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Biomedical subjects

H Kuwano

Publications and source records attributed to H Kuwano.

At least 181 records · Page 10Linked to original sources
PubMed1992

Concurrent adrenal pheochromocytoma and papillary adenocarcinoma of the thyroid in a 20-year-old man.

A 20-year-old man was admitted to Kyushu University Hospital with complaints of severe headache and episodic hypertension (200/100 mmHg). Ultrasonograms and computed tomographs revealed tumors in the left adrenal region and in the right lower lobe of the thyroid gland. Total thyroidectomy and left adrenalectomy were performed. The excised thyroid tumor and adrenal tumor were pathologically diagnosed as papillary adenocarcinoma and pheochromocytoma, respectively. A chromosome analysis revealed no karyotypic abnormality. Whereas the world literature records such occurrences in women, this is the first report of a simultaneous occurrence of pheochromocytoma and papillary adenocarcinoma of the thyroid in a young man.

Adenocarcinoma, Papillary↗
PubMed1992

Gastric involvement of oesophageal squamous cell carcinoma.

Among 402 patients with squamous cell carcinoma of the oesophagus, gastric wall involvement was evident in 32 (8.0 per cent). These could be grouped into four types according to the pattern of involvement: group 1 included six patients with gastric involvement via metastases in perigastric lymph nodes; group 2 consisted of 11 patients with gastric intramural metastasis; group 3 contained 12 with direct invasion of the gastric wall by the oesophageal squamous cell carcinoma; and group 4 three patients with intraepithelial spread of oesophageal cancer to the gastric epithelium. Prognosis was poor, all patients dying except for one in each of groups 3 and 4. The mean survival time was 5.6, 8.6, 14.8 and 18.7 months in groups 1, 2, 3 and 4, respectively. Gastric involvement via metastases to lymph nodes and by intramural metastasis therefore indicates an extremely poor prognosis, while the prognosis in groups 3 and 4 was influenced by the depth of invasion and lymph node metastasis of the oesophageal cancer. Histological examination of tissues from group 4 patients demonstrated that malignant squamous cells proliferated and invaded the gastric epithelial layer, that is, there was intraepithelial spread of the oesophageal cancer.

Aged↗
PubMed1992

Influence of preoperative treatment and surgical operation on immune function of patients with esophageal carcinoma.

Multiple immunological parameters, including total lymphocyte count, lymphocyte subpopulations (CD2+, CD19+, CD3+, CD4+ and CD8+), phytohemagglutinin (PHA) response, and natural killer (NK) activity, were measured in 66 patients with previously untreated esophageal carcinoma. The influence of preoperative treatment and/or surgical operation on the immune function were evaluated in 40 patients. The PHA response and NK activity of the patients with esophageal carcinoma were 229 +/- 103 S.I.% and 18.5 +/- 11.9% lysis, respectively, and were significantly depressed as compared with the control. The CD4+/CD8+ ratio, PHA response, and NK activity in stage IV were also significantly depressed compared to that in stages I-III. Preoperative treatment induced significant reductions in the total lymphocyte count (1,994 +/- 644 to 670 +/- 274/mm3), PHA response (219 +/- 77 to 159 +/- 59 S.I.%), and NK activity (19.7 +/- 13.2 to 11.1 +/- 10.3% lysis) as well as a significant gradual decrease in the CD4+/CD8+ ratio (2.09 +/- 1.42 to 0.69 +/- 0.48), while the surgical operation significantly influenced only the total lymphocyte count. This study demonstrates that preoperative treatment induces a more pronounced influence on the immune function than surgical operation alone, in patients with esophageal carcinoma in which the immune function is disturbed prior to these treatments.

Adult↗
PubMed1992

Determination of the resection line in early esophageal cancer using intraoperative endoscopic examination with Lugol staining.

Determination of the resection line using intraoperative endoscopic examination with Lugol staining was performed when preoperative examinations such as an esophagogram could not be effectively carried out and the carcinoma was not palpable from the outer surface of the esophageal wall. During the past two years, we performed this technique on eight patients. The carcinoma was restricted within the epithelium in one, the mucosal layer in five, and the submucosal layer in two. Although intraepithelial carcinoma contiguous to the main lesion was seen in six and cancer multiplicity was evident in two, all of the resected stumps were free of any cancer tissue. There have been no cases of recurrence and a limited operation, such as distal esophagectomy, was able to be performed in six. Therefore, intraoperative endoscopic examination is useful for early esophageal cancer.

