Clinical experience with pancuronium bromide in infants and children.
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Biomedical subjects
Publications and source records attributed to H Baba.
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The contribution of glycerol to glucose production has been measured in healthy volunteers by the simultaneous primed constant infusion of 1-[13C]glycerol and 3-[3H]glucose and the determination of the rates of appearance (Ra) of glycerol, glucose, and glycerol-derived glucose. In the postabsorptive state, glycerol Ra was 3.11 +/- 0.44 mumol.kg-1.min-1, of which 36% was converted to glucose, accounting for 4.5% of total glucose production. After 62-86 h of starvation, glycerol Ra rose to 5.32 +/- 0.58 mumol.kg-1.min-1, and 68% of glycerol was converted to glucose. This accounted for 21.6% of total glucose production. Glycerol Ra was closely correlated with its conversion and contribution to glucose. These findings confirm that the contribution of glycerol to glucose production is directly correlated to its release as a consequence of lipolysis and support the notion that the central physiological role of accelerated lipolysis in fasting is the provision of gluconeogenic precursor.
We report here a rare, rapid peritoneal recurrence after curative gastrectomy for gastric cancer occurred in a 51 year old woman who had been treated with hemodialysis due to chronic renal failure for 8 years. Preoperatively, her immune status was very low, as indicated by decreased natural killer cell activity and photohemagglutinin reaction and by increased immunosuppressive acidic protein. The density of S-100 positive intratumoral dendritic cells in the resected stomach was low, which also suggested a lower level of loco-regional immunity. Rapid progress of the recurrent disease and the poor prognosis might be related to the suppressed immune activity induced by a long-term chronic renal failure and hemodialysis. Thus, for patients with chronic renal failure who require resection of a gastric cancer, close follow-up is important.
The chemosensitivity of 43 human sarcoma tissues, including 18 osteosarcomas, 16 leiomyosarcomas and 9 liposarcomas, was compared with that of 28 adenocarcinomas of the stomach, using the in vitro succinate dehydrogenase inhibition (SDI) test. These tissues were exposed for 3 days to each antitumor drug, including adriamycin (ADM), 5-fluorouracil (5-FU), mitomycin C (MMC), cisplatin (CDDP), aclacinomycin A (ACR) and carboquone (CQ), them the cell viability was estimated based on the succinate dehydrogenase (SD) activity, determined using [3-(4,5-dimethyl-2-thiazolyl) -2,5-diphenyl-2H tetrazolium bromide] (MTT). SD activity was significantly lower in the osteosarcoma as compared to that in the adenocarcinoma, for ADM, MMC, CDDP, ACR and CQ (p < 0.01), and was higher for ADM (p < 0.05) in cases of leiomyosarcoma and for CDDP (p < 0.01) and ACR (p < 0.05) in cases of liposarcoma. The sensitivity rate was higher in osteosarcoma than in adenocarcinoma for ADM, MMC and CDDP. These findings suggest that patients with osteosarcoma will probably show a fairly good response to antitumor drugs, and that when liposarcoma or leiomyosarcoma tumors show resistance to antitumor drugs, then resection at the time of initial exploration and combined modalities, including radiation and hyperthermia, should be considered.
To maximize the thermal enhancement of antitumor effect and minimize normal tissue damage, the timing of Adriamycin (ADM) administration in relation to hyperthermia was examined. Tumor growth of a subcutaneously transplanted fibrosarcoma as well as damage in normal tissues were measured in F344 rats treated with variable schedules of ADM and hyperthermia. Simultaneous application of 5 mg/kg i.v. of ADM with hyperthermia (120 min at 41.5 degrees C) resulted in a synergistic antitumor effect, but there was no thermal enhancement of the antitumor activity when 2.5 mg/kg ADM was given. Thermal enhancement of the antitumor effect induced by 5.0 mg/kg ADM was greater when ADM was given 30 min before or just prior to hyperthermia compared to that given during hyperthermia. ADM given prior to hyperthermia caused less damage to normal tissue than that given during hyperthermia, as evidenced by a prolonged survival and lower incidence of ascites and tendency to bleed. Thus ADM administration 30 min before or just prior to hyperthermia resulted in greater therapeutic gains than ADM given during hyperthermia. In the light of these results, the optimal scheduling of administration of ADM with hyperthermia is important for a therapeutic gain for cancer patients.
