Biomedical subjects
Publications and source records attributed to G Nishimura.
The distinctive radiographic features - megaepiphyses, hypoplastic fibulae, ulnar pseudoepiphyses and brachymesophalangy - in a 14-year-old Japanese boy with mental retardation are reported.
We report the case of a Japanese boy whose dysmorphic features were consistent with those of Shprintzen-Goldberg syndrome. The radiological features were characterized by late-onset craniosynostosis, arachnodactyly, undermodeling of short tubular bones, mildly undermodeled and slightly bowed long bones, twisted ribs and tall vertebral bodies with elongated neural arches. Apart from the craniosynostosis, these skeletal changes resembled those of frontometaphyseal dysplasia, a well-known craniotubular dysplasia. Shprintzen-Goldberg syndrome also shares many clinical features with frontometaphyseal dysplasia.
We report the case of a 10-year-old boy with typical manifestation of Hajdu-Cheney syndrome. MRI demonstrated syringohydromyelia involving almost the entire spinal cord, although neurological symptoms had not yet developed. Syringohydromyelia is considered to be a sequel to progressive basilar invagination and is one of the essential features of this rare osteolytic bone dysplasia.
We report a boy with dysplasia epiphysealis hemimelica of the knee, particularly emphasizing MRI findings. When he was 14 months of age, plain radiography exhibiting juxta-articular soft tissue mass with small, punctate, calcified foci did not warrant the definitive diagnosis, while MRI clearly demonstrated osteocartilaginous overgrowth of the femoral epiphysis. The epiphyseal mass mostly showed the same signal intensity as normal cartilage but contained low signal spots corresponding to calcified foci. The cartilaginous cap was depicted as a mottled area of high intensity on a T2-weighted image. When the patient was 4 years of age, this ossified mass was resected surgically and pathologically identified as osteochondroma incorporated into the epiphysis.
UNLABELLED: We report on a 14-year-old Japanese boy with radiographic features resembling those of Desbuquois dysplasia, including advanced carpal ossification, a "monkey wrench" appearance of the proximal femora, mild spondylar dysplasia, and generalized osteopenia. In contrast to the hitherto known patients with this disorder, however, his birth length was normal, and his short stature, which became apparent postnatally, was much milder than that of the previously reported cases (approximately -5 SD of average), and the joint laxity was more subtle. In addition, facial dysmorphism was absent, as were radial deviation of the second fingers and thoracolumbar kyphoscoliosis. CONCLUSION: The present patient may represent the mildest end of the variable phenotypic manifestation of the recently described Desbuquois dysplasia.
OBJECTIVE: The objective of this study was to elucidate the relationship between lateral collateral ligamentous injuries of the ankle (ankle sprain) and bone bruise (trabecular trauma) of the talus and/or malleoli in the patients with twisting injuries of the ankle. DESIGN: Magnetic resonance studies of the ankle were retrospectively reviewed, focusing on the presence or absence of lateral collateral ligamentous injuries and the location of bone bruise in the talus and/or malleoli. PATIENTS: Thirty-five patients with acute twisting injuries of the ankle were studied. RESULTS AND CONCLUSION: Four patterns of bone bruise were found in 14 patients: (1) bone bruise in the talar dome equivalent to osteochondral fracture in two patients, (2) bone bruise in the posteromedial aspect of the talus and the medial malleolus singly or in combination in four, (3) bone bruise in the anteromedial aspect of the talus in six, and (4) bone bruise with a combination of the second and third patterns in two. The second pattern was associated with tear of the anterior talofibular (ATAF) ligament in all patients and injury of the calcaneofibular (CF) ligament in one out of four. The third and fourth patterns were associated with tears of both ATAF and CF ligaments in all patients. The identification of bone bruise was of value in indicating lateral collateral ligamentous injuries.
OBJECTIVE: To report examples of disorders characterized by bone fragility, calvarial and/or gnathic fibro-osseous lesions, and metadiaphyseal undermodeling of the tubular bones. DESIGN: The clinical, radiological, and pathological features of two patients are described and the literature reviewed. PATIENTS: The patients comprised a 10-year-old boy and a 48-year-old woman. The former exhibited multiple fractures starting in early childhood and calvarial masses which developed in late childhood; the latter showed a mandibular mass. RESULTS: Calvarial doughnut lesions, osteopenia with coarse bony trabeculae, and undermodeling of the lower limbs were radiologically demonstrated in the first patient, while multiple sclerotic foci in the maxilla and mandible, spontaneous bowing of the right femur, and minimal undermodeling of the tibiae were demonstrated in the second. Bone biopsy of the iliac crest in the first patient revealed histologically normal bony trabeculae. Bone histomorphometry suggested an increased osteoid surface. Osteoid volume was also slightly increased. The pathological findings of the mass in the jaw in the latter patient were consistent with it being a fibro-osseous lesion. The literature review revealed several patients whose features overlapped with those of our patients. CONCLUSION: These patients may represent a group of fragile bone syndromes which differ from osteogenesis imperfecta.