Aged↗
PubMed1992

Synergistic effects of intratumor administration of cis-diamminedichloroplatinum(II) combined with local hyperthermia in melanoma bearing mice.

The synergistic effect of local hyperthermia (LHT) with intratumor injection (i.t.) of cis-diamminedichloroplatinum (II) (DDP) was studied using a rodent model with implanted B16 melanoma tumors. The hindfoot of the C57BL/6 mouse bearing the tumor was placed in a water bath at 42.5 +/- 0.2 degrees C (intratumor temperature was at 42.3 +/- 0.1 degrees C) for 30 minutes just after local (i.t.) or systemic (intraperitoneal;i.p.) administration of DDP (1-3 mg/kg once in experiment I and 1-3 mg/kg three times in experiment II). The tumor growth ratio (TGR) at 7 days after treatment in the group given DDP 3 mg/kg (i.t.) with LHT was 1.1 in experiment I and 0.5 in experiment II, and there was a statistically significant difference in both experiments compared to findings in other groups (P < 0.01). The mean survival time was 42.1 days in experiment I and 50.2 days in experiment II, with a significant difference in the latter (P < 0.001). Thus regional injection chemotherapy given concomitantly with local hyperthermia promotes the anticancer effects and improves the prognosis without either severe renal injury or the promotion of hematogenic metastasis.

Animals↗
PubMed1992

Preoperative hyperthermia combined with chemotherapy and radiotherapy for patients with rectal carcinoma may prevent early local pelvic recurrence.

We examined retrospectively the results of hyperthermia combined with irradiation and chemotherapy (HCR) prescribed preoperatively for patients with adenocarcinoma of the rectum. We compared two groups of patients: Group A: 23 were treated surgically between 1986-1988 and received HCR therapy; group B (controls) 48 were treated with surgery alone or surgery plus chemotherapy from 1980-1985. The recurrence rate within 2 years was compared. Although there was a difference in follow-up time, the two groups were comparable with regard to various prognostic factors. The incidences of local recurrence and of lung metastasis were nil in those given the HCR therapy. In group B, however, the incidences were 15% and 10%, respectively. These differences were statistically significant (P < 0.05). The incidence of liver metastasis was much the same between the two groups. All patients tolerated the HCR therapy well except for one with myelosuppression and who refused local hyperthermia because of mild anal pain. There were no other side effects requiring cessation of this treatment. These findings suggest that preoperative HCR therapy for patients with rectal carcinoma decreases the frequency of local recurrence and the likelihood of tumour cell spread during surgical procedures.

Adenocarcinoma↗
PubMed1992

Vascular invasion of colorectal carcinoma readily visible with certain stains.

We made use of hematoxylin and eosin (H&E) stain, Verhoeff van-Gieson stain for elastic tissue (EVG), and factor VIII-related antigen (FVIII-RA) to stain tissues excised from 94 patients with colorectal carcinoma. Of these 94, 49 died of disease within two years (Group I), and 45 survived for five years or longer (Group II) after surgery. In the tissues from both groups, the use of EVG stain revealed a higher incidence of vascular invasion than was seen with H&E stain. In Group I, the rates were 28.6 percent and 61.2 percent with H&E and EVG, respectively, and those in Group II were 4.4 percent and 31.1 percent, respectively. Conversely, the FVIII-RA stain showed a decrease in the incidence of vascular invasion in both groups. In Group I, when vascular invasion was examined in EVG-stained tissues, the incidence was 81.3 percent in cases of hematogenous metastases and 23.5 percent in those without hematogenous metastases (P less than 0.01). These differences were not evident with H&E. When observing the site of vascular invasion in tissues of the colorectal wall stained with EVG, intramural and extramural types of vascular invasion were seen in 20 percent and 80 percent of cases in Group I and in 93 percent and 7 percent of those in Group II, respectively. Thus, not only the frequency, but also the site, of vascular invasion into the colorectal wall evidenced with EVG stain provides a more precise prediction of the recurrence of hematogenous metastases.

Colorectal Neoplasms↗
PubMed1992

Multivariate analysis of postoperative complications after esophageal resection.