We compared the survival time and drug toxicity between patients with stage IV gastric cancer who were over and under 65 years. All had undergone gastric resection followed by treatment with mitomycin C and a fluorinated pyrimidine. There were no differences in prognostic factors or doses of drugs prescribed between the two groups, nor were there differences in survival rates or toxicities. As advanced chronological age is not sufficient justification to limit or withhold treatment with anticancer drugs, postoperative chemotherapy should be designed for patients with gastric cancer, regardless of age.
The effect of PSK, a protein-bound polysaccharide and an immunomodulator, on lymphocytes was examined in vitro for 36 patients with gastric cancer and 26 with colorectal cancer. Cultured lymphocytes with PSK at 100 micrograms/ml increased the level of DNA synthesis, as determined by the 3H-thymidine uptake, from 0.9 to 3.0 fold, compared to the PSK non-treated cells. The increase was 1.36 +/- 0.46 fold for the gastric cancer cases and 1.37 + 0.45 fold for the colorectal cancer cases, and these levels were significantly the finding of 1.93 + 0.55 fold for a control group consisting of 15 healthy volunteers (P < 0.01). When the 1.3 fold increase of 3H-thymidine uptake was defined as the PSK-reactive group, 52.8% (19/36) of the patients with gastric cancer and 50.0% (13/26) for colorectal cancer were found in the PSK-reactive group. The PSK-reactive group demonstrated no relation to the age and sex of the patients, tissue differentiation type or tumor advancement. Our findings thus show that the in vitro activation of lymphocytes by PSK can help identify the candidates with either gastric or colorectal cancer who are the best suited to undergo immunochemotherapy including treatment with PSK.
BACKGROUND/AIMS: In patients with gastric carcinoma, the prognostic significance of c-erbB-2 oncogene expression was elucidated, but its role in the aggressive behavior of tumors is not clear. PATIENTS AND METHODS: We asked whether or not cerbB-2 gene expression may have predictability with regard to the metastatic potential in 160 patients with gastric carcinoma using a immunohistochemical staining and a multivariate analysis. RESULTS: c-erbB-2 immunoreactivity was observed in 11% (17/160) of tumors. Patients with c-erbB-2 product positive tumors had a significant shorter prognosis (p < 0.05), and were characterized by a high incidence of peritoneal dissemination (41%), liver metastasis (18%) and lymph node involvement (94%). In the multivariate logistic analysis revealed that c-erbB-2 expression was a significant risk factor related to lymph node involvement (p < 0.01). CONCLUSIONS: Our multivariate analysis revealed that c-erbB-2 expression is linked to the metastatic potential in patients with gastric carcinoma.
BACKGROUND/AIMS: Laparoscopic surgery or endoscopic mucosal resection for early stages of gastric cancer have been introduced recently in many regions. In such cases, a precise diagnosis is needed prior to treatment, since understaging of gastric cancer may lead to treatment failure and impairment of curability and prognosis. The clinicopathological features of understaged cases in macroscopic Stage 1 gastric cancer have not been clarified yet. MATERIAL AND METHODS: We examined 435 patients with intra-operative findings of macroscopic Stage 1 gastric cancer and compared clinicopathological features of 354 patients (Group A) with both macroscopic and histological stage 1 cancer and 81 patients (Group B) with macroscopic Stage 1 but histologically proven to be more advanced cancer. RESULTS: Among 435 patients with macroscopic Stage 1, there were 81 (18.6%) with histologically more advanced stages (44 of stage 2, 34 of stage 3, and 3 of stage 4). There were no statistical differences in age, sex, operative procedure, and extend of lymph node dissection between the groups. Carcinomas in the 81 Group B patients tended to have larger tumors (> 4 cm), located in the middle third and along the lesser curvature of the stomach, appeared to be Borrmann V type (unclassified type) and were histologically more often associated with undifferentiated type, INF-gamma, lymphovascular invasion, lymph node metastasis, and invasion into a layer deeper than submucosa, all of which resulted in significantly poorer prognosis. CONCLUSIONS: Pre-operative and intra-operative assessment of the stage for gastric cancer was not always accurate enough and about one fifth cases with macroscopic Stage 1 gastric cancer were understaged. Thus, we recommend gastrectomy plus radical lymphadenectomy (at least D2) for the treatment of choice, from the points of view of curability and prognosis when gastric carcinoma is associated with the above mentioned characteristics.