BACKGROUND: The most common cause of noncurative resection and recurrence is gastric cancer is peritoneal seeding. However, the results of treatment of peritoneal dissemination with chemotherapy have been poor with 5-year survival rates of 0%. METHODS: A new in vitro thermochemosensitivity test was performed on gastric cancer cells obtained from 19 surgically resected specimens by using tetrazolium-based colorimetric assay (MTT assay). A novel treatment of the intraoperative chemohyperthermia was undertaken in 83 patients with gastric cancer with peritoneal dissemination. After aggressive resection of primary tumor, lymph nodes, and peritoneal metastases, warmed saline solution containing mitomycin C 30 mg, etoposide 150 mg, and cisplatin 300 mg was introduced into the peritoneal cavity via a closed circuit continuous hyperthermic peritoneal perfusion (CHPP) for 60 minutes to keep the abdominal temperature at 42 degree to 43 degrees C by means of a heat exchange mechanism. RESULTS: The in vitro thermochemosensitivity test that 43 degrees C enhanced the cytotoxin effects on gastric cancer cells under clinically achievable drug concentrations. During CHPP, drug concentrations of cisplatin, mitomycin C, and etoposide in the perfusate remained statistically higher than in the peripheral venous circulation. Among 43 evaluable patients with residual peritoneal seeding, eight (19%) and nine (21%) exhibited complete response and partial response, respectively. The overall 1- and 5-year survival rates were 43% and 11%, respectively. Patients who underwent complete resection survived significantly longer than those with residual disease, and those with complete response had a significantly better prognosis than did those with partial response, and nonresponders. One-year survival rates with complete response, partial response or nonresponders were 88%, 27% and 22%, respectively. Five patients survived longer than 5 years. CONCLUSIONS: Our triple treatment combining surgery and CHPP is an effective therapy for selected patients with gastric cancer with peritoneal dissemination.
Using time-resolved spectroscopy, we have developed an experimental approach to obtain the absolute changes in concentration in the scattering medium of living tissues. The time-resolved Beer-Lambert equation can be applied to living tissue due to the fact that the optical attenuation by absorption can be separated from that by scattering, and the intensity of the light along the non-linear scattered optical path is exponentially attenuated by the absorption. Based on the above, the absolute concentration of haemoglobin as well as oxygen saturation in the rat head can be determined in situ under various respiratory conditions where multiwavelength measurements were performed. The optically assessed values agree with those determined directly by the gas analysis of our previous report. The present method is very simple and therefore opens up wide applications for time-resolved spectrophotometry in clinical medicine as a technique for quantitative near-infrared oxygen monitoring.
Hematological abnormalities, commonly associated with anorexia nervosa (AN) patients, are thought to be the results of serous atrophy in the bone marrow. Magnetic resonance imaging (MRI) has been utilized to ascertain T1 and T2 prolongation of marrow intensity in the lumbar spine, pelvis and proximal femora. The results correlate well with the severity of hematological abnormalities, and body mass index. More importantly, the propensity for peripheral marrow involvement of T2 prolongation contrasts with the axial involvement in other marrow disorders. MRI undertaken in patients with AN to exclude hypothalamic tumor showed that the clival marrow was equivalent to the peripheral marrow. The signal pattern of clival marrow on sagittal T1 weighted MR images was evaluated in four teenage female patients with AN complicated by hematological abnormalities. Although the clival marrow intensity should be uniformly high in teenagers, three patients, two with pancytopenia and one with leukopenia and anemia, exhibited homogeneous low intensity. One patient who had leukopenia only and the highest body mass index, showed inhomogeneous low intensity. The signal changes returned to normal in all patients but one, who died before examination after 6-11 months, at which time the others had almost recovered their original weight and normal hemogram. T1 prolongation in the clival marrow represents bone marrow dysfunction and the inhomogeneity of the signal change may imply relative preservation of hematopoiesis and body fat composition. Lack of knowledge of this phenomenon may lead to diagnostic confusion with other marrow disorders on cranial MRI.
Patients who underwent curative resection for colorectal cancer between January 1987 and June 1989 were divided into two groups, to assess the usefulness of preoperative chemotherapy (400 mg UFT therapy daily for 10 days more) and to analyze changes in the proliferative activity of tumor cells. Fifty-five cases were included in the study. Thirty-three had received no preoperative chemotherapy (Group A), and 22 had received the preoperative chemotherapy (group B). The five-year cumulative survival rate was 81.1% for group A and 90.2% for Group B. The proportion of patients with no recurrence was 75.7% in Group A and 85.7% in Group B. Both parameters thus tended to be better in patients who had received preoperative chemotherapy. When PCNA labeling before UFT therapy was compared with that after UFT therapy in 13 cases, the PCNA labeling rate decreased after UFT therapy in 9 (69%) of the 13 cases. These results suggest that preoperative chemotherapy using UFT is useful in treating colorectal cancer, and that the proliferative activity of colorectal cancer can sometimes be reduced by such preoperative adjuvant therapy.