To determine the contributing factors for eight postoperative complications after esophagectomy through a right thoracoabdominal approach, a multivariate analysis was carried out on preoperative and intraoperative variables in 141 patients with thoracic esophageal cancer. Although postoperative complications occurred in 125 patients, only 7 died of such complications. The multivariate analysis indicated that the retrosternal route was a significant factor predisposing to postoperative atelectasis. Age, preoperative arterial oxygen tension, and volume transfused were significant factors predisposing to postoperative hypoxemia, whereas age, routes other than the intrathoracic route, and volume transfused were significant factors predisposing to prolonged respiratory support. In addition, preoperative total serum bilirubin level and volume transfused were significant factors predisposing to postoperative hyperbilirubinemia; preoperative serum creatinine level was a significant contributing factor for postoperative renal insufficiency; and sex, antesternal route, and substituted colon were significant contributing factors for anastomotic leakage. There were no significant factors predisposing to postoperative pneumonia and liver dysfunction. These significant factors should be taken into consideration not only during perioperative management but also when choosing the operative procedures and extending the surgical indication for esophagectomy through a right thoracoabdominal approach.

Age Factors↗
PubMed1992

Successful radiofrequency current catheter ablation of sustained ventricular tachycardia.

We performed radiofrequency current catheter ablation in two patients with nonischemic sustained ventricular tachycardia (VT). In one patient, two morphologically distinct VTs were induced by electrical stimulation. One showed right bundle branch block pattern and the other left bundle branch block pattern. The earliest site of activation during each VT was determined at the septum of the right ventricle. However, these two sites were close to the His-bundle electrogram recording area. In the other patient, a VT with a left bundle branch block pattern occurred spontaneously after the administration of isoproterenol. The earliest site of activation during VT was determined at the outflow tract of the right ventricle. During tachycardia, radiofrequency current ablation (40 W x 30 sec) was delivered to the earliest site of activation. A few seconds after fulguration, each VT was terminated and additional radiofrequency currents were given near these sites. After the ablation, VT could not be induced by the electrical stimulations, nor did it recur. No side effects were observed and the atrioventricular conduction remained intact. We feel that nonischemic VTs could possibly be treated by using radiofrequency current catheter ablation.

Aged↗
PubMed1992

Hyperthermo-radiosensitivity of esophageal cancer cells with high DNA ploidy in vitro.

The in vitro sensitivity to hyperthermia and radiation of esophageal cancer cells obtained from 50 patients was assayed by using the in vitro succinate dehydrogenase inhibition test, and the findings were correlated with data on DNA analysis. The DNA distribution patterns were grouped into types I, II, III and IV, according to the frequency of aneuploid cell populations. Esophageal cancer cells of high ploidy (type IV) had a lower sensitivity to radiation, however, a greater sensitivity to hyperthermia as compared to cells of low ploidy (type II). The sensitivity to hyperthermia was determined as positive in 2 of 8 for type II, in 7 of 25 for type III, and in 9 of 17 for type IV. In contrast, the positive sensitivity rates to radiation in type II, III, and IV were 25.0, 8.0, and 5.9%, respectively. When cells were exposed to combination of radiation with hyperthermia, the positive sensitivity rates increased in all groups (50.0, 44.0 and 70.6% in type II, III, and IV, respectively). There was a significant correlation between mean DNA values and the SD activities following exposure to heat treatment or radiation. These data, describing that cancer cells of high ploidy might have greater sensitivity to hyperthermia compared to radiation, indicate the clinical benefits of hyperthermia in cases of esophageal carcinoma, especially for patients with high DNA ploidy.

Adult↗
PubMed1992

Acute hemodynamics of pimobendan in chronic heart failure. A comparative crossover study of captopril and pimobendan.

Acute hemodynamics of pimobendan were compared to captopril in a crossover trial in patients with chronic heart failure (NYHA II-III). Heart failure had been stabilized by conventional therapy with diuretics and digitalis for more than 2 weeks. Patients receiving vasodilators were excluded. The hemodynamics were analyzed using a Swan-Ganz catheter at the bedside during drug administration. Following an intravenous injection of 2.5 mg of pimobendan, there was a significant increase in heart rate and decrease in mean pulmonary artery pressure, total pulmonary resistance, mean arterial pressure, systemic vascular resistance and mean right atrial pressure 2 hours after the injection. Captopril (12.5 mg, orally) significantly decreased mean arterial pressure, systemic vascular resistance and double product 2 hours after administration. In this study, the inotropic effect was evaluated through the relation between the stroke volume index and diastolic pulmonary artery pressure, and also between the stroke volume index and mean arterial pressure. Although decreases of diastolic pulmonary artery pressure and mean arterial pressure were seen with both drugs, the differences in stroke volume index were not significant. In comparison with captopril, the acute hemodynamics of pimobendan are characterized as follows: 1) the systemic arteriovasodilating effects of the two drugs were equal, 2) the pulmonary arteriovasodilating effect of pimobendan was marked, 3) a venodilating effect, documented through a decrease of mean right atrial pressure, was seen only with pimobendan. This study concluded that pimobendan is a stronger arterio-venodilator than captopril.