BACKGROUND: Levels of serum and plasma metalloproteinases, especially type IV collagenases are important factors related to metastasis and invasion in various human cancer. The clinical significance of serum matrix metalloproteinase 2 (MMP-2, 72 kDa type IV collagenase) and plasma matrix metalloproteinase 9 (MMP-9, 92 kDa type IV collagenase) was evaluated as possible tumor markers in gastric cancer. MATERIALS AND METHODS: The precursor form of MMP-2 (proMMP-2) in serum and the precursor form of MMP-9 (proMMP-9) in plasma were examined prior to surgery on 70 patients with gastric cancer, one-step sandwich immunoassay (EIA) was used and serum carcinoembryonic antigen (CEA) levels were also examined in the same patients. Normal sera and plasma samples obtained from healthy individuals without cancer were used as controls. RESULTS: ProMMP-2 levels in patients (mean +/- standard deviation) with gastric cancer (602 +/- 200 micrograms/l) were significantly higher than levels (542 +/- 80 micrograms/l) in sera from 70 healthy individuals (P < 0.02). Plasma proMMP-9 levels (119 +/- 232 micrograms/l) in patients with cancer were also significantly higher than those (37 +/- 13 micrograms/l) in plasma (P < 0.004). On the other hand, there was no significant correlation between CEA and proMMP-2 levels, and between CEA and proMMP-9 levels. Neither proMMP-2 levels nor proMMP-9 levels significantly related to clinicopathologic features. CONCLUSIONS: Serum proMMP-2 levels and plasma proMMP-9 levels may serve as tumor markers, independent from known factors and CEA.
OBJECTIVE: To investigate the histological and immunohistochemical properties of the lumbar ligamentum flavum with calcium crystal deposition. METHODS: We examined the histological characteristics of the ligamentum flavum of the lumbar spine containing calcium deposits, obtained from 16 surgical cases with symptomatic lumbar spinal stenosis. Sections of the ligaments were also immunostained for elastase, chymotrypsin and S-100 protein, and examined by energy dispensive X-ray microanalysis and scanning electron microscopy. The results were compared with those of ligaments without calcium deposits. RESULTS: The elastic fibres of ligaments with calcium deposits showed marked degeneration (irregular arrangement and fragmentation of the fibre bundles) and nodular granulomatous lesions. Calcium crystal deposits were present in this area and in the nodular granulomatous areas. The calcified areas were surrounded by neutrophils and new small blood vessels. Immunostaining for elastase and chymotrypsin was positive in these areas, and S-100 protein-containing chondrocytes were detected around and within the calcified areas. Calcium pyrophosphate dihydrate crystals were identified in the calcified areas in all patients. CONCLUSION: Nodular degeneration of the elastic fibres of the ligament is probably caused by the action of proteolytic enzymes. Degeneration results in small granulomatous areas that form the nidus for calcium crystal deposition. Accumulated neutrophils, and S-100 protein-containing chondrocytes appear to precipitate the deposition of calcium crystals in the granulomatous lesions of the degenerated lumbar ligamentum flavum.