A 49-year-old woman who suffered from caecal cancer in 1988 underwent chemohyperthermic peritoneal perfusion for peritoneal and ovarian metastases in 1990, and high dose chemotherapy (HDC) with peripheral blood stem cell transplantation (PBSCT) for lung metastases in 1995. Heated saline containing anticancer drugs such as cisplatin, mitomycin C, etoposide (ETP), and pirarubicin, was intraperitoneally perfused at 43 degrees C for 60 minutes. The CD34 positive cells were mobilized by intravenous 500 micrograms G-CSF administration on five consecutive days. These cells were transplanted three days after the last day in the course of HDC, which included intravenous administration of 475 mg carboplatin, 2,020 mg cyclophosphamide, and 540 mg etoposide. The patient has survived with no sign of the disease.
Serum CYFRA21-1 levels were studied in 127 cases of colorectal cancer. The positive rates for serum CYFRA21-1 were 34.6% in primary colorectal cancer. There was a significant correlation between the positive rates of serum CYFRA21-1 and liver metastases, peritoneal dissemination, lymph node metastases, or clinical stage. The survival rate for patients in the CYFRA21-1 positive group was lower than those with CYFRA21-1 negative group. Among patients who underwent curative operation, patients is the CYFRA21-1 positive group gave a recurrence rate of 26.6%, against 9.4% in the CYFRA21-1 negative group. There was no correlation between serum CYFRA21-1 levels and serum CEA levels. These findings suggest that Serum CYFRA21-1 levels may be a useful indicator in estimating the prognosis for colorectal cancer.
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We describe a 5-year-old Japanese boy who has some radiographic findings characteristic of asphyxiating thoracic dystrophy (ATD)-chondroectodermal dysplasia with a de novo chromosome abnormality. He also has mild mental retardation, short stature, hypoplastic hair and skin, oligodontia, small thoracic cage, hypoplastic pelvis and cone-shaped epiphyses of hands. On cytogenetic studies he was found to have a de novo del(12)(p11.21p12.2). These results suggest that the locus of the gene associated with ATD-chondroectodermal dysplasia may be situated at 12p11.21p12.2.
By extensively examining the experimental conditions for time-resolved spectrophotometry of non-transparent light scattering systems, we demonstrated the feasibility of quantitative analysis of both the fluorescence lifetime and intensity of reduced pyridine nucleotides in living tissues, suspensions of isolated liver mitochondria, and hepatocytes, as well as hemoglobin-free perfused rat liver being used systematically for measurements. The fluorescence decay was analyzed by the maximum likelihood method with a 4-component decay model. The lifetime of NADH observed in mitochondria (mean: 2.8 +/- 0.2 ns) was much longer than that of the free form in an aqueous solution (mean: 0.43 +/- 0.01 ns), and it was characterized as a protein-bound form. The lifetime was not affected by either aerobic or anaerobic conditions nor by the energy state, though the intensity changed markedly. The decay curves of isolated hepatocytes under normal aerobic conditions were the same as those of isolated mitochondria, though cytosolic NADH and NADPH were superimposed. Under the conditions of "unphysiological" acidosis, the mean lifetime became about 1.5 times longer than that under normal conditions. With perfused liver, the relative contributions of cytosolic NADH and NADPH were determined by infusing lactate and tert-butylhydroperoxide. Cytosolic NADH did not contribute to the overall fluorescence of pyridine nucleotides. In contrast, about 70% of the total fluorescence intensity was due to cytosolic NADPH, but its decay parameters were essentially the same as those of mitochondrial NADH. No free form of either NADH or NADPH was detected in the cytosolic and mitochondrial spaces. We concluded that the changes in fluorescence intensity observed under the various conditions can be simply explained by a change in the amount of reduced pyridine nucleotides in tissues, rather than by changes in the microscopic environment. The wide applicability of time-resolved fluorescence photometry to in vivo studies is well documented.
We encountered an unusual case of an intracranial wooden stick penetrating through the frontal bone, without remarkable neurological findings. That foreign body was shown to be a low-density area similar to an intracranial air pocket by a standard computed tomogram. Here we discuss the potential hazards of intracranial wooden foreign bodies and emphasize the necessity for special attention to them during radiologic examination.
It is universally accepted that the fascial flap is one of the best reconstructive strategies for contour and tendon-gliding function. In this study we compare the free temporoparietal fascial flap (n = 20) and the free scapular fascial flap (n = 6) mainly for these reconstructions and discuss their characteristics, including different clinical applications and histologic examination. Our histologic analysis reveals that the free temporoparietal fascial flap has a potential like a muscle flap; moreover, it is very thin. The free scapular fascial flap is very rich in adipose tissues to prevent adhesion between the flap and underlying tissues. Both flaps in our experience can bring satisfaction to the recipient site, but the donor site of the free temporoparietal fascial flap sometimes suffers from conspicuous widened scars in short-haired patients, and the scapular fascia has a tendency to be thicker in obese patients. Therefore, we recommend using the free temporoparietal fascial flap for women, who tend to have more fat and longer hair, and the free scapular fascial flap for men, who tend to be lean and shorten their side hair.