Aged↗
PubMed1992

Hyperthermo-chemo-radiotherapy as a definitive treatment for patients with early esophageal carcinoma.

Ten patients with early stage esophageal carcinoma were treated with hyperthermo-chemo-radiotherapy (HCR) without surgery. The reasons for the inoperability of these patients included medically inoperable unresectable cancers, advanced age, and/or refusal to undergo surgery. The diagnosis of early esophageal carcinoma was determined by esophagograms, endoscopy, and ultrasonography. Squamous cell carcinoma was histopathologically confirmed in each case. Each patient underwent four to nine sessions of hyperthermic treatment combined with external irradiation and chemotherapy using bleomycin; eight of these patients received additional radiation, and two terminated treatment after the HCR therapy. The tumors in all patients showed either a complete response (CR) or a partial response (PR) after HCR therapy; in two patients viable cancer cells remained, but later disappeared after additional radiation. Five patients experienced no local recurrence for 12 to 70 months and are now alive and doing well, three died of other medical conditions without any evidence of esophageal cancer, and two died of recurrent esophageal cancer 20 to 27 months after initial admission. All ten patients tolerated the HCR well without any systemic side effects. However, in two patients, esophageal erosion was recognized endoscopically. HCR therapy therefore deserves serious consideration when treating patients with small malignant lesions of the esophagus who, for various reasons, are unable to undergo surgery.

Aged↗
PubMed1992

[Mode of origin of esophageal squamous cell carcinoma--serial histopathologic and immunohistochemical studies].

I. Serial histopathologic study of esophageal squamous cell carcinoma. A review of 335 cases of squamous cell carcinoma disclosed 55 cases (16.4%) with glandular components in addition to the ordinary component of squamous cell carcinoma, suggesting that this type of esophageal tumor had originated not only from the covering squamous epithelium but from esophageal gland or ductal epithelium. Intra-epithelial carcinoma concomitant with squamous cell carcinoma was seen in 95 cases (28.4%). The incidences of coexistence in such lesion were higher in the groups of early stage esophageal cancer. These observations support the concept of field carcinogenesis of esophageal cancer. II. Histopathologic study of squamous epithelial dysplasia. Among 91 cases without preoperative treatment, there were 40 dysplastic lesions in 23 cases (25.3%). The continuity of dysplasia to the carcinoma was 48.3% and it was often encountered in severe dysplasia rather than in moderate or mild dysplasia, suggesting some relationship between the severity of dysplasia and carcinoma. III. Immunohistochemical study of EGF and c-myc. Among 27 cases, EGF was positive in 10 (37.0%). c-myc was positive in 18 (66.7%) not only cancer but normal epithelium suggesting that some change of products of oncogene occurred also in the normal epithelium of the patients of esophageal cancer.

Carcinoma, Squamous Cell↗
PubMed1991

Histopathologic findings of minute foci of squamous cell carcinoma in the human esophagus.

To examine the histogenesis and progression of esophageal squamous cell carcinoma, 76 cases of a primary squamous cell carcinoma were reviewed retrospectively, and 16 lesions of squamous cell carcinoma of the esophagus less than 1.0 cm in diameter were studied histopathologically. None of the patients had received radiation therapy preoperatively. Among 16 foci, 13 were intraepithelial carcinomas, and three were restricted to within the mucosa. In two patients with a solitary, minute cancer, there were no associated areas of dysplasia. In 11 patients with multiple primary minute foci, seven contained 14 areas of dysplasia in the esophagus. There was no continuity between the minute foci of carcinoma and areas of dysplasia. These findings are interpreted to mean that dysplasia is a "subcancerous" lesion rather than a "precancerous" one and that various degrees of lesions such as dysplasia and carcinoma occur multicentrically in the same esophagus. The sequence of dysplasia to carcinoma must be examined using the techniques of molecular biology.