We examined the occurrence of second primary extracolonic cancers in 1,170 patients with nonpolyposis colorectal cancer who underwent a resection between 1972 and 1994. Such cancers occurred more often in cases with hereditary nonpolyposis colorectal cancer (HNPCC) than in those without (11.1% vs. 3.6%, P=0.0286). Five HNPCC cases developed 6 cancers in the stomach, endometrium, ovary, and ureter. The mean interval between the first and second operation was 66 months (range: 18-153). These findings thus indicate the importance of targetted surveillance for any second primary cancers in the upper gastrointestinal, female genital, or upper urologic tract, especially in HNPCC patients.
We investigated the occurrence of multiple primary colorectal and gastric cancer (MPCGC) in 1277 colorectal cancer patients between 1972 and 1996. MPCGC was found in 65 (5.1%). In the 28 synchronous cases, gastric or colorectal cancer was accidentally detected by pre-, intra-, or postoperative examinations. In 23 of the 37 metachronous cases, colorectal cancer developed on average 83 months after the operation for gastric cancer. In the other 14 cases, gastric cancer developed on average 70 months after the operation for colorectal cancer. Therefore, careful pre-, intra-, or postoperative examinations are strongly called for in order to not overlook the presence of colorectal or gastric lesions in MPCGC cases.
We compared the characteristics between the 281 cases with right colon cancer (RCC) and 438 cases with left colon cancer (LCC) who underwent a resection for the disease at our hospital between 1972 and 1995. The mean patient age was significantly higher for RCC than for LCC (62.5 years vs 60.4 years). The mean tumor size was also significantly larger in RCC than in LCC (6.1 cm vs 4.8 cm). The type of recurrence or survival was similar between RCC and LCC. Elderly patients were also found to be more likely to develop RCC than younger patients. This cancer often grows to a large size before being diagnosed. These findings, therefore, suggest the need for targeted examinations for the early detection of RCC, especially in the elderly.
OBJECTIVE: To examine the relationship between radiographic abnormalities and arthroscopic findings of the cartilage lesions in patients with osteoarthritis (OA) of the knee. METHODS: Arthroscopy was performed in 190 patients with primary medial compartment (MC) OA of the knee to assess the severity of the cartilage lesion. Standing radiographs of all patients were graded according to the joint space narrowing (JSN) and Kellgren-Lawrence (K/L) scales. In addition to evaluating the correlation between arthroscopic articular cartilage lesions and the radiographic scale, multiple regression analysis was used to identify the arthroscopic findings and clinical factors that influenced the cartilage lesions. RESULTS: The positive predictive values of the JSN and K/L scales of the MC for the presence of essentially abnormal articular cartilage in the MC by arthroscopy were high (0.98, 0.96, respectively). The sensitivity and specificity of the JSN scale and the sensitivity and negative predictive value of the K/L scale were also high in the MC. In contrast, the positive predictive values of these radiographic scales for the presence of arthroscopic lesions in the lateral compartment (LC) were poor (0.20 and 0.19). In this study population with severe OA, there were more patients with a high K/L score than with a high JSN score in the MC. CONCLUSION: In MC-OA of the knee, the JSN and K/L scores for the MC correlated highly with cartilage lesions of the MC by arthroscopy. However, the cartilage lesion of the LC correlated poorly with both of these radiographic scales.
We herein present a case of diffuse bone metastasis from early gastric cancer with disseminated intravascular coagulation (DIC) in a 40-year old man, who had undergone a curative gastrectomy and had no evidence of recurrence for five years after surgery. The patient was treated with an intravenous administration of sequential methothrexate (MTX) and 5-fluorouracil (5-FU), and demonstrated a favorable clinical course without any severe pain. Despite the fact that the presence of diffuse bone metastasis from gastric cancer plus hematologic disorders tends to indicate a significantly poor prognosis, the patient survived for a relatively long period (11 months) following chemotherapy. We thus conclude that MTX/5-FU sequential therapy seems to be a clinically useful regimen to improve both the symptoms and survival for cases of diffuse bone metastasis from gastric cancer.