoter-driven lacZ expression in CEA-producing adenocarcinoma cells including VMRC-LCD and LoVo than in CEA-non-producing cells. AdCEATK-infected LoVo showed higher sensitivity to ganciclovir than control vector-infected LoVo or AdCEATK-infected HeLa both in vitro and in subcutaneously implanted tumors of nude mice. Moreover, total tumor elimination in vivo was achieved by either pre-infection of as few as 30% of cells comprising tumors or by direct in vivo injection of AdCEATK to pre-established LoVo tumors. In addition, CEA promoter-driven lacZ expression in LoVo cells was enhanced by the addition of interleukin-6 (IL-6) in vitro. These results provide a rationale for CEA-promoter-driven, adenovirus-mediated gene therapy for CEA-producing adenocarcinomas in colon and lung with reduced toxicity to normal cells.

Adenocarcinoma↗

PubMed1999

[CA72-4 (TAG72)].

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Antigens, Tumor-Associated, Carbohydrate↗

PubMed1998

Clinicopathologic and genetic features of nonfamilial colorectal carcinomas with DNA replication errors.

BACKGROUND: DNA replication errors (RERs) are closely associated with hereditary nonpolyposis colorectal carcinoma (HNPCC). Recently, alterations in DNA mismatch repair genes, including hMSH2, hMLH1, and hPMS2, have been implicated in the pathogenesis of HNPCC: Several studies have demonstrated RER in 13-17% of nonfamilial colorectal carcinomas. It is unclear, however, as to whether or not these RER positive nonfamilial colorectal carcinomas are incomplete forms of HNPCC or are caused by incidental alterations of DNA mismatch repair genes. Consequently, the authors studied the characteristics of RER positive nonfamilial colorectal carcinomas, placing particular emphasis on hMSH2 and hMLH1 gene mutations. METHODS: Fresh or frozen samples of 103 nonfamilial colorectal carcinomas were examined for RERs using the polymerase chain reaction (PCR) and specific microsatellite primers. The authors also identified mutations of the hMSH2 and hMLH1 genes in RER positive samples by a PCR single strand conformational polymorphism analysis followed by direct nucleotide sequencing. RESULTS: The incidence of RER was 15.7% (17/103) in nonfamilial colorectal carcinomas, and only 1 case, which was found in the ascending colon, showed a somatic mutation at exon 12 in the hMSH2 gene. Neither germline nor somatic mutations of the hMSH2 or hMLH1 genes could be found in any of the remaining RER positive tumors. RER positive nonfamilial carcinomas tended to be located more frequently in the right colon. There was no increased prevalence in young patients, and the clinicopathologic characteristics of HNPCC were absent in the patients with RER positive nonfamilial colorectal carcinoma. CONCLUSIONS: Based on these findings, the carcinogenesis of RER positive nonfamilial colorectal carcinoma is considered different from that of HNPCC:

Adaptor Proteins, Signal Transducing↗

PubMed1998

Significance of microsatellite instability in different types of early-stage nonfamilial colorectal carcinomas.

PURPOSE: The aim of this study was to investigate the genetic alterations of early-stage nonfamilial colorectal carcinomas regarding microsatellite instability, with special reference to the shape of the tumors and the site of the lesions. METHODS: Formalin-fixed, paraffin-embedded specimens of 44 early-stage nonfamilial colorectal carcinomas were examined for microsatellite instability with use of polymerase chain reaction. RESULTS: The 44 carcinomas consisted of 16 flat carcinomas and 28 polypoid carcinomas. Nineteen carcinomas were located in the proximal colon (9 flat type and 10 polypoid type), whereas 25 were in the distal colon and rectum (7 flat type and 18 polypoid type). Ten (22.7 percent) of the 44 carcinomas had at least one positive locus, whereas five (11.4 percent) of them had two or more positive loci. In the proximal colon the percentage of flat carcinomas with at least one positive locus was significantly greater than that of the polypoid carcinomas (4/9 (44 percent) vs. 0/10; P = 0.04). Six patients had synchronous or metachronous colorectal carcinomas or both. They harbored microsatellite instability more frequently than patients with single colorectal carcinomas, and the differences were statistically significant (P < 0.02). CONCLUSIONS: These data suggest that in nonfamilial carcinomas in the proximal colon, the genetic pathway in flat carcinomas may be different from that in polypoid carcinomas.

Adult↗

PubMed1998

Hirschsprung's disease in an adult patient with familial occurrence: report of a case.

Hirschsprung's disease is almost always associated with newborns or infants; however, we report herein the unusual case of a 46-year-old woman in whom the symptoms of Hirschsprung's disease emerged late in adult life. The involved rectosigmoid region was successfully removed by performing Duhamel's operation with a diverting colostomy. After the colostomy was closed, she regained normal defecatory function. She had one male child affected by Hirschsprung's disease of the total colon type who was operated on as a 12-month-old baby. The genetic predisposition of Hirschsprung's disease has been reported, but its mode of inheritance has not yet been clarified. Moreover, most papers on the familial occurrence of this disease have reported that siblings were affected. Our patient was unique for the definite occurrence of the disease in successive generations. The features of Hirschsprung's disease in adults and the familial occurrence are discussed with a review of the literature.

Anastomosis, Surgical↗

PubMed1998

Important microsatellite markers in the investigation of replication errors (RER) in colorectal carcinomas.

BACKGROUND: DNA replication errors (RER) have been found in hereditary nonpolyposis colorectal carcinomas and in sporadic colorectal carcinomas. The incidence of RER depends on which and how many markers are examined. The main purpose of the present study was to determine the key markers for detecting RER most efficiently. METHODS: The RER status of 76 sporadic advanced colorectal carcinomas in the proximal colon were investigated. Seven microsatellite markers (D2S123, D3S1029, D3S1611, D2S72, TP53, Mfd26 and BAT26) were chosen to determine the RER status by PCR using the non-Rl method, because these seven markers have frequently been used in other studies and also detect RER. RESULTS: It was found that 44.7% of sporadic colorectal advanced carcinomas in the proximal colon (34 of 76) showed RER at one or more loci. Among these 34 cases, RER was present at three or more markers (severe RER) in 22. All 22 of these cases showed RER at BAT26 and TP53. The other 12 cases with RER showed RER at one or two markers (mild RER). Eleven of these 12 cases (91%) showed RER at Mfd26 and there were one or two cases with mild RER at each of the other loci. CONCLUSIONS: When one intends to analyze routinely a large number of cases, an analysis of two or three markers (Mfd26 and BAT26 or TP53) is considered to be sufficient for detecting mild and severe RER.

Aged↗

PubMed1998

[Bleeding from the alimentary tract--acute hemorrhage from gastrointestinal tumors].

The sources of bleeding from the alimentary tract varies significantly. In this article we describe clinical aspects of gastrointestinal tumors that cause gastrointestinal hemorrhage. Emergency operation for bleeding was decreased because of the advances in endoscopic treatment. However tumors with bleeding had the risk of rebleeding. When the diagnosis of tumor was established, resection was immediately recommended. Emergency operation was associated with a higher mortality rate than elective surgery. It was better to get histological diagnosis before surgery even in emergency operation. Local resection was chosen for the treatment of benign tumors and complete resection and lymph node dissection were chosen for most malignant tumors. It is important to build up a closer connection with endoscopists, surgeons and pathologists.

Acute Disease↗