Aged↗
PubMed1991

Increased hyperthermic response with prostaglandin E1 in VX2 liver carcinoma in rabbits.

Most studies examining the potential of vasoactive drugs to selectively reduce the blood flow in a tumor and to enhance the thermal response to hyperthermia have used tumors growing in muscle tissues. We investigated the effect of prostaglandin E1 on a VX2 liver carcinoma in 95 female Japanese white rabbits. During continuous 20-minute intravenous infusions of prostaglandin E1 at doses of 1, 3, and 5 micrograms/kg per minute in rabbits with this liver tumor, the mean arterial blood pressure decreased to 81%, 74%, and 51% of initial levels, respectively. In the tumor, regional blood flow was 86%, 70%, and 56% of initial levels, respectively; in the adjacent liver tissue, it was 149%, 110%, and 86% of initial levels, respectively. The tumor and adjacent liver tissues were heated by a microwave generator, and the liver tissue was kept at 42.0 degrees C. The average temperature at the center of the tumor, which was 43.0 degrees C in the absence of prostaglandin E1, increased to 44.3 degrees C, 44.3 degrees C, and 44.2 degrees C when doses of 1, 3, and 5 micrograms/kg per minute were given, respectively. The therapeutic effect was determined on the basis of the tumor growth ratio (geometric tumor volume 7 days after treatment/volume at start of treatment). Hyperthermia alone resulted in a small reduction in the tumor growth ratio--from the control value of 11.82 to a value of 9.03. Hyperthermia combined with prostaglandin E1 led to an augmented reduction in tumor growth ratio (4.28, 4.70, and 4.79 during 1, 3, and 5 micrograms/kg per minute, respectively), compared with findings with hyperthermia alone. These results indicate that prostaglandin E1 reduces tumor blood flow, elevates tumor temperature during hyperthermia, and retards tumor growth after local heat treatment. For these reasons, prostaglandin E1 may be an effective adjuvant drug in clinical studies of hyperthermia in liver tumor.

Alprostadil↗
PubMed1991

Prognostic significance of argyrophilic nucleolar organizer regions in esophageal carcinoma.

The argyrophilic nucleolar organizer region (AgNOR) of 100 cancer cells from biopsy specimens of esophageal squamous cell carcinomas in 98 surgically treated cases was examined, using a silver colloid staining technique on biopsy specimens. The number of AgNOR per nucleus (AgNOR number) was higher in the more advanced groups with regard to the length of the tumor (P less than 0.01), the depth of penetration (P less than 0.05), and lymph node metastasis (P less than 0.01). The survival of the patients with a high AgNOR number (greater than or equal to 6) was significantly poorer than those with either a medium range AgNOR number (4 less than or equal to-less than 6) (P less than 0.05) or a low AgNOR number (less than 4) (P less than 0.01). In the multivariate analysis including conventional clinicopathological factors, the AgNOR number was found to be one of the independent and significant variables (P less than 0.01). Because the AgNOR method is simple and can be applied to paraffin-embedded sections, the AgNOR number may provide potential benefit in the pretherapeutic assessment of malignant potentiality in esophageal carcinoma.

Adult↗
PubMed1991

Growth patterns and prognosis of submucosal carcinoma of the esophagus. A pathologic study.

Sixteen cases of esophageal carcinoma invading the submucosa were analyzed in terms of growth patterns. Seven were classified into the massively penetrating (down growth) type, four into the superficially spreading (spreading growth) type, and five into the unclassified type. In the down growth type, the ratio of the submucosal area to the total (mucosa and submucosa) area was more than 0.2 (one fifth), and in the others that ratio was less than 0.2. The down growth type is characterized by a tendency toward elevated lesions, a high incidence of vessel invasions and lymph node metastasis, and a poor prognosis after surgery. Lymphatic and/or vascular invasions were recognized in six of seven cases, and the 5-year survival rate was 0%. In contrast, the spreading growth and unclassified types was characterized by superficial lesions, a low incidence of vessel invasions and lymph node metastasis, and a favorable prognosis. In only one with the spreading growth type was there lymphatic invasion. Three of the four with the spreading growth type survived over 5 years, and the other one with the spreading growth type and all of five with the unclassified type are alive without recurrences 15 to 52 months after surgery. Thus, growth patterns reflect well the prognosis of the submucosal carcinoma of the esophagus.

Aged